CAW ENDOMETRIOSIS SPREAD DURING SURGERY?

In her letter to me, a twenty-eight-year-old Grand Rapids high school teacher wrote of her fears about undergoing surgery. It seems that Marilyn’s reservations about having surgery—even though it was tor diagnostic purposes only —win based on a misinformed connection to cancer. She wrote:

“My doctor feels I have endometriosis, but he wants to do surgery to confirm it. I’m worried that if I have surgery, the disease will only get worse. I have heard that endometriosis acts just like cancer. If you cut into it, the disease can spread because (1) some cells can get free from the tumor and infect other organs and (2) the cells arc stimulated Co grow from the oxygen in the air. Is there a way to confirm my endometriosis without the risk of making it worse?”

Marilyn’s questions touch on two important issues involved in understanding and treating endometriosis. The first is the reason tor surgical diagnosis, and the second involves the confusion between the pathology of cancer as one type of disease and endometriosis as another.

A woman’s medical history in combination with her doctor’s clinical findings might clearly indicate endometriosis, thereby making surgical diagnosis unnecessary. But this cannot always be the case. If a doctor is unsure of the diagnosis (especially when endometriosis is at an early stage of growth and docs not yet produce large masses), or if he is unable to determine the nature of the tumor he feels while giving his patient an internal examination, he will want to do a laparoscope Although this is minor surgery (it will be discussed and illustrated in the next chapter), it is for Marilyn and women like her, still an operation wherein something might go amiss.

There has been some documentation of endometriosis spreading as a result of laparoscope but this is rare and is most likely to occur when there is a history of repeated laparoscopics. In these cases, the endometriosis grows internally around the area of incision and implants itself in the scar, and a second or third incision in the same scar could free some cells. In a few cases, women who underwent surgery for hernias were later found to have endometriosis in the scar tissue.

If Marilyn’s doctor feels that laparoscopy is called for, and there is no emergency, he might prescribe the medication Danocrine renders endometriotic cells inactive. Taking Danocrine for a two-month period preceding laparoscopy should be sufficient to halt the growth of Marilyn’s endometriosis, as well as lay to rest her Sears about contamination during the procedure.

Cancer and endometriosis do not have much in common, other than their methods of invasion in the body. Cells of either type may use similar channels to reach internal organs such as the lymph system or the blood, or, after implanting themselves, cells may metastasize, or grow into a cyst or tumor. Endometrial cancer and endometriosis are not the same disease, although it has been found that childless women tend to be vulnerable Co both conditions and that a great percentage of women with endometrial cancer suffer from menstrual irregularities.