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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Pelvic Pain And Abdominal Bloating Along With Nausea?

I had a precancerous cyst on one of my ovaries which was removed during a total hysterectomy. My cervix, fallopian tubes and ovaries were removed. This was done about 5 years ago. I have had pelvic pain that never goes away, bloating and some nausea. I m wondering if I can still get cancer even if after a total hysterectomy. Thanks
Thu, 10 May 2018
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General & Family Physician 's  Response
Hello and Welcome to ‘Ask A Doctor’ service.
I have reviewed your query and here is my advice.

Short answer: Future cancer cannot be excluded.

Detailed answer: First, I will address the issue of the pain you are having since your operation. The chronic pain could be attributed to the so-called "Ovarian Remnant Syndrome (ORS)". This condition occurs when ovary tissue is not completely removed. In fact, it is not easy to completely remove the ovarian tissue as the boundaries with surrounding tissues are not clear-cut, it depends on surgeon experience, etc. Women suffering from ORS experience pelvic pain in 85% of cases.

Therefore, you have to take into consideration this suggested diagnosis and talk to your doctor in order to verify if this is the case. There are several ways to check for remaining ovarian tissue, including careful and complete pelvic examination, imaging, laboratory tests such as follicle-stimulating test (indicating if there is any functional remaining ovary tissue) or the test of provocation of remnant ovarian tissue with clomiphene citrate (50 mg twice daily for 10 days) that could demonstrate the presence of remnant tissue (in about 75% of cases). The later test is helpful if imaging is negative.

In case ORS is detected, then it could be treated via laparoscopy, a relatively simple procedure nowadays.

Secondly, returning to your question about the possibility of having cancer in the future despite removing the uterus, cervix, ovaries, and fallopian tubes, the answer is Yes. Cancer can never be ruled out even though the primary neoplasm cite has been removed.

In fact, there is an ongoing debate on whether radical surgery is beneficial versus local surgery or conservative treatment for cancer. Those who support radical surgery (removal of affected tissue, together with a wide range of surrounding tissues, muscles, fascia and lymph nodes) argue that in such way the doctor removes all cancer cells and even healthy tissues as a precaution and prevention method.

Those who are against radical surgery (they opt for local removing of cancer tissue and then chemotherapy, as needed) argue that cancer cells are free to move within the body, cancer cells can detach at any time from their primary site and get implanted anywhere and so, there is no guarantee that radical surgery will have any effect on future probability of cancer and overall survival but it will heavily affect patient's quality of life.

Therefore, the way a doctor treats such conditions is mainly based on the school or philosophy they believe in. There are pros and cons to both approaches.

I said all this in order to support my answer that cancer can never be ruled out. However, with the right treatment and support after surgery, the overall survival and quality of life for the patient can be greatly improved.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Ervin Toçi
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What Causes Pelvic Pain And Abdominal Bloating Along With Nausea?

Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Short answer: Future cancer cannot be excluded. Detailed answer: First, I will address the issue of the pain you are having since your operation. The chronic pain could be attributed to the so-called Ovarian Remnant Syndrome (ORS) . This condition occurs when ovary tissue is not completely removed. In fact, it is not easy to completely remove the ovarian tissue as the boundaries with surrounding tissues are not clear-cut, it depends on surgeon experience, etc. Women suffering from ORS experience pelvic pain in 85% of cases. Therefore, you have to take into consideration this suggested diagnosis and talk to your doctor in order to verify if this is the case. There are several ways to check for remaining ovarian tissue, including careful and complete pelvic examination, imaging, laboratory tests such as follicle-stimulating test (indicating if there is any functional remaining ovary tissue) or the test of provocation of remnant ovarian tissue with clomiphene citrate (50 mg twice daily for 10 days) that could demonstrate the presence of remnant tissue (in about 75% of cases). The later test is helpful if imaging is negative. In case ORS is detected, then it could be treated via laparoscopy, a relatively simple procedure nowadays. Secondly, returning to your question about the possibility of having cancer in the future despite removing the uterus, cervix, ovaries, and fallopian tubes, the answer is Yes. Cancer can never be ruled out even though the primary neoplasm cite has been removed. In fact, there is an ongoing debate on whether radical surgery is beneficial versus local surgery or conservative treatment for cancer. Those who support radical surgery (removal of affected tissue, together with a wide range of surrounding tissues, muscles, fascia and lymph nodes) argue that in such way the doctor removes all cancer cells and even healthy tissues as a precaution and prevention method. Those who are against radical surgery (they opt for local removing of cancer tissue and then chemotherapy, as needed) argue that cancer cells are free to move within the body, cancer cells can detach at any time from their primary site and get implanted anywhere and so, there is no guarantee that radical surgery will have any effect on future probability of cancer and overall survival but it will heavily affect patient s quality of life. Therefore, the way a doctor treats such conditions is mainly based on the school or philosophy they believe in. There are pros and cons to both approaches. I said all this in order to support my answer that cancer can never be ruled out. However, with the right treatment and support after surgery, the overall survival and quality of life for the patient can be greatly improved. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Ervin Toçi