Most endometriosis is like what is seen in this picture, a small powder burn hidden deep in the pelvis seen at the time of laparoscopy. But some endometriosis is found by the presence of a cyst of the ovary. Indeed that cyst, known as an endometrioma, probably is due to a simple ovarian cyst that is invaded by endometriosis. Cysts are relatively easy to find, the endometriosis shown here is much harder to find. And now a study by the Ovarian Cancer Association Consortium is pointing out the links between ovarian cancer and endometriosis and the importance of controlling endometriosis to help prevent ovarian cancers. Pelvic endometriosis is most often found when evaluating a patient for pelvic pain, infertility, or literally stumbled upon when a woman is getting pelvic surgery for another reason. Endometriosis is common, occurring in 1/10 women. Endometriosis, however is rarely felt on exam, found on an x ray or an ultrasound, unless a woman has a large ovarian mass. For
most, this challenge means that there are significant delays in the
diagnosis of endometriosis. In fact only 25% of those women undergoing hysterectomy for chronic pelvic pain have endometriosis actually discovered at the time of surgery! The average delay has been said to be 7-9
years between the start of symptoms and the diagnosis. And that long sequence, accompanied by the fact that endometriosis that is not symptomatic means many women with endometriosis harbor their disease for a long time and may find themselves at risk for having their endometriosis turn cancerous. Even once the diagnosis of endometriosis is made by
surgery has been frustrating for patients as there is no way to figure
out at what rate the disease will progress for women who want children
and even more importantly, for all patients with endometriosis, what
puts them at risk for disease progression is still unknown. But we do think that it is clear that there is a link between endometriosis and ovarian cancers of a particular cell type. Even the original purveyor of the disease mechanism of endometriosis, Dr. J. Sampson in 1925 thought there was a link between ovarian cancer and endometriosis. and to prevent ovarian cancer we now think carefully removing all endometriosis at surgery, removing the fallopian tubes when possible to prevent uterine tissue from gaining access to the pelvis, and checking for when there is a change to ovarian cysts is going to all help prevent ovarian cancers. What Dr. Sampson couldn't have known is the link between certain genetics and the predisposition of a woman to have her endometriosis turn to cancer. Knowing a woman's genetics is probably the future of predicting who will be at risk for her endometriosis to convert to a cancer. For now we have to use tests that will reveal endometriosis. Blood testing for inflammation had been proposed as a way to detect endometriosis in young women in a study we reported from Human Reproduction . Indeed they found that levels of IL-6, IL-8
and in their study even CA-125 were increased in all women with
endometriosis. They think they will be able to use a panel of six blood
tests, called biomarkers, to determine within 90% accuracy if a patient
has endometriosis even in the mild to minimal stages (Stages I or II out
of IV). With endometriosis
if gynos could find a panel of tests to use, like the screening blood tests
that are used to screen some women for ovarian cancer, many women could
be helped significantly. And in a study published in the American
Journal of Obstetrics and Gynecology researchers from Utah used MRI's non-invasively to diagnose endometriosis. Although ultrasound is very good at finding the endometriosis experts reporting on the Consortium's findings also note that an MRI may be better at determining if the malignant transformation has occurred in women who are keeping their cysts and not removing them. Removing these cysts will help to prevent conversion to ovarian cancer. Do you think you need additional testing because of symptoms of pelvic pain?
endometriosis is not likely from the uterus, multiple studies not point to the presence of endo in premarchal infants undergoing autopsy to determine cause of death at a rate of 1 in 10. Should shift our thinking away from reflux as cause, since the tissues are dissimilar in many ways and there is no evidence of initial attachment
ReplyDeleteEndometriosis still remains some what mysterious. Menstrual blood regularly gains access to the deep pelvis through retrograde menstruation. There are multiple theories of how endometriosis evolves, and we do know there is evidence that some cases are from attachment of endometrium that is present in the pelvis. Laboratory studies confirm that enddometrium can grow remotely in tissues other than the interior of the uterus. Other examples would include the fact that a enlarged fibroid uterus is more likely to be associated with endometriosis. The thinking being that there is more endometrium that gains access to the pelvis. Thanks for the comment, and readers should know this post is by no means exhaustive on the topic.
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