Diagnosing and Removing a Pelvic Mass

Approximately 20 percent of women will develop a pelvic mass at some point in their lives. When a woman is referred to Willamette Valley Cancer Institute, a gynecologic oncologist works to determine whether the mass is benign or malignant. Determining whether a pelvic mass is cancerous or benign requires surgery. Treatment depends on the size of the mass and its appearance on imaging studies, such as an ultrasound or a CT scan. Depending on the size, the patients pelvic mass can either be removed laparoscopically or laparotomy. 

Understandably, this can be an anxious time for patients and having the right information is important. “When a patient has a consultation, we discuss different scenarios,” say gynecologic oncologist Dr. Kathleen Yang. “What if the mass is benign? And what if the mass is cancerous? We also describe the procedure the patient will undergo and the steps we will take.”

In the video below, Dr. Kathleen Yang explains the planning process and what patients can expect before, during and after surgery.

Overview of open surgery for pelvic mass

 

Surgically Removing a Pelvic Mass

Treatment depends on the size of the mass and its appearance on imaging studies, such as an ultrasound or a CT scan. Depending on the size, the patients pelvic mass can either be removed laparoscopically or laparotomy.

Laparoscopically

If the mass is small, it may be removed laparoscopically with robotic technology using the da Vinci XI Surgical System. This is less invasive than traditional gynecologic surgeries.

The da Vinci System features a magnified 3-D high-definition camera and tiny wristed instruments that bend and rotate far greater than the human wrist, enabling surgeons to operate with enhanced vision, precision, dexterity and control, through a few small incisions.

The technology allows our gynecologic oncologists to treat patients through just a few small incisions, while maneuvering the surgical tools in a way that is more gentle on the body. The surgeon is 100 percent in control of the da Vinci System at all times, and the system cannot be programmed or perform in any way without the surgeon’s input.

The equipment rotates around a single spot, so there is minimal tugging on the patient’s tissue, which contributes to pain. Through the use of this technology, patients come out of the surgery with significantly less pain, need significantly fewer narcotics, and they are up and walking much sooner.

Potential benefits of the da Vinci Surgical System for patients include:

  • Reduced pain
  • Lower risk of infection or complications
  • Less blood loss (fewer transfusions)
  • Shorter hospital stays
  • Less scarring, due to smaller incisions
  • Faster return to normal activities

Robotic surgery offers less invasive treatment of gynecologic cancers

Robotic surgery offers less invasive treatment of gynecologic cancers

 

Laparotomy

When a mass is too large to remove laparoscopically, it is often removed through a vertical incision in the wall of the abdomen, a procedure called a laparotomy.  While the patient is still under anesthesia, the mass is sent to the lab where a pathologist looks at it under a microscope.

“Twenty minutes after the removal of the mass, we will be able to tell if this is cancer or not,” says Dr. Yang. “If the pathologist determines the growth is benign, we’ll finish the procedure and the patient will go to the recovery room.”

If cancer is present

If the pathologist determines that the mass is ovarian cancer, a complete hysterectomy is generally performed at that time. That includes removal of the uterus, cervix, both ovaries and fallopian tubes. In addition, nearby lymph nodes are removed for biopsy along with sample tissues from the pelvis and abdomen. This will help determine if the cancer is contained to the ovary or if it has spread.
“The goal is to do the entire procedure at one time, under one anesthesia to make it easier for the patient,” Dr. Yang says.

Recovery

Robotic surgery has been proven to reduce recovery time for gynecologic cancer patients, significantly improving recovery time and getting patients back to their daily routines, often within a couple weeks, instead of six to eight weeks with traditional surgery. Often, patients are able to go home the same day.

Because a laparotomy procedure requires a large incision, a patient generally remains in the hospital for 3-5 days following surgery. Patients are able to go home once they are able to get up and walk around, tolerate food and urinate. Expect 4-6 weeks for full recovery.

Patient support

Going through cancer can be scary for anyone, which is why we offer support services for patients, including our Ovarian/Gynecologic Cancer Support Group.

Our oncology social worker and oncology care manager provide one-on-one counseling to help patients cope with emotional, psychological and social challenges related to their diagnoses. They also connect patients with support groups, financial aid, and other assistance that may be needed.