Endometriosis as a Risk Factor for Colorectal Cancer
Abstract
Endometriosis is a common benign disease in women of reproductive age, it has been associated with an increased risk of various malignancies that is defined by certain histological criteria mainly 80% in ovary and 20% in extragonadal sites such as intestine, rectovaginal septum, abdominal wall , pleura and others; the greatest risk for colorectal cancer is women with adenomyosis or endometriosis; Several genetic alterations have been found in the risk of endometriosis associated with cancer; The symptomatology, imaging and endoscopic characteristics simulate other inflammatory and malignant lesions that make the preoperative diagnosis of extragonadal endometriosis difficult. This is a review of the knowledge about endometriosis and its potential risk of malignancy, particularly with colorectal cancer.
Endometriosis is a proliferative disease that is defined as the presence of endometrial glands and stroma outside the uterine cavity; or in extrauterine sites, it is a common chronic gynecological disease; the incidence in women of reproductive age is 5 to 17%; its cause is unknown; But, the accepted hypothesis is the implantation of endometrial tissue in the peritoneal cavity due to retrograde menstruation, or when endometrial tissues and cells adhere to the surfaces of the peritoneum, annexes and other pelvic organs [1-4]. The main symptoms are dysmenorrhea, pelvic pain and infertility. Although endometriosis is considered a benign condition, it shares some characteristics of cancer proliferation, such as invasion, tissue damage, neoangiogenesis and spread to distant organs [3].
The development of cancer is a rare complication of endometriosis, and mainly in some gynecological cancers 5 and others extragonadal [3], the first case of malignant transformation was described in 1925 1 of endometriosis in the intestinal tract, 17 cases have been reported of neoplastic changes 6; the most common location being the colon and rectum-sigmoid (50 to 90%) 1 small intestine (7%), blind (3.6%) and appendix (3%); other locations are in the pleura, pericardium, navel, rectovaginal septum (13%) 7, bladder, lungs, central nervous system and even skin 1, as in scars from surgeries or previous episiotomies, [5-8], (Figure 1). Despite epidemiological evidence, the association between endometriosis and cancer has not been elucidated so far.
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