In this episode of PodMD, experienced Endo-Gynaecologist, Advanced Laparoscopic Surgeon and General Gynaecologist Dr Dan Krishnan will be discussing the topic of pelvic masses, including what pelvic masses are, how a patient would typically present, the treatment options available, the role a GP plays in treatment and more.
Please note this is a machine generated transcription and may contain some errors.
*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMD studio Dr Dan Krishnan
Dr Dan Krishnan is an Endogynaecologist and General Gynaecologist providing care in Liverpool and Ashfield. Dan completed his medical degree from The University of Queensland in 2011, his passion for Obstetrics and Gynaecology landed him a registrar position at King Edward Memorial Hospital for Women, Perth.
Dr Krishnan spent two years at the prestigious Sydney Minimally Invasive Gynaecology Surgery (SMIGS) unit, an AGES-accredited fellowship at the Sutherland Hospital where he now holds a staff specialist position. Upon completing his fellowship and obtaining his FRANZCOG, Dan decided to venture further into complex pelvic surgery at Westmead Hospital as a Gynaecological Oncology Fellow. He currently holds a staff specialist position at Liverpool Hospital, where he leads Endogynaecology clinics and surgeries.
Today, we’ll be discussing the topic of pelvic masses, which is the third in a four-part series called ‘The Women in Pain’.
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.
Dan, thanks for talking with us on PodMD today.
Dan : Thank you for having me.
The topic of today’s discussion is pelvic masses. Dan, can you give us a brief overview about pelvic masses?
Dan: So a pelvic mass describes any benign, benign meaning in brackets, non-cancerous or malignant, malignant being cancerous growth or enlargement that originates inside the pelvis. And specifically, for us in gynaecology, it originates from either the cervix, the ovary, the uterus or any surrounding structures close to the reproductive organs. Most women would develop a pelvic mass at some point in their lives, although many go undetected. A few examples of pelvic masses in younger women particularly would be atopic pregnancies, endometriosis, endometrial hyperplasia, or endometrial cancer can cause a mass. Polycystic ovaries can sometimes cause a mass, ovarian cysts can cause a mass, fibroids, adenomyosis that we spoke about in our last podcast can also form a mass, or any other form of benign or malignant tumours that is close to the reproductive organs.
How would a patient with a pelvic mass typically present?
Dan: So the most common symptoms that I’m going to list next would be pelvic pain. So any form of pain that we previously have mentioned in our series of podcasts, women in pain, should always be investigated, cause a really dangerous cancerous pelvic mass can be a possibility. So pelvic pain can be a huge symptom for a pelvic mass, frequency to urinate or urgency of urination is something that should be investigated in women. Abnormal nausea or vomiting, bloating, abdominal swelling or feeling full. Vaginal bleeding that is abnormal or heavy menstrual bleeding. Unusually heavy bleeding that is irregular and not of a certain usual pattern. Changes in bowel habits, including constipation, blood in the bowel, diarrhoea, feeling of fullness despite emptying bowel. All of these can be a symptom of pelvic masses.
What are the risks of the condition?
Dan: When we talk about the risk of pelvic masses, we should always address that the most dangerous or difficult to treat of pelvic masses is a cancer. So I think it is really important to keep that in mind. That ruling out any form of pelvic malignancy should be absolutely vital to any medical practitioner that is seeing a patient with symptoms of a pelvic mass. When we talk about cancer, pelvic masses that can cause cancer, that is related to the reproductive organs would be cervical cancer, ovarian cancer, endometrial cancer, and sometimes fibroid cancers as well. Once we’ve ruled out any form of cancerous lesions, we can always look into fixing or looking into treating any other form of pelvic masses. Because some of these messes went untreated, causes a lot of lifestyle changing side effects, including frequency of urination, pain, feeling of bloating, bowel changes that can be very inconvenient for women.
As previously mentioned, an ovarian mass can be present. It can be an ovarian cyst, and if it’s an ovarian cyst that’s causing a mass, sometimes in younger women that can cause an acute condition called ovarian torso. And certainly needs immediate attention because an ovarian torsion untreated can lead to a loss of the ovary and future reproductive potential. Other forms of masses could be ectopic pregnancies, so a mass in pregnancy that is not showing a baby inside the uterus should always be investigated. Atopic pregnancies can be life threatening because when they do rupture, it is a fresh blood and fresh bleeding inside the abdominal cavity. And a a young woman can become completely unstable within minutes of this occurrence. It causes severe pain as well.
Other forms of masses that can cause a lot of issues or risks to a woman would be fibroids because they can cause severe bleeding and sometimes requiring transfusion. In young women, so these are the risks of pelvic masses, and I think it is really important that we stay on top of things in in patients reporting symptoms of a pelvic mass. Also important to note that pelvic masses do not are not age-related. Younger women are also susceptible to developing malignant pelvic masses. So it’s always important to keep that in. Mind signs of a pelvic mass is often identified upon routine gynaecological exam, sometimes a GP or a specialist will be able to feel these tumours by pressing down on the tummy.
Anything felt on abdominal palpation should be immediately investigated. With a form of medical imaging, starting with a pelvic ultrasound, occasionally an MRI or a CT scan will also help. GPS and specialists help differentiate types of pelvic masses.
What are the treatment options?
Dan: So treatment options for pelvic masses will depend on multiple factors such as the size, the type, the location of the growth and whether or not we think it’s cancerous. Some masses will only require some monitoring, whereas surgical removal will be recommended for others. As a minimally invasive gynaecological surgeon, I perform advanced laparoscopic procedures to remove these masses with little disruption to surrounding healthy tissues. My approach being minimally invasive usually means that there’s a shorter hospital admission time in a quicker recovery. With less postoperative pain for my patients.
It is very important to note that some pelvic masses cannot be removed via minimally invasive approach due to 1 the potential origin of it being cancerous and two the potential life threatening situation such as bleeding that will require a different form of surgery which is open surgery to ensure. Safe removal of masses performed by the. There are multiple other treatment options in recent years, including neutron artery embolization to reduce the size of fibroids, but we will discuss this in the next question.
Have there been any developments in treatment in the last years or are there any in trials or development now?
Dan: So there’s a lot of hot topics regarding magnetic resonance guided reduction in pelvic masses, particularly fibroids. It can be aided by uterine artery embolization. These methods of treatment will reduce the burden of the disease, such as bleeding and symptoms of pelvic fullness. These treatment options usually retain gynaecological organs without removing them via surgery. It is important to note that these recent developments of reducing the burden of the disease. This does not mean that the disease is removed or the pelvic mass is completely removed. The only way to remove a pelvic mass from the pelvis is by a surgery.
Are there any warning signs a GP or their patient can look out for?
Dan: So I always tell my patients that any pattern of bleeding that has changed in recent years should always be investigated. And as previously mentioned in all my podcasts, pelvic pain should never be normalised. Any pelvic discomfort, fullness or pelvic pain requires urgent investigation, starting with a pelvic ultrasound. Any form of bloating or central obesity that is new in patients should also warrant a pelvic ultrasound to ensure there’s no dangerous masses that can be life threatening in women.
What is the likelihood of recurrence of the condition?
Dan: This is a rather challenging question to address. Recurrence of disease is very much dependent on the type of disease or the type of mass. In view in view of removal of fibroids, we sometimes know that in certain cases of myomectomies, fibroids can recur. Recurrence is also common in certain types of cancer, and also endometriosis. With regards to recurrence, it is important to note that most patients, upon removal of a pelvic mass, will require some form of surveillance, either by their specialist gynaecologist or their specialist GP.
When should a GP refer?
Dan: I think it is absolutely important that as the moment a pelvic mass is suspected, A referral process to a gynaecologist is. It is important to ensure there is no malignant condition in these masses associated with the patients symptoms.
What role does the GP play in the treatment of the condition?
Dan: The most important thing is early detection. It is absolutely important to investigate a patient who’s presenting with pelvic mass symptoms. An early ultrasound or an at least an early pelvic examination to determine what type of mass it is and an early referral to a specialist gynaecologist is the biggest role a GP specialist can play.
Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on pelvic masses?
Dan: No bloating or bowel change is ever normal. Pelvic fullness requires prompt investigation and abnormal menstrual bleeding or discharge should always warrant an urgent ultrasound to start with.
Thank you again for your time and the insights you’ve provided.
Thanks for your time and the insights you’ve provided.
Dan: Thank you so much for everyone’s time