About the size of a grapefruit. As big as a basketball. Comparisons like these are sometimes used to describe an oversized tumor. But in rare cases, ovarian tumors can grow much larger. In early 2018, a young woman underwent abdominal surgery to remove a 132-pound ovarian growth. Thankfully, the enormous growth was benign and the patient is now doing fine.
When it comes to ovarian cancer, size doesn’t necessarily matter: Smaller tumors are just as likely to be malignant. Unfortunately, symptoms of ovarian cancer are vague, causing women to delay seeking care. Here’s how ovarian tumors of varying sizes have impacted the lives of three women.
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
Overwhelming Abdominal Mass
The young woman was gaining 10 pounds a week. The mass in her abdomen rapidly grew, placing intense pressure on her internal organs. She couldn’t eat, but her ballooning weight forced her into a wheelchair. A CT scan revealed she had a 132-pound ovarian tumor.
The woman, who prefers not be named, was referred to Dr. Vaagn Andikyan, a gynecologic oncologist with Western Connecticut Health Network. She was evaluated and treated at Danbury Hospital, part of the network.
“She was very, very sick,” says Andikyan, an assistant professor at the University of Vermont Larner College of Medicine. However, at 38, age was an important factor in her favor. “Her heart and lungs were in good shape,” he says. “Her kidney and intestines — everything was healthy and young. Somebody at 68 probably would not even be able to tolerate a benign tumor of this size.”
Surgical challenges and medical consequences from removing the immense tumor had to be anticipated and carefully considered. “We had a very fine balance [in determining] how we would take out this tumor without compromising her heart and lungs from functioning normally,” Andikyan explains. The five-hour surgery would also include removing excess skin stretched by the tumor and reconstructing the patient’s abdomen.
The appearance of the mass, first on radiology images and then on the operating table, was “very surprising,” Andikyan says. It was the first time he’d ever seen anything like that in his career, and “I doubt I will ever see another tumor of this size.”
On Feb. 14, 2018, the tumor was safely removed. Fortunately, it was a benign type of mass called a mucinous tumor. As she recovered, the woman lost about 175 pounds overall, including the extra fluid she had been carrying. “Despite the tumor being so big, we were able to preserve her future fertility,” Andikyan says. Now she’s back to her normal life, he says, working and enjoying her family.
Unexpected Bloating
For another woman, early symptoms didn’t seem to make sense. At 56, Marion Roth of Ridgefield, Connecticut, had gone through menopause. Yet, her belly was becoming distended and she didn’t know why. When she stood sideways in front of the mirror, she says, she looked pregnant.
Roth felt bloated and nauseated. She urinated frequently and had back pain. “I just figured those were normal hormonal changes, until I noticed the bloating was beyond mild bloating and the back pain was persistent,” she says.
When Roth was examined by a primary care physician, she says that while it hurt, the pain wasn’t sharp or overwhelming. She noticed the ache seemed to originate from her pelvic area and she followed up with an OB-GYN specialist, who diagnosed the presence of a mass.
In October 2016, Roth was treated at the Praxair Cancer Center at Danbury Hospital, as a patient of Dr. Andikyan. Her tumor was somewhat larger than usual, nearly 4 inches in diameter. The tumor’s appearance was a bigger concern, Andikyan says. “It had both a fluid and a solid component,” he says. “The solid component always worries us, because it means that’s not just a cyst.”
Roth grew up with Type 1 diabetes. Her treatment team took her diabetes risk factors and insulin requirements into account when planning her care.
Had the tumor been smaller, a minimally invasive procedure — using robotic and laparoscopic technology, with a smaller incision and quicker recovery — might have been feasible, Andikyan says. “With a large tumor, it could be harder to remove the tumor intact to avoid spreading,” he explains. In this case, he says, “We performed old-fashioned, traditional open surgery with a good outcome.”
[See: 10 Innovations in Cancer Therapy.]
Pathology laboratory tests revealed Roth had a rare type of ovarian cancer called a granulosa cell tumor, an estrogen-producing tumor. About 400 patients are diagnosed with it in the U.S. yearly, Andikyan says. Roth had a stage 1 tumor with malignant cells on the ovary’s surface.
Her surgery was extensive: removal of her uterus, cervix and both ovaries and fallopian tubes. She also had surrounding lymph nodes and fatty tissue removed, and underwent abdominal reconstruction.
The aftermath was difficult, including “considerable” bedrest, Roth says. “It was painful to have everything in your midsection removed,” she says. “It was a slow recovery process.” She would undergo 18 rounds of chemotherapy over the next six months.
Almost two years after her surgery, Roth is doing well. Last year, she traveled to Africa to do charitable work and go on safari. She’s back to normal life, including returning to work at her job at Apple.
Roth is appreciative of all the medical care and community support she’s received. “It was, many times, the little things that people did that helped me deal with losing my hair or having my health decline and dealing with the fear of the unknown, because this is not a well-known form of cancer,” she says. Having made it this point, Roth says, she’ll continue to weather whatever else comes her way. “But it won’t be alone,” she adds.
More than 22,000 women are diagnosed with ovarian cancer each year in the U.S., according to the American Cancer Society. Roth is sharing her story to help raise awareness of ovarian tumors and encourage women to seek care as soon as possible.
Symptoms include bleeding in postmenopausal women, abdominal pain, nausea, vomiting, weight loss and abdominal distension and bloating. “Please, tell your doctor,” Andikyan says. If a family member develops ovarian, breast or colon cancer, he adds, it’s worth asking whether it’s a genetic, BRCA-positive cancer, which increases the risk of ovarian cancer, and following up with your doctor if so.
Benign but Still Harmful
Large, benign tumors often turn out to be mucinous, says Dr. Jonathan Herman, an OB-GYN and partner in Elite Women’s Health Care in New Hyde Park, New York. A mucinous tumor is just what it sounds like, he says: filled with mucus. “When you cut it open, it looks like someone sneezed,” he says. Rarely do these tumors pop, he says. Instead, they keep stretching and stretching.
More than a decade ago, a couple appeared on the doorstep of Herman’s Long Island home. They had just found out their teen daughter had a large ovarian tumor. They showed him her imaging report. He called the radiologist and learned the girl had a roughly 20-pound tumor filling her entire abdomen.
[See: 12 Medical Emergencies You Need to Address Right Away.]
Although oversized mucinous tumors aren’t cancerous, they’re clearly far from harmless. “Even though they are benign, they do cause all kind of havoc on the body,” Herman says. It’s as if someone was standing on your body, he says. Pressure on the bladder makes it difficult to pee. Kidney damage could occur. The tumor could press on vital blood vessels such as the aorta and vena cava, causing heart and circulation problems. Electrolyte imbalances could arise as the large tumor draws water to itself.
As soon as possible, the girl was in the operating room. “These big tumors are very shocking to see, even for physicians,” Herman says. “Thank God they are very rare.” The patient did quite well, he says. A few years later she went to nursing school, he says, where she enjoyed showing pictures of her tumor to classmates. She maintained her fertility and later was able to have children.
Normal-sized tumors, while less surprising, are every bit as concerning, Herman emphasizes. “Smaller tumors could also have a very important effect,” he says. “Smaller tumors could also be cancerous. If you don’t feel right, get it checked out. Early detection is really the key.”
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Ovarian Tumors Can Grow Amazingly Large originally appeared on usnews.com
