15 - Emergencies and treatment-related complications in gynaecological oncology

Summary

Introduction

Gynaecological cancers are more common in postmenopausal and elderly women. Most treatments in gynaecological oncology are instituted as elective procedures but acute presentations are not uncommon. Emergencies in gynaecological oncology are influenced by the site of cancer, stage of disease, presence of associated comorbidities and the treatment received. Emergencies can be medical or surgical.

Cancer-related emergencies

COMPLICATIONS RELATED TO ADNEXAL MASSES

Acute abdominal pain

The causes of acute abdominal pain associated with an adnexal mass are torsion, infarction, rupture and haemorrhage. Twisting of the ovarian pedicle results in torsion of the cyst causing a reduced blood supply, which leads to infarction and ischaemic pain. While smaller dermoid cysts are notorious for undergoing torsion, large tumours filling the entire pelvis rarely have space to undergo torsion. Infarction can also be caused by increasing size in a solid tumour resulting in diminished central blood supply. Rapidly growing tumours can develop internal haemorrhage by stretching and tearing of the feeding blood vessels or rupture of the cyst wall with bleeding into the peritoneal cavity.

Presentation

Patients usually present with sudden onset of abdominal pain radiating to the back and the thighs. Eventually, symptoms of peritonism (guarding, rigidity, rebound) and haemodynamic instability will develop with raised inflammatory markers and anaemia.