Introduction
Ovarian cyst is a medical condition that affects women, and it has received attention in study, research, and treatment for a long time. As a medical condition, ovarian cysts is defined as a sac that normally develops and forms itself on the ovary of a woman and in nature, this sac is filled with fluid (Ricci and Kyle, 2008). Further, it has been established that this common growth condition is normally benign 90% of the time and is asymptomatic in many women (Hackey, 2007 cited in Ricci and Kyle, 2008). Further, it has been established through research that ovarian cysts normally affect 30% of women who experience regular menses while 50% of women with irregular menses are affected with ovarian cyst (Ricci and Kyle, 2008). More so, research shows that 6% of women in post-menopause are affected with ovarian cyst (Ricci and Kyle, 2008). It is within this understanding of ovarian cyst that this research paper aims at specifically analyzing an ovarian cyst case from its history, diagnosis, care, and treatment in a particular given case study of a patient.
Case Study: Ovarian Cyst
Sarah is a woman aged 35 years old. Two days ago, she presented herself to the clinic complaining of pelvic pain, bloating and early satiety, accompanied by breathlessness. She had no vaginal discharge. Facial expression showed Sarah looking pale and felt cold. Further, the patient indicated that prior to her coming to the clinic, she had vomited twice, and she had experienced pain around the hypogastrium. On further examination, it was found out that Sarah had tense, tender cystic swelling from the pelvis almost reaching the epigastrium. After this early testing had been done, it was recommended that Sarah needed an ultrasound examination. Ultrasound findings were as follows: Sarah’s uterus was normal in size; myometrium was present and had uniform low-level echoes while the endometrial was empty. Further, the ultrasound examination indicated that there was a spherical transonic mass of 8.6 cm wide seen to the right side of the uterus and had irregular lines (septa) within it. The mass was seen arising from the pelvis and positioned above the upper border of the uterus and had acoustic enhancement. Moreover, two ill-defined parallel lines were seen arising from the lower border of the mass reaching the uterus. The identified lines represent the pedicle, which is discontinuous at the middle.
Discussion
Differential diagnosis of Sarah with regard to presentation and findings
The above presented symptoms from Sarah and further the symptoms identified through ultrasound examination points to existence of three medical conditions.
Ovarian cysts
The above physical and informal examination would point to the existence of ovarian cysts in the patient. However, ultrasound is the only method that would confirm the presence of ovarian cyst. In the above case, according to the findings of the ultrasound examination it is clear to state that chances of Sarah suffering from ovarian cyst are high. In most cases, ovarian cyst can be diagnosed from the following identified symptoms: pelvic discomfort, lower-back pain, and sometimes, abnormal uterine bleeding (Keir, Wise and Wise, 1997). Other symptoms of this condition may include; acute abdominal pain that is similar to appendicitis, massive intraperitoneal hemorrhage, and delayed menses that sometimes is accompanied by prolonged or irregular bleeding (Keir, Wise and Wise, 1997).
Ovarian carcinoma
It must be recognized that diagnosis for ovarian carcinoma is sometimes problematic given the few symptoms that are associated with the medical condition (Dizon, Abu-Rustum, and Brown, 2004). However, considering the case of Sarah, early resolution can indicate to the presence of ovarian carcinoma (Dizon, Abu-Rustum, and Brown, 2004). Key symptoms of this medical condition include bloating, abdominal discomfort, and distension (Dizon, Abu-Rustum, and Brown, 2004). When the above three symptoms manifest themselves clearly, then it can be deduced that Ovarian carcinoma has spread beyond the ovary and there are likeliness that it is present in the abdomen (Dizon, Abu-Rustum and Brown, 2004). Further, when bloating is evident then there is likelihood of buildup of fluid (ascites) into the abdomen and this may indicate the presence of ovarian carcinoma (Dizon, Abu-Rustum, and Brown, 2004). Nevertheless, given few symptoms are associated with the condition it is always advisable for women to look out for such signs as bloating, increase in waist line, abdominal discomfort, pelvic pain, and discomfort during sex or even vaginal bleeding which should inform the woman to seek physician advice (Dizon, Abu-Rustum and Brown, 2004).
Tubo-ovarian mass
Tubo-ovarian mass, sometimes referred to as the tubo-ovarian abscess, manifests itself in limited symptoms that sometimes may be mistaken for ovarian cyst (Keir, Wise and Wise, 1997). The most prevalent signs of this medical condition include severe abdominal pain, guarding and rebound tenderness, nausea and vomiting, abdominal distention, and fever (Keir, Wise and Wise, 1997).
Epidemiology of the Differential Diagnosis
International medical journals have ascertained that ovarian cysts of several types are common in women of reproductive age (Ricci and Kyle, 2008). The etiology of these ovarian cysts is not known but majority of research points to the possibilities of perturbations in the hypothalamic-pituitary-gonadal axis as the main cause of the disease (Ricci and Kyle, 2008). Cysts are of different types whereby, the most common type is the follicular cyst, which typically ranges in diameter from 3-8 com and resolves quickly in 4-8 weeks (Ricci and Kyle, 2008). Most cysts are small and benign which indicate absence of cancer and normally go away on their own. However, in some cases, larger cysts can result into pain and other medical related problems. It must be noted that causes of ovarian cysts largely originate from multiple factors that normally happens during the childbearing years of a woman (Ricci and Kyle, 2008). During this period, there is normally the growth of follicles in the ovaries every month. Given that an egg a productive egg is normally produced, the egg together with follicle becomes a small functional cyst (Ricci and Kyle, 2008). Follicles are known to make hormones and during ovulation release an egg. In other instances, the follicles grow in size and transform into cysts. It has been estimated that ovarian cysts occur in about 30% of females who experience regular menses, 50% in women who experience irregular menses and further 6% of postmenopausal females (Ricci and Kyle, 2008). Further, polycystic ovary syndrome has been estimated to affect about 10% of women. On overall, it has been estimated that the incidence of ovarian cancer affecting women is believed to be 15 cases per 100,000 women (Ricci and Kyle, 2008).
Ovarian carcinoma (cancer) is ranked at position eight in the new cancer cases identified among the women (Lockwood, 2008). As a constituent medical condition, ovarian cancer is estimated to affect 3% of women affected by cancer and it ranks as the fifth leading cause of cancer death among women (Lockwood, 2008). Ovarian cancer has been identified as the most lethal of all the cysts malignancies and in 2008, the American Cancer Society established that about 21,650 women were diagnosed with ovarian cancer whereby, 15,520 of these women were at danger of succumbing to the condition (Lockwood, 2008). Exact causes of ovarian cancer remain an intensive area of research but numerous presumptions exist on the possible causes of the medical condition. Top among the causes is the presumption incessant and uninterrupted ovulation in an environment that is conducive to tumorigenicity is likely to lead to ovarian cancer (Lockwood, 2008). Further, more epidemiological studies and findings indicate that ovarian cancer is likely to appear among aging women and among those women with familial background of the disease (Lockwood, 2008). Other identified causes of the condition include the infertility medication among this sub-set of women and high intake of carcinogens (Lockwood, 2008). In addition, women who do not give birth have been identified as another group likely to develop ovarian cancer, and this has been associated with lower use of oral contraceptives among these women (Lockwood, 2008).
Tubo-ovarian abscess (TOA) has been categorized as one of the critical complications of acute pelvic inflammatory disease (PID). It is believed to occur in up to 15% of ambulatory treated women with PID and further 34% of women who need hospital treatment (Halperin, Levinson, Yaron, Bukovsky, and Scheider, 2003). Some of the prevalent reason associated with the development of TOA is the nulliparity, where it was found to manifest itself in 25-50% of diagnosed women (Halperin, Levinson, Yaron, Bukovsky, and Scheider, 2003). Other identified cause of the condition include presence of previous episodes of PID, multiple sexual partners and the use of intrauterine device (IUD) as a prevention method for pregnancy (Halperin, Levinson, Yaron, Bukovsky and Scheider, 2003). At the same time, the development of TOA has been regarded as an end stage in the wider progression process of upper genital tract infections (Halperin, Levinson, Yaron, Bukovsky, and Scheider, 2003). Numerous researches that have been conducted have shown that TOA occur in women who are aged between 30-40 years, but much recent researches point to the growing number of infections among older women aged 50-60years (Halperin, Levinson, Yaron, Bukovsky, and Scheider, 2003).
Appropriate Diagnostic Testing For the Differentials
An evaluation of a patient suffering from ovarian cysts stars by the clinical history and physical examination. For any clinical advanced testing technique to be incorporated, it must be enhanced by the additional clinical information. Multiple disease processes may present with a similar clinical condition and it is from this fact that differential diagnosis should be constructed from data obtained from the clinical history, that include the age of the patient and sometime menopausal status. Further, the duration and recurrence of the problem should be construed together with the current medications of the patient (Bluth, 2008). At the same time, the differential diagnosis should be informed by laboratory information, hematological and blood chemistry studies, which are important in determining the origin of pain (Bluth, 2008).
Ovarian cysts diagnosis can effectively be carried out through ultrasound imaging largely by using endovaginal sonography technique-EVS (Bluth, 2008). Through ultrasound imaging, it becomes possible to identify and differentiate between the varying causes of acute pelvic pain. At the same time, ultrasound techniques have been favored due to their low levels of adverse effects, ready availability, low cost, and high sensitivity for many disease processes (Bluth, 2008). By using EVS, there is likelihood of improved visualization of the pelvic structures such that it becomes possible to view the adnexal masses, collections, free fluid, hydroureter and other critical clues for diagnosis (Bluth, 2008). By using this technique, it should be able for the physician to establish whether the cyst is hollow or solid, determine its size and exact location and also find out whether the cyst contain fluid or abnormal structure. At the same time, this technique has a calculated specificity and sensitivity of 98.9% and 81% respectively (Bluth, 2008).
Screening for ovarian cancer has been regarded as a strenuous and difficult task given that the disease is not prevalent in the larger society (Alberts and Hess, 2005). However, in selecting the appropriate diagnosis it has been advised that an effective screening test for ovarian cancer should have a sensitivity of at least 80% for early stage, curable disease, a positive predictive value of at least 10% and a specificity of over 99% (Jacobs, 1998 cited in Alberts and Hess, 2005). Diagnosis of ovarian cancer usually has to involve blood test, which in most cases is to find out a substance in the blood known as CA-125 (Alberts and Hess, 2005). Medical studies have established that the amount of this protein substance increases in blood of women who may be affected by the ovarian cancer. Position emission tomography (PET) appears to be appropriate diagnosis technique for ovarian cancer (Alberts and Hess, 2005). However, the adoption of this technique has been hampered by high cost. The PET has more value in the setting of evaluation for recurrent disease or for ruling out and confirming the growth of an existing tumor (Alberts and Hess, 2005). At the same time, the technique is in a position identify the presence of other related conditions like fibroid tumor and pelvic inflammatory disease since it demonstrate the capacity to detect presence of mass (Alberts and Hess, 2005).
Standard of Care and Treatment for Ovarian Cancer Patients
Upon identification or detection, standard care is needed for patients with ovarian cancer. Some of the suggested standard care strategies include administration of oral contraception and ablation (Delbruck, 2007). In this way, the pills have been identified to have the potential of reducing the risk of developing cancer by about 60% when used for about six years (Delbruck, 2007). Further, families and individuals perceived to be at the highest risk should be given the opportunity to participate in specific early cancer detention programmes such as the vaginal exploration and ultrasound tests (Delbruck, 2007). Further individualized psychological is necessary to ensure the patient lives a health life and observes doctor’s medical prescriptions. Lastly, administration of fertility-deserving treatment is appropriate but care should be given to preserve uterus and the contra-lateral ovary (Delbruck, 2007).
First line treatment for ovarian cancer is surgery that has been identified as the cornerstone treatment of this disease (Bristow and Karlan, 2006). Surgery when undertaken serves many roles and on top of that provides definitive diagnosis (Bristow and Karlan, 2006). In most cases, patients with early-stage ovarian cancer usually benefit from provision of accurate and comprehensive staging surgery. Among patients with advanced ovarian cancer, there is the cytoreduction (debulking) of large tumor volume that always results in improved outcomes (Bristow and Karlan, 2006). The second line treatment is the carrying out of neoadjuvant chemotherapy (Bristow and Karlan, 2006). This has been identified as the effective treatment method especially in managing symptoms of ascites in patients who are unlikely to respond well to the cytoreductive surgery (Bristow and Karlan, 2006).
Conclusion
Through research, it has been established that when the cysts grow large and exert pressure on the surrounding structures it is always advisable for women to seek medical help (Ricci and Kyle, 2008). Due to its growing prevalence, ovarian cysts should draw attention of practitioners into more advanced research work to identify the most innovative techniques of screening, identifying, and treatment the various types of ovarian cysts. At the same time, it should be remembered that today affected women are at high risk of developing long-term health problems that may include cardiovascular disease, hypertension, dyslipidemia, type 2 diabetes, and cancer (Lorenz and Wild, 2007 cited in Ricci and Kyle, 2008). Therefore, more need to be done in ensuring medical solution to mitigating ovarian cysts are identified and implemented.
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