New growths

New growths

Pelvic tumors

A.  Fibroids (fibromyoma)

These are firm tumors of muscular and fibrous tissue, ranging from the very small to the very large. They are most frequently found in woman at the older & end of the child bearing age range.

Types: - They are named according to their position.

i.                     Sub mucous- when it is situated immediately beneath the surface of the endometrium (decidua)

ii.                     Subserous - When it is beneath the serous coat of the uterus

iii.                     Intramural – a fibroid confined to the myometrium.

iv.                     Pedunculated - occasionally when submucous and subserous fibroids develop stalks.

Effect on pregnancy, labour & puerperium

Depends on the site of the uterus whether it is in the lower or upper segment and layers of uterus they occupy.

·        Subfertility

·        Abortion

·        PPH

·        Malpresentation

·        Obstructed labour

·        Poor uterine contraction

·        Subinvolution and prolonged red lochea.

Symptoms

·        Painless abdominal swelling

·        Menorrhagea

·        Rarely pressure on bladder or bowel 

Complication

·        Menorrhagia

·        Torsion of pedanculated fibroid

·        Malignancy

Ovarian tumors can be primary and secondary and can be benign or malignant. Secondary tumors are always malignant.

Management

·        Myomectomy or removal of fibroid

·        Hystrectomy if the women is older

Ovarian cyst

Types: - depending on constitution of the cyst it has 4 types

·        Serous cysts- contains serum

·        Mucinoid cyst- contains mucin

·        Endometrial cysts / chocolate cyst. Its colour looks chocolate

·        Dermoid cyst - This is a type of cyst containing hair, teeth or bone. These cysts are said to be originated from the material derived from the ectoderm, endoderm and mesoderm. These are congenital.

Effects on pregnancy and labour

·        It occupies pelvic cavity and causes obstruction

·        Possibility of infection in the puerperium

·        Haemorrhage into the cyst.

·        Pressure symptom

Management

·        Removal of the cyst (ovarian cystectomy)

·        Biopsy- if malignant total hysterectomy

Complication of ovarian cyst

i.                     Torsion or twist - of the cyst is pedunculated it may twist. - Sever abdominal pain, tenderness, shock

ii.                     Rupture of the cyst

iii.                     Sepsis - the cyst may become infected (pain tenderness & fever)

iv.                     Malignancy 

Uterine Polyp

Polyps are small bright red, fleshy, pedunculated, benign growths which may cause bleeding usually originated in thecervical canal and are multiple. The bigger ones can protrude from the cervix into the vagina.

Diagnosis - Speculum examination Treatment: - It is usually removed by curettage off the uterus

Cancer of the Cervix

It occurs most commonly between 30 and 45 years of age.

Cause:- unknown

Risk factors

·        Early age at first intercourse

·        Early child bearing

·        Multiple partners

-Chronic cervical infections

Signs and Symptoms

·        Metrorrhagia

·        Spotting of blood

·        Bleeding after intercourse or douching or defecation

·        Pain in the back and legs 

Diagnosis

·        Evaluation of sign and symptoms

·        Biopsy

·        Colposcopy

·        Dilatation and Curettage

Stages of cervical cancer

Stage 0 - is called cancer in situ. It is limited to the epithelial layer.

Stage I - Confirmed to the cervix

Stage II - It has extended to the vagina

Stage III - It has extended up to the vagina & has extended to one or both pelvic walls.

Treatment:

·        Surgery

-                  Total hystrectomy

-                  Radical hystrectomy (wertherin) - removal of uterus, adenexia, proximal vaginal and bilateral lymph nodes

-                  Radical vaginal hystrectomy

·        Radeim treatment (radiation)

·        Cytotoxic drugs

Vulval Growths

·        The growth in the vulva may be benign or malignant

·        Benign tumors may be fibromas, adenomas, lipomas fibro adenomas, moles, and elephantionsis.

·        Malignant tumors are squamous cell carcinoma and basal cell carcinoma

Treatment-Benign tumors can be treated by surgical removal of lesion.

·        Malignant tumors are treated by vulvectomy

Vulval Cysts

Bartholin’s cyst- It arises on the Bartholin’s gland at theposterior end of labia minora. It may be asymptomatic. Infection may be due to the gonococal organisms, escherichia coli or staphylococcus auereus can cause an abscess.

Treatment:

·        Incision and drainage

·        Antibiotics

Inclusion cyst of the preclitoral area- It develops followingcircumcision in infancy.

Sebaceous cyst- It can occur in the anterior part of labia meniora.