What to know about ovarian cysts

Vague, often mild symptoms can make it difficult to diagnose ovarian cancer early but gynaecologist Olivia Smart had some useful advice for about keeping it on the radar at her March Continuing Medical Education (CME) session.

On balance most ovarian cysts are benign and often asymptomatic. In fact, it is an ovary’s job to produce a cyst every month as part of normal cyclical changes. However, we need to be vigilant, to pick up on cysts that have features associated with ovarian cancer, to avoid the potentially devastating impact of this disease on a woman’s health.

Educating women about the signs of ovarian cancer and encouraging doctors to investigate what often seem like vague symptoms is the key to early diagnosis and treatment of the disease.

I like the simple acronym B.E.A.T.

B   is for bloating that doesn’t come and go.

E   is for eating difficulty and feeling full more quickly.

A   is for abdominal and pelvic pain that you feel most days.

T   is for toilet changes in urination or bowel habits.

Pain and abdominal distension may be symptoms of ovarian cancer, and can be accompanied by other issues such as feeling that you need to frequently pee, changes in weight or post menopausal bleeding.
Of course, these symptoms can be associated with a wide range of other conditions, such as Irritable Bowel Syndrome, Urinary Tract Infections and diverticulitis, but the possibility of ovarian cancer should
 

Olivia Smart

always be considered alongside these more common health issues. Gynaecologists use a variety of tools to determine what investigations and surgery may be required for cysts.

Among them is the Ovarian-Adnexal Imaging Reporting Data System (ORADS) which is used to assess whether a cyst is at low, moderate or high risk of being cancerous. Levels of the protein CA125 in a blood test may also indicate that ovarian cancer is present.

Achieving earlier diagnosis is hard due to the lack of a successful screening programme and  the high level of resources needed to investigate symptoms that are generally associated with less serious conditions. This is why it is important that we continue to  highlight the symptoms of ovarian cancer and persist in community education.

Many women who are diagnosed with ovarian cancer will be post menopausal but it can affect younger women also. Investigating persistent symptoms is important for women of all age groups.

If you have a family history of breast or ovarian cancer, this could influence your future risk and you may be eligible for genetic screening for inherited familial conditions, which may influence future management.
 

Welcome to Jane Scott and Victoria Price

We’re delighted to announce that Jane Scott and Victoria Price have joined us in our Menopause Centre.

Jane is a General Practitioner with 30 years’ experience in New Zealand and the United Kingdom. Her special clinical interests are in women’s hormonal health and lifestyle medicine. She supports women’s wellbeing through evidence-based nutritional advice and helping patients incorporate easy relaxation techniques into their lives. She has co-led hormonal health workshops, using the principles of Dr Louise Newson and Dr Rangan Chatterjee.

As well as her role at Oxford Women’s Health, Jane works as a GP at the University of Canterbury Health Centre and is involved in the University’s Ruahinetanga: Menopause@Work initiative.

Victoria also has a special clinical interest in women’s health and lifestyle medicine, and is passionate about supporting women through all stages of their lives. She has international experience in the British Royal Navy and UK hospitals, and has completed the Newson Health Menopause training course. Since moving to New Zealand, Victoria has worked as a clinical lecturer at the University of Otago Medical School and is a General Practitioner at the University of Canterbury Health Centre.
 

Jane Scott

Victoria Price

Breast cancer management – an update from Josie Todd

Our Oncoplastic Breast and General Surgeon, Josie Todd, recently presented a breast cancer update. Below are some of the key points from her CME presentation in May.

There are two established pathways for the identification and management of breast cancer in New Zealand. The first is the long standing BreastScreen Aotearoa (BSA) programme, which is provided free to all women aged 45 to 69. Screening mammograms are offered to these women every two years. Early detection of cancer helps improve outcomes for these women and is reflected in the decline in mortality from breast cancer over the last two decades.

The second pathway for the diagnosis of breast cancer involves women who have a new breast problem, such as a lump or bleeding from the nipple, which prompts them to see their GP for further investigation. This usually involves a mammogram, Ultrasound scan and breast biopsy. These symptomatic cancers can occur in women outside the screening age group or between the two yearly screening mammograms.

Women who have an above average risk of breast cancer due to a significant family history of the disease may be screened more frequently. Women in the moderate risk category, as identified by their family history, are offered annual mammograms between the ages of 40 and 50. This can be organised by their GP following risk assessment.

There is a small category of high risk women, such as carriers of genetic mutations (e.g. BRCA1 and BRAC2), who require more intensive monitoring with breast specialists in a hospital setting. Patients in the high risk category usually have multiple generations of family members who have had breast or ovarian cancer, and may be eligible for genetic testing. 

Genetic testing
In New Zealand, Regional Genetic Services through the public system, offer genetic testing to those women who fulfil the eligibility criteria. While genetic testing sounds simple, the implications of the test are challenging and Genetic Services offer counselling to people who are eligible for it. These tests need to be interpreted with caution and this is best managed by
 

Josie Todd

specially trained genetic specialists. Hereditary breast cancers account for about five per cent of all breast cancers. Younger women who are identified as carriers of a “faulty” gene mutation are referred to the high risk clinic and offered more intensive surveillance. This may include an MRI for younger people (between 25 and 35 years of age). 

Mastectomy v lumpectomy and radiotherapy
Once a woman has been diagnosed with breast cancer, the treatment options can be daunting. The choice between mastectomy and lumpectomy could depend on the type of cancer and more importantly on the extent of disease. For the vast majority of screen detected and early symptomatic breast cancers, women can safely be offered lumpectomy (or Breast Conserving Surgery (BCS)), followed by radiotherapy. 

Helping women decide what to do once they are diagnosed with breast cancer, is an important role for General Practitioners, who have long-standing relationships with their patients.

In women with large tumours or multiple areas of disease within the same breast, mastectomy is the recommended treatment. 

Breast reduction with lumpectomy
For large breasted women, Therapeutic Reduction Mammoplasty (TRM) offers a cost-effective and improved quality of life option, as another way of managing breast cancer. TRM uses the principles of breast reduction surgery in the context of breast cancer and can be regarded as an extension of BCS.

It also allows the surgeon to remove a much larger area of disease, achieve a smaller breast size, and conserve the breast tissue. These patients will need surgery on the normal breast at the same time to help achieve symmetry. 

Janene Brown appointed new Clinic Director

We are delighted to announce that Janene Brown has been appointed as Oxford Women’s Health’s new Clinic Director.

Janene is an Obstetrician and Gynaecologist who specialises in laparoscopic surgery, total laparoscopic hysterectomy, endometriosis, prolapse surgery and hormone and fertility issues.

She is a Director of Oxford Women's Health, an Ethicon Oxford Women's Health Laparoscopic Fellow, and a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
 

Janene Brown

Accreditation recognises commitment to best practice

Oxford Women’s Health has received a national award of certification, demonstrating our commitment to meeting standards of practice and ensuring effective systems for quality and risk management within our service.

The award was presented by the DAA Group.

Repeat prescriptions made easier

We are now offering a repeat prescription service through our website. 

This option is available to people who have seen a specialist for the condition associated with their medication within the last six months. For some medications, this may be three months.

Repeat prescriptions are at the specialist’s discretion and Oxford Women’s Health will contact patients to make an appointment if we believe a review is necessary.
 

If you require an urgent repeat prescription, please phone the Oxford Women’s Health clinic on 03 379 0555.

For more, visit: oxfordwomenshealth.co.nz/repeat-prescription

New Queenstown Location

We have now moved into our new clinic at the Queenstown Centre of Medical Excellence at Kawarau Park.

Gynaecologists Janene Brown, Ben Sharp and Olivia Smart continue to be available for appointments in Queenstown. You will find the Oxford Women’s Health clinic in unit G, opposite the new Southern Cross 
 

Hospital on the Frankton side of Queenstown.