1. What is endometriosis?
  2. Which are the symptoms?
  3. Endometrial cancer and classification
  4. Symptoms and diagnosis

What is endometriosis?

Endometriosis is a pathology characterized by the presence of endometrial tissue where this tissue is normally not supposed to be, outside of the uterus. This type of endometrium is called ectopic endometrium. Endometriosis is a chronic condition, which means it is a long term condition and is distinguished into internal endometriosis, when the ectopic endometrium is localized near the myometrium, and external endometriosis, when the ectopic endometrium is at pelvis level both inside and outside the pelvis. The latter is the most common form.

Which are the symptoms?

Endometriosis can cause no symptoms at all and its diagnosis is often casual. Women with endometriosis that present symptoms are usually affected by chronic pelvic pain, dysmenorrhea (very painful menstruation), dyspareunia, pelvic and vaginal pain during sexual intercourse, painful pelvic masses and fertility reduction. The ectopic endometrium behaves exactly like uterine endometrial tissue. This implies that about once a month in women with menstruation, the ectopic endometrium sheds and causes bloody lesions that produce the symptoms and signs of the pathology. However, the blood deriving from these lesions does not have the chance to leak out and tends to accumulate causing an inflammation and sometimes cysts called endometriosis cysts or endometriomas. In addition, these lesions can lead to the formation of adhesions between the different organs in the pelvis. Endometriosis tends to reverse with menopause.

Endometrial cancer and classification

Endometrial cancer originates from the glands of the uterine mucosa. This cancer is the most frequent of the female genital system even though the mortality rate is much lower compared to that of ovarian or cervical cancer. Endometrial cancer appears between 55 and 65 years of age, in the postmenopausal period. Women with greater risk of endometrial cancer are characterized by obesity, late menopause or early menarche, polycystic ovary syndrome and the use of oestrogens not associated to progesterone for long periods of time. This type of cancer can be localized or diffuse. Localized endometrial cancer appears as a polyp or ulceration and can deeply affect the myometrium causing a progressive lesion of the muscle groups. The diffuse form instead occupies the majority of the uterine cavity and is caused by the extension of a localized form of cancer. Endometrial cancer has several degrees of differentiation that are very important for the elaboration of a prognosis and for the evaluation of the most suitable type of therapy. The degrees of differentiation are: G1, G2, G3. G1 degree is formed by glands similar to normal ones but more complex; this degree has a better prognosis. G2 degree has a low degree of differentiation and cells are called atypical. G3 degree is the most serious one in which cells are completely undifferentiated.

Symptoms and diagnosis

The symptoms that characterize endometrial cancer usually appear belatedly and include blood or whitish malodorous vaginal discharge and chronic pelvic pain. Blood discharge is the most important sign especially during menopause or in the postmenopausal period. The diagnosis of this type of cancer is most of the time obtained because women experience blood discharge and go to the gynaecologist for an examination. Therefore it is very important that women pay attention to the discharges that occur during menopause or in the postmenopausal period. To diagnose this form of cancer it is necessary to collect cellular material for the cytological and/or histological examination with single-use medical devices that penetrate in the uterine cavity. The best method to check on the endometrium is the use of the hysteroscope and the micro-hysteroscope that allow a complete view of the uterine mucosa and of the superficial cells to identify tumour areas. Transvaginal ultrasound with flowmetry and colour Doppler can also help in defining the risk of endometrial cancer.

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