Ovaries are organs found only in females. They are oval-shaped, typically 2-3 cm in size (about the size of a quail egg), located on both sides of the uterine horns. They have two main functions:
- Egg production When an egg is fertilized by sperm, it implants in the uterus to develop into an embryo. If the egg is not fertilized, it will disintegrate.
- Hormone production which causes physical changes in girls as they enter puberty, such as breast development, widening hips, higher-pitched voice, and hair growth in the pubic and underarm areas.
Types of Ovarian Tumors
- Cysts (Cyst) are tumors that appear as sacs containing fluid, water, or tissue inside.
- Benign tumors or non-cancerous types (Benign)
- Malignant tumors or cancerous types (Malignant)
Risk Factors for Ovarian Cancer
The exact cause is unknown, but risk factors include:
- Genetics: family history of cancer in grandmother, aunt, mother, sister
- Women who breastfeed have a lower risk
- Age entering menopause or over 55 years old
Symptoms of Benign Ovarian Tumors
- Menstrual irregularities
- Frequent urination due to the tumor pressing on the bladder
- Constipation due to the tumor pressing on the intestines
- Abdominal enlargement
- Acute abdominal pain, which may result from complications when the tumor grows larger, causing twisting, rupture, bleeding, or infection
- Bloating and loss of appetite
Medical Diagnosis
- Doctor takes medical history, asks about symptoms, and performs a general physical examination
- Palpation of the abdomen may detect a mass
- Internal examination or rectal examination
- Ultrasound examination via abdomen or vagina
- Computed tomography (CT scan)
- Magnetic resonance imaging (MRI)
Symptoms Suggestive of Malignant Ovarian Tumors (Ovarian Cancer)
- Loss of appetite and weight loss due to rapid tumor growth
- Ascites (fluid in the abdominal cavity) may be detected by physical exam or ultrasound due to cancer cell spread to other organs
- Biopsy results can classify the type of ovarian tumor
Treatment Approaches for Ovarian Tumors
- If diagnosed with a benign ovarian tumor, treatment involves medication and monitoring whether the tumor shrinks or grows, with periodic ultrasound follow-ups
- If diagnosed with ovarian cancer, surgery will be performed to remove as much malignant tissue as possible, combined with chemotherapy or radiation therapy
- For surgery of benign ovarian tumors, indications include failure of medication and monitoring to reduce tumor size, tumor growth, or complications such as acute pain from tumor torsion, rupture, or bleeding, in which case surgery is recommended
Two Types of Gynecological Surgery
- Traditional surgery involves a 10 cm long abdominal incision, requiring a longer recovery time and leaving a scar
- Modern technology surgery called Gynecological Laparoscopic Surgery is suitable for gynecological diseases such as ovarian tumors, ovarian cysts, chocolate cysts, etc. However, it may not be suitable for reproductive organ cancers as it may increase the risk of cancer cell spread
This special surgical equipment includes the following important devices:
- A small camera with a magnifying lens connected to a receiver that displays images on a screen
- A light source to provide clear images
- Forceps for grasping tissue
- Scissors for cutting tissue and dissecting adhesions
- Electrocautery device to stop bleeding
- Suturing equipment
The equipment used in laparoscopic surgery is designed for high efficiency in use.
Advantages of Gynecological Laparoscopic Surgery
- Very small surgical wounds, less pain
- Less blood loss, faster recovery
- Most patients can eat immediately after surgery
- Hospital stay is about 1-2 days, shorter than open abdominal surgery
Procedure of Gynecological Laparoscopic Surgery
The anesthesiologist will administer general anesthesia. Then the doctor will make 3-4 small abdominal incisions, each about 0.5-1 cm, to insert small surgical instruments. During the surgery, the doctor and team can view the internal organs on a monitor receiving signals from the laparoscopic camera.
Complications from Laparoscopic Surgery
Because carbon dioxide gas is introduced into the patient’s abdominal cavity to facilitate surgery, after the procedure, the doctor will remove as much gas as possible. Some gas may remain, which can push against the diaphragm causing shoulder pain. This discomfort usually resolves within 1-2 days as the body naturally absorbs the gas.
Limitations of Gynecological Laparoscopic Surgery
- It may not be suitable for cancer cases due to the risk of cancer cell spread, depending on the doctor’s judgment and the cancer stage
- Patients with anesthesia problems may not be suitable candidates
General Preoperative Preparation
- Fasting from food and water for 6-8 hours before surgery
- Patient signs a consent form for surgery
Postoperative Care
- For open abdominal surgery, fasting from food and water for at least 24 hours until the doctor permits eating. For laparoscopic surgery, most patients can eat immediately, depending on the doctor’s discretion
- Avoid sexual intercourse and heavy lifting for a period as determined by the doctor
- Keep the wound dry
- Walking and light exercise are allowed
- Take medications regularly as prescribed
- Attend follow-up appointments
Since the exact cause of ovarian tumors is still unknown medically, it is important to reduce risk factors such as maintaining a healthy weight, breastfeeding, regular exercise, and monitoring for abnormal symptoms. For asymptomatic individuals with a family history of ovarian cancer, screening can be done through annual physical exams such as ultrasound or blood tests for ovarian cancer markers.
