Can a 10 centimeter ovarian tumor presenting with radiculopathy (nerve pain) radiating down the medial thigh and posterior leg cause permanent back pain and muscle weakness after tumor resection?

From the Guidelines

Yes, a 10 centimeter ovarian tumor that caused nerve pain radiating down the inner thigh and back of leg could potentially lead to permanent back pain and muscle weakness even after resection. This occurs because large pelvic tumors can compress or infiltrate nearby nerves, particularly the lumbosacral plexus, obturator nerve, or sciatic nerve, causing nerve damage. If the compression existed for an extended period before removal, the nerves may have sustained permanent injury. Additionally, the surgical procedure itself carries risks of nerve damage during dissection and removal of the tumor, as emphasized by the need for surgery to be carried out by experienced teams with a multidisciplinary approach, as stated in the study on ovarian cancer 1.

The risks associated with surgical resection, including the potential for ultraradical surgery, which is a controversial issue, highlight the complexity of managing such cases. Post-surgical complications like scar tissue formation can also entrap nerves, leading to persistent symptoms. Treatment options might include pain management with medications, physical therapy to strengthen weakened muscles, and in some cases, nerve blocks or neurostimulation for refractory pain. The longer the nerve compression existed before surgery, the higher the likelihood of permanent deficits, as nerves have limited regenerative capacity, especially after prolonged compression injury.

Key considerations in managing a patient with a large ovarian tumor and associated nerve symptoms include:

• Prompt and accurate diagnosis to minimize the duration of nerve compression
• Surgical intervention by a skilled and experienced team, as recommended in the guidelines for ovarian cancer management 1
• Comprehensive post-operative care to address potential complications and optimize recovery
• Multidisciplinary approach to pain management and rehabilitation to improve quality of life and functional outcomes.

From the Research

Ovarian Tumor Resection and Permanent Back Pain

• A 10 centimeter ovarian tumor that presented with nerve pain radiating down the inner thigh and back of leg may cause permanent back pain and muscle weakness after resection, although there is limited direct evidence to support this claim.
• The provided studies focus on the treatment of cancer-related neuropathic pain using gabapentin, rather than the specific effects of ovarian tumor resection on back pain and muscle weakness 2, 3, 4, 5.
• However, it is possible that the nerve damage caused by the tumor could lead to chronic pain and muscle weakness, even after the tumor is removed.

Gabapentin for Neuropathic Pain

• Gabapentin has been shown to be effective in treating neuropathic pain, including cancer-related neuropathic pain 2, 3, 4, 5.
• Studies have demonstrated that gabapentin can provide significant pain relief for patients with postherpetic neuralgia and painful diabetic neuropathy 4.
• The use of gabapentin in combination with opioids may also be beneficial for patients with neuropathic cancer pain, as it can reduce the need for high doses of opioids and improve pain control 5.

Limitations of Current Evidence

• There is limited evidence specifically addressing the effects of ovarian tumor resection on back pain and muscle weakness.
• Further research is needed to fully understand the relationship between ovarian tumor resection and permanent back pain and muscle weakness.
• The current evidence suggests that gabapentin may be a useful treatment option for patients with neuropathic pain, including those with cancer-related neuropathic pain, but more research is needed to confirm its efficacy in this population 2, 3, 4, 5.