NOTES

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Surgical Staging of Early-Stage Ovarian Cancers: A Report of Two Cases

https://tinyurl.com/y6tc5bum

 

         Modern surgical practice is developing to enable minimal access procedures. One technique becoming more common is called natural orifice transluminal endoscopic surgery (NOTES) where the abdominal cavity is accessed via the posterior fornix of the vagina with previous gaseous distension of the peritoneum allowing safe access to the pouch of Douglas. This is a potential space between the vagina and the rectum.

         Advantages of this technique include no visible scar and possibly no hernia complication. NOTES is being used for salpingectomy and management of cysts and endometriosis.

         This case report records the use of NOTES in early stage ovarian cancer. The procedure is combined with a transvaginal hysterectomy and enables removal of both ovaries and tubes together with biopsy of any suspicious lesion with removal of the peritoneal fold known as the lesser omentum. One of these patients was 81 years old and a low impact surgical approach was advantageous.

Lymphedema disability

Association of Lower Extremity Lymphedema With Physical Functioning and Activities of Daily Living Among Older Survivors of Colorectal, Endometrial, and Ovarian Cancer

https://tinyurl.com/y2v6x5t5

 

         Lymphedema is a complication of cancer treatment. Fluid normally travels through the lymphatic system from the extremities back to the vascular system. When the normal passage of this fluid is interrupted due to pressure changes, clear fluid collects in superficial soft tissues, causing pain and disability.

         This study looks at 900 women who are survivors of cancer surgery and determines the numbers who have lymphedema and the effect of this on their lives. Damage to lymph vessels and nodes causing lymphedema frequently occurs, either as a result of surgery or chemo and also following radiotherapy.

         Results from the study show a high prevalence of lymphedema for these women, especially those who had ovarian cancer surgery (31%). Quality of life changes were assessed using standardised scales. Every woman had decreased quality of life after surgery but this was much greater for those women with lymphedema. More women with lymphedema required assistance with normal life activities.

What next?

Predicting Ovarian-Cancer Burden in Catalonia by 2030: An Age–Period–Cohort Modeling

https://tinyurl.com/myc5rtkb

 

         Sometimes when engaged in the day-to-day management of serious disease it is important to consider the future and the impact of change. This article is a statistical review of current trends in the incidence of ovarian cancer and a prediction of future numbers.

         In recent times there has been a pleasing gradual reduction in the number of women who contract ovarian cancer. Thought to be due to two major factors; increased use of hormonal contraception and less postmenopausal hormone therapy, this decrease has been noted worldwide.

         However, there is a concerning rise in the incidence of ovarian cancer for women born during the 1980s. The article documents this shift amongst the population of Catalonia. Thus far a cause has not been determined, one possible factor is the prevalence of obesity. Also, change in survival due to new maintenance therapy will result in a delayed, hopefully short time, increase in mortality. Planning for these changes should commence now.

Care for the dying

Age Disparities in End of Life Symptom Management Among Patients with Epithelial Ovarian Cancer

https://tinyurl.com/46vyempm

 

         The final stages of cancer are challenging for patients and treating medical professionals. Ovarian Cancer is no exception and unfortunately most women who have ovarian cancer will die from the disease.

         This study looks at the symptoms women experience during their last hospital admission. 82 women were included; most had fatigue, pain and shortness of breath as the reasons for admission. About 40% of these women received palliative care only.

         For the remainder invasive procedures such as drainage of ascites were undertaken. It is noted that these women were younger and usually had been sensitive to platinum chemo. No difference in survival was shown for those women who received active treatment. The authors suggest, “Futile treatments…should be avoided”.