Genito-Urinary Findings in Women with Ovarian Tumors View PDF

Ovarian tumors are the most common gynecological problems, mostly present as cystic lesions. Its incidence ranging from 5% to 15% worldwide. Benign fibroids are the most common, reaching a third of new gynecological cases annually. Non-neoplasms benign ovarian tumors are caused by inflammation or the late effects of endocrine secretions, whereas neoplasms are caused by abnormal growth of cells [1]. Globally, there were 313,959 new cases of ovarian tumor, and 207,252 new deaths in 2021 [2]. In Iraq, there were 914 new cases of ovarian carcinoma, in addition to 678 deaths in 2020 [3]. Early menarche and late menopause are commonly known risk factors, besides, endometriosis, smoking, alcohol and family history [4,5].
Ovarian cancers are asymptomatic and have non-specific symptoms, making them difficult to diagnose early. Initial physical examination is the easiest approach to suspect the diagnosis of ovarian tumor [5]. Although screening methods have been developed to be able to diagnose ovarian tumors at an early stage [4]. Therefore, practitioners were able to perform the correct physical examinations and findings that support workup for ovarian tumors [4,5].
Ovarian cancer is revealed an increased abdominal volume, which confused with gastrointestinal and urinary tracts conditions [1,4]. About 80% of cases are diagnosed at advanced stages, and symptoms will depend on the organ affected and invaded. At this time the woman experiences gastrointestinal upset, with lower abdominal or pelvic pain, constipation, diarrhea, vaginal bleeding, ascites, and may be UTI symptoms [4].

In adolescents girls often report secondary amenorrhea, abdominal pain and distention. In adult women, heavy irregular bleeding and postmenopausal bleeding are the most frequent symptoms [6].

Based on Surveillance, Epidemiology, and End Results program (SEER)-Medicare linked data, higher rates of hypertension, thromboembolic events, congestive heart failure, UTI, and anemia were observed among ovarian cancer survivors [7]. Another study reported high prevalence of cognitive changes, peripheral neuropathy, and sexual changes [8]. In Sweden, a study reported higher prevalence of several self-reported urinary tract and pelvic symptoms [9]. Also, genitourinary complications during treatment are well-known among ovarian cancer patients [9,10].

Study Design and Setting

An observational study was conducted in Baghdad, Iraq, between September 2018 and February 2021.

Participants

Women diagnosed with ovarian tumors at 18 years of age or older. A total of Fifty women who enrolled in our hospital. Ovarian tumors was classified according to the International Classification of Diseases for Oncology, version 3 (ICD-O-3 code: C56.9), after followed the 2014 WHO classification guidelines to categorize the histopathology types [11-13].

Data Collection

Clinical and pathological data collected and analyzed. History was taken for every case including age, marital status, pregnancy history, parity, contraceptive history, and family history. Histopathology and staging of disease plus other properties was recorded from file of each woman. Data about comorbidities and outcomes were approved and diagnosed by full team of multidisciplinary gynecological and urological doctors, including Nephritis; Acute renal failure; Chronic kidney disease; UTI; Calculus; Hydronephrosis; Bladder obstruction; Ureteric stenosis

Urine retention; Urine incontinence; Hematuria; PID; Organ adhesion; Cervicitis; Endometriosis

Cyst; Menstrual disorders; Infertility and Menopausal pain were recorded.

Statistical Analysis

Study data were collected and processed using statistical analysis was performed using SPSS v24 (IBM Inc., Chicago, IL, USA). Descriptive statistics consist of numbers, and percentages were measured. Mean, median, range, min, max, and SD for categorical data calculated. A twosided P value of less than 0.05 was considered statistically significant.

Overall incidence of ovarian tumors was 70% malignant and 30% benign (Table 1).

The study showed that the most age group of ovarian tumors was above 55 years (62%). Women lived in urban areas were (52%), whereas those lived in rural were (48%). Half of patients were nulliparities. Educational level was mostly of low level in illiterate (20%), primary (24%), secondary (36%) compared to high level in university (10%) and postgraduate (10%). High percentage of women were not married (18, 36%) in compares with married women 16 (32%). Women used contraception in 52%. Whom housewives 58% in comparison with employer women 42%. The family history reported in 18% of women (Table 2).

The most common histopathological type was ovarian serous carcinoma 15 (30%), and a presence of other types in different proportions. Regional stages were common in 50% of patients. Low grade tumors in 32%, intermediate in 36% and high in 32%. Almost, 80% of women underwent TAH. About 60% of patients received chemotherapy (Table 3).

Genitourinary findings of ovarian tumors were reported in different proportions (Table 4).

Ovarian cancer is one of the most common gynecologic cancer types and is the third type after uterine and cervical cancers. These percentages were obtained due to improved ovarian cancer diagnosis, mainly sonography [14]. This result is similar to the results in other studies in Egypt and Jordan [15,16]. Other obtained data showed that ovarian cancer was most common in women aged above 55 years, for only 56.2% of their cases [18]. Most of the patients in Egypt (84.3%) presented with advanced stage III and IV, whereas only 15.7% of patients presented with stage I and II [25]. While in England, the percentage of stage III was 31.1% and stage IV was 18.1% whereas stage I was noted in 30.6% and stage II in 5% of cases [20].

Complications of ovarian cancer can include its spread to other organs, progressive function loss of various organs, ascites, and intestinal obstructions [26].

In this hospital-based study, we documented that ovarian tumor had an increased risk of several genitourinary diseases. The long-term adverse genitourinary health outcomes correlated included

Nephritis (6%), Acute renal failure (16%), chronic kidney disease (18%), UTI (38%), Calculus (16%), Hydronephrosis (20%), Bladder obstruction (2%), Ureteric stenosis (12%), Urine retention (8%), Urine incontinence (12%), Hematuria (22%), PID (14%), Organ adhesion (8%), Cervicitis (2%), Endometriosis (2%), Cyst (6%), Menstrual disorders (24%), Infertility (2%), and Menopausal pain (32%). Increased risks of urinary system disorders among ovarian cancer patients were associated with cancer treatment, advanced stage, serous histology, age at cancer diagnosis, and higher baseline comorbidity [14].

According to a SEER patterns of care report, the percentage of ovarian cancer patients who received chemotherapy was 64% for stage I or II and 80% for stage III or IV [27]. In our study, the percentage of receiving chemotherapy was similar (60%).

An increased risk of urinary system disorders in high stage disease is likely due to advances in the treatment. A SEER Medicare study including 5,087 ovarian cancer survivors ≥ 66 years reported higher incidence of renal disease 3- and 12-months after cancer diagnosis compared with cancer-free women [7].

A systematic review, including data from 31 publications, reported that gynecologic cancer survivors had a higher prevalence of pelvic floor disorders (which include urinary incontinence, fecal incontinence, and pelvic organ prolapse) [28].

Women who were >50 years of age had completed menopause, after which there is less hormonal and metabolic activity associated with the female reproductive organs, and they were not at risk of certain genital organ disorders, such as menstrual disorders and infertility [29]. Women who had hysterectomy or oophorectomy would not be at risk of genital organ disorders, such as endometriosis, menstrual disorders, menopausal disorders, and ovarian cyst [14].

According to the National Comprehensive Cancer Network (NCCN) guidelines for ovarian cancer patients, follow-up is recommended every 2 to 4 months during the first two years, every 3 to 6 months during the following three years after cancer treatment and once per year after 3 years [30]. Therefore, ovarian cancer survivors may be more likely to be diagnosed earlier with their adverse health outcomes compared with women from the general population. However, the frequency of clinic visits likely decreases over time, and the follow-up period of >5 years after cancer diagnosis should be less affected by increased surveillance [14].

Ovarian cancer represents the third most common gynecologic cancer type. It was more common in women aged above five decades. The most common histopathological type is ovarian serous carcinoma. We observed that ovarian cancer survivors experienced increased risks of various genitourinary diseases. Understanding the multi-morbidity scenarios for ovarian tumors is of vital importance to improve clinical care after diagnosis.

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