Ovarian cancer: preventive surgery is invasive and brings risks to the patient
Angelina Jolie had surgery in March to remove ovaries and fallopian tubes after doctors detected early signs of cancer. Ovarian cancer accounts for about 6% of women's cancers, but has a high mortality rate. This is because it is most often discovered in advanced stages (75% of cases) and because it is inside the abdominal cavity, with the capacity to invade nearby organs.
There are several types of ovarian cancers with different expressions clinics and aggressiveness. When the tumor grows, it may spread through the peritoneum, the lining of the abdominal cavity, leading to an extravasation of fluid called ascites, which can occur in varying degrees. The main symptoms of the disease are: pelvic and back pain, increased abdominal volume by ascites and / or tumor and urinary and intestinal discomfort. There are no tests to detect the tumor early.
All conditions that keep the ovaries at rest reduce the risk of the disease, such as gestations, pills, and other medications that cause a woman to become anovulation. Obesity, dietary factors with increased weight, especially in adolescence, increase the risk. The most effective method to prevent ovarian cancer, although not totally, is prophylactic surgeries
About 80% of cases of cancers are sporadic and about 20% have a family connection, that is, we can find a higher frequency in certain families, but we can not "connect" relatives with cancer. Genetic cases occur in 5% to 10% of cases, and in these we can see family members affected in several generations, mainly young people (before the age of 50), men with breast cancer, bilateral or concomitant breast cancers. The major genes that are involved in the growth, division, and repair of altered cell genes are BRCA 1 and 2. Patients who exhibit these changes may have a chance of up to 40% for ovarian cancer and 65% for breast cancer during
Therefore, alteration of these genes leads to a higher frequency of ovarian and breast cancer in these families.
Knowing the risk
When these mutations are suspected, the patient and family should be oriented and should be offered tests for genetic evaluation. We can use some measures to reduce the risks with very small final impact, such as not gaining weight, decrease alcohol consumption and exercise. The most effective method currently used to prevent ovarian cancer, although not totally, is prophylactic surgeries. They are mutilating surgeries, which must be done as early as possible - before the age of 50, especially when the offspring are already formed. If the woman still wants to have children, one can keep frozen eggs or embryos (cryopreservation). These surgeries should be evaluated by a multidisciplinary and time-aware team to avoid hasty decisions.
For the prevention of ovarian cancer, the removal of the tubes already decreases the risk, but for greater effectiveness the complete surgery is the withdrawal of the ovaries, fallopian tubes and uterus. We should evaluate the effects of lack of hormones, which can lead to osteoporosis, heat waves, heart attack, lack of libido, vaginal dryness and other symptoms with loss of quality of life. And it is important for the patient to be informed about this, but there are steps to try to get around these problems.Multiprofessional evaluation is fundamental for better decision making regarding prophylactic surgical treatment and its consequences for women's health.
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