Endometrial ablation with the neodymium:yag laser

Article Abstract:

Approximately 20 percent of all hysterectomies (removal of the uterus) are performed to control abnormal uterine bleeding. However, because there are many physical, psychological, and sexual changes that can occur after hysterectomy, alternative treatments to hysterectomy are needed. The neodymium:yag (Nd:Yag) laser, which uses high intensity amplified light to manipulate tissue, can be utilized to destroy the inner endometrial lining of the uterus in order to control bleeding without removing the uterus. This is called endometrial ablation; the procedure as performed with the Nd:Yag laser was evaluated as an alternative to surgical hysterectomy. The subjects were 45 women who had benign (non-cancerous) disease and did not want children in the future. Hormone therapy and dilation and curettage (D&C), the traditional first-line treatments for uterine bleeding, had failed in these women, so they were referred for endometrial ablation. The subjects were given medroxyprogesterone to promote endometrial tissue shrinkage before laser ablation. The light-touch or no-touch laser technique, in which the laser fibers are held close to the uterine lining without making contact with the tissue, was used. The laser ablation procedure was successful in 34 women (81 percent). Fourteen women (33 percent) have no bleeding and 13 (31 percent) experience less than 25 percent of their original blood flow. The procedure was technically difficult to perform in women with an enlarged uterus (greater than 10 centimeters), who usually had to be excluded from the treatment. In those women who were treated, patient weight, uterine size, and the presence of uterine abnormalities did not affect the treatment outcome. Twelve women had a severe medical condition contributing to uterine bleeding which made them poor candidates for hysterectomy, and endometrial ablation was successful in 11 of these patients. The Ng:Yag laser was found to be a useful alternative to hysterectomy in controlling benign uterine bleeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Surgery, Uterine bleeding, Uterine hemorrhage, Hysterectomy, Ablation (Surgery), Lasers in medicine, Medical lasers

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Magnetic resonance imaging in stage I endometrial carcinoma

Article Abstract:

Correctly staging (classifying) malignant tumors is important for appropriate diagnosis and treatment, and methods that improve accuracy, especially at early stages, are under evaluation. One of these is magnetic resonance imaging (MRI), an approach that produces high-resolution views of internal organs and structures. To determine the accuracy of MRI for staging endometrial cancer (cancer of the cells lining the uterus), the method was used to examine 50 patients one week before they underwent surgical treatment for stage I endometrial cancer. Thirty-five received the diagnosis of stage Ia (less advanced) and the remainder, Ib. The images obtained with MRI clearly showed extensive invasion of the myometrium (the muscular wall of the uterus) in 17 of 18 patients whose surgical results showed they had such invasion. The method also accurately detected invasion of the cervix in the three of the 17 women who had tumor cells in the samples removed from their cervixes by curettage (scraping). Six patients appeared on MRI to have dissemination (spread) of tumor cells beyond the uterus; these, plus the three with cervical involvement, represented 18 percent of the whole group. Thus, MRI could result in advance staging for this proportion of endometrial cancer patients, potentially of value in determining therapeutic approaches. MRI appears to be an important tool for proper clinical staging, especially for patients with certain surgical results. These include papillary serous carcinoma (a particular type), a positive ECC (endocervical curettage), or grade 3 tumors (a measure of tumor cell differentiation). (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Endometrial cancer, Magnetic resonance imaging

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Ovarian carcinoma arising in atypical endometriosis

Article Abstract:

Endometriosis is a condition in which cells that normally line the inside of the uterus attach, grow and function in other areas of the body. Endometrial tissue can be found on the outside of the uterus, fallopian tubes, ovaries and on pelvic structures. Pain is the most common symptom. In only one percent of the cases, endometrial cells become cancerous. A 44-year-old woman experiencing pelvic pain had an enlarged ovary. The patient underwent exploratory surgery and an ovarian cyst was removed along with associated fallopian tube and uterus. Microscopic evaluation revealed atypical endometrial-type tissue consistent with endometriosis. Three years later pelvic pain returned. A large mass was felt on the remaining portion of the right ovary, which proved to be malignant. This is the first documented case of atypical cell-type endometriosis which became cancerous within a few years. Atypical endometriosis may be a precursor to ovarian cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Causes of, Complications and side effects, Development and progression, Ovarian cancer, Precancerous conditions, Carcinogenesis, Endometriosis

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