Women with endometriosis have higher comorbidities: Analysis of domestic data in Taiwan

AbstractEndometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long-term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, four on links with chronic liver disease, four on links with rheumatoid arthritis, four on links with chronic renal disease, five on links with diabetes mellitus, and five on links with cardiovascular diseases (hypertension, hyperlipidemia, etc.). The data available to date support that women with endometriosis might be at risk of some chronic illnesses and certain malignancies, although we consider the evidence for some comorbidities to be of low quality, for example, the association between colon cancer and adenomyosis/endometriosis. We still believe that the risk of comorbidity might be higher in women with endometriosis than that we supposed before. More research is needed to determine whether women with endometriosis are really at risk of these comorbidities

Clinical implication for endometriosis associated with ovarian cancer

We reviewed current literature regarding the association of endometriosis and epithelial ovarian cancer based on epidemiology studies, molecular researches and clinical observations. Our methods include a review of literature research of MEDLINE, PubMed, Cochrane Library of Systematic Reviews and reference search in selected papers. The life time risk of epithelial ovarian cancer in women with endometriosis is low, yet there might be a cluster of individuals who have higher risk of developing epithelial ovarian cancer from endometriosis. Endometriosis associated ovarian cancer (EAOC) is predominant in particular histological subtypes of epithelial ovarian carcinoma and are related to some specific molecular aberrations. Clinical observations showed age as an important variable to the development of EAOC. Rapid growth of tumor and solid components in sonography are key features to detect malignant transformation of endometriosis. Evidence is not clear about prophylactic oophorectomy in preventing EAOC in patients with endometriosis. This review provided rationale data for identifying, monitoring, counseling and management of women with endometriosis who are potentially high risk for malignant transformation. Keywords: Endometriosis, Epithelial ovarian cancer, Malignant transformatio

Adhesion prevention in laparoscopic myomectomy

Adhesions are common sequels of laparoscopic myomectomy (LM), even though they are much reduced compared with laparotomy. Good surgical technique is the main principle to reduce post LM adhesion. Based on electronic research of the PubMed database using specific keywords, barrier materials offer promise for adhesion prevention at second look laparoscopy. However, pregnancy outcome when influenced by adhesion formation after LM is unclear and warrants further investigation

Prognostic significance of stromal metalloproteinase-2 in ovarian adenocarcinoma and its relation to carcinoma progression

Objectives. MMP-2 expression in ovarian cancer cells has been correlated with poor prognosis. This study attempts to assess the prognostic importance of stromal MMP-2 in patients with ovarian endometrioid & serous adenocarcinoma. Methods. MMP-2, MMP-2 activator, MT1-MMP, & its inhibitor (TIMP-2) were immunostained in 84 primary epithelial ovarian carcinomas (EOCs) (35 endometrioid adenocarcinomas [ECs] & 49 serous adenocarcinomas [SCs]). Results were correlated to pathological subtypes, tumor stage, grade, size, & to recurrence-free & cancer-specific survival. Results. MMP-2 & stromal MMP-2 were detected in all carcinoma cells of 22.2% of EC & 77.8% of SC tumors. MT1-MMP colocalized with MMP-2. TIMP-2 staining was weak & cytoplasmically distributed in all tumors. Univariant analysis showed expression of stromal MMP-2 significantly associated with advanced stage ( P = 0.018), higher grade ( P = 0.005), serous subtype ( P = 0.02), smaller tumor size at operation ( P = 0.001), & higher incidence of recurrence ( P = 0.042), but not with the rate of death due to cancer. By multiple Cox proportional hazard regression analysis, patient survival & disease-free survival were significantly related to the presence of stromal MMP- 2 in EC but not SC patients ( P < 0.05). However, after multivariant analysis, the associations with patient age, tumor stage, grade, & size no longer existed. In stepwise selection, tumor stage remained the most important predictor of patient survival & disease-free survival in ovarian EC & SC, but stromal MMP-2 remained the most important predictor of recurrence-free survival in patients with EC. Conclusions. Stromal MMP-2 occurs early & may play a role early in EOC invasion. Tumor stage & stromal MMP-2 are important predictors of disease-free survival