After the six-and-a-half hour surgery in February, the patient’s recent scans show no sign of cancer.

In February, 58-year-old Samantha* found herself in a troubling situation. She had put on significant weight, and her belly had begun protruding, almost as though she was pregnant. When she approached a private hospital in Bengaluru with these health issues, little did she realise how much more serious the ultimate diagnosis would be.

After scans revealed that she had a mass in her abdomen, she was referred to Manipal Hospital in the city, where a successful surgery removed a nine-kilogram cancerous tumour from her abdomen. It has been about two months since this surgery, and her scans show no signs of the cancer.

Dr Shabber S Zaveri, a consultant surgical oncologist and robotic surgeon, who handled Samantha’s case, spoke to TNM about how they went about it.

How she was diagnosed

When Samantha approached a gynaecologist at the private hospital, she was told that her uterus had prolapsed — a medical term for when an organ or part of an organ slips forward or down — and was coming out of her vagina. A CT scan was prescribed, which clearly showed the presence of a huge tumour. Doctors diagnosed it as a retroperitoneal liposarcoma, which is a cancer that arises out of fat.

Liposarcoma is different from lipoma, which is the most common form of tumour in the human body. Lipomas are benign and do not cause any damage other than perhaps altering appearance. A liposarcoma rarely ever originates from an existing benign lipoma. Dr Shabber says that among liposarcomas, a retroperitoneal liposarcoma which arises at the back of the abdomen, is most common.

After the CT scan, Samantha approached Manipal Hospital, situated on Bengaluru’s Old Airport Road. There Dr Shabber reviewed the situation. “The tumour was extended from her diaphragm to her pelvis. It had displaced several organs too – the left kidney had been pushed to the right side. The pancreas and spleen were also displaced. The tumour had pushed down her uterus too,” he explains.

A six-and-a-half-hour surgery

It became clear that Samantha would have to undergo surgery to remove the malignant tumour. The risk was that some of her major organs like the left kidney and pancreas would have to be removed as well because the tumour had displaced them completely. “We took her consent for the same, that we may have to remove those organs if the necessity arose,” Dr Shabber says.

Fortunately, however, the six-and-a-half-hour surgery was successful. The tumour, that was about 18 inches and weighed nine kilos, was removed. Apart from her ovaries, uterus and part of the diaphragm, the surgeons did not have to remove any other organs.

The tumour that was removed

“The beauty of this case was that we were able to save most of her major organs. As she was post-menopausal, removing the uterus and ovaries weren’t an issue for her. We were also able to realign her organs to their original place. We secured them with sutures as they had been displaced, so that they would stay in place and not move when the patient walked around,” Dr Shabber explains.

Samantha slowly recovered and she was discharged after a week. However, the doctors had to wait for a few months to ensure that she was cancer-free. The latest PET scan was clear, meaning Samantha was healthy and the surgery had been successful.

Health advisory

As per online resources, liposarcoma is a rare form of cancer and usually affects people who are above the age of 40.

The tricky thing about this cancer is that the tumour forms over a period of time, says Dr Shabber. “The patient would present to the doctor only after some unusual symptoms start developing. In the present case, it was the uterine prolapse,” he says.

In context of retroperitoneal liposarcoma, symptoms include bleeding from the anal area, blood in urine or stool and difficulty in swallowing persist; if one has mouth ulcers that don’t heal after two weeks; or if they have an appearance of something like a lump on their body, which seems to be growing over time, even if it is painless.

He asserts that while these symptoms may not necessarily mean that one has liposarcoma, but seeking medical attention is a must. In Samantha’s case for instance, if the gynaecologist had not prescribed an ultrasound, the tumour may not have been detected.

“Generally, a prolapsed uterus is removed by a vaginal hysterectomy; basically meaning that it is removed through the vagina. Had the ultrasound or CT scan not happened and only the uterus was removed, the tumour would have gone unnoticed because the patient did not have other alarming symptoms,” Dr Shabber.

“She would have had to come back after a few months with much more alarming symptoms like being unable to eat and a distended abdomen. In my opinion, the organs we were able to save now would have had to be compromised had there been a delay,” he adds.

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