MORRA, ILARIA
(2017)
NEW STRATEGIES IN THE APPROACH TO ENDOMETRIAL CANCERS IN YOUNG WOMEN WITH DESIRE OF OFFSPRING.
[Tesi di dottorato]
| Tipologia del documento: |
Tesi di dottorato
|
| Lingua: |
English |
| Titolo: |
NEW STRATEGIES IN THE APPROACH TO ENDOMETRIAL CANCERS IN YOUNG WOMEN WITH DESIRE OF OFFSPRING |
| Autori: |
| Autore | Email |
|---|
| MORRA, ILARIA | ilmi26@hotmail.it |
|
| Data: |
11 Dicembre 2017 |
| Numero di pagine: |
68 |
| Istituzione: |
Università degli Studi di Napoli Federico II |
| Dipartimento: |
dep16 |
| Dottorato: |
phd058 |
| Ciclo di dottorato: |
30 |
| Coordinatore del Corso di dottorato: |
| nome | email |
|---|
| Annunziato, Lucio | lannunziato@unina.it |
|
| Tutor: |
| nome | email |
|---|
| Bifulco, Giuseppe | [non definito] |
|
| Data: |
11 Dicembre 2017 |
| Numero di pagine: |
68 |
| Parole chiave: |
Endometrial cancer, Pcos, LOD, THL |
| Settori scientifico-disciplinari del MIUR: |
Area 06 - Scienze mediche > MED/40 - Ginecologia e ostetricia |
[error in script]
[error in script]
| Depositato il: |
08 Gen 2018 11:24 |
| Ultima modifica: |
20 Mar 2019 11:41 |
| URI: |
http://www.fedoa.unina.it/id/eprint/12183 |
Abstract
Endometrial Adenocarcinoma (EA) is the most common gynecological tumor in developed countries. In young women, the majority of cases correspond to the type-I EA, since these are of endometrioid type, focal, well differentiated and limited to endometrium or superficial myometrium (stage FIGO IA). An excellent oncologic outcomes associated with early stage EA in young women, the fertility-sparing is an important issue to consider when deciding the most proper management to be taken in women diagnosed with EA and AEH who desire pregnancies
We have conducted a retrospective study that assess safety and effectiveness of combined hysteroscopic and medical treatments of AELs in young women who desired to preserve their own fertility
Nulliparity and infertility are also classical risk factors for endometrial cancer. Among the causes of infertility, polycystic ovarian syndrome (PCOS) seems to be the most important, with an almost threefold increase in risk (OR 2.79–2.89). Endometrial hyperplasia is mostly the result of persistent and prolonged estrogenic stimulation of endometrium (absolute or relative hyperestogenesis). Endogenous absolute hyperestrogenic conditions are determined by obesity, the presence of polycystic ovary syndrome (PCOS) and the presence of granular or adrenal cell tumors.
A growing scientific interest is emerging in endocrinology and gynecologic oncology in assessing the risk of endometrial carcinoma in women with PCOS.
Currently, the high-grade drug for induction of ovulation in patients with PCOS anovulatory infertility remains clomiphene citrate (CC) and has been around for nearly 50 years. The CC has good management, is inexpensive and has minimal side effects.
In addition, although limited, there are some studies that show how CC can, in the long term, double the risk of developing a endometrial cancer. Indeed, studies claim that the CC has a structure similar to tamoxifen (SERM) and the latter is recognized as a potentially predisposing factor to endometrial hyperplasia and therefore a precursor to endometrial cancer
Laparoscopic Ovarian Drilling (LOD) has been shown to be a viable therapeutic alternative for patients with PCOS-resistant patients, for patients who are hyper-responsive to gonadotrophin therapy and for patients who need diagnostic laparoscopy for infertility
However, two major disadvantages do not allow laparoscopic ovarian drilling to be considered the first line of PCOS treatment: the risk inherent in surgery as such and the risk associated with the formation of post-operative adherence that may further interfere with fertility .
We conducted a review of the literature and described a new mini-invasive surgical approach to ovarian drilling in patients with PCOS anovulatory infertility, using the Transvaginal Hydrolaparoscopy technique to reduce the rate of ovarian adherence. From the results we have shown that patients undergoing ovarian drilling by THL showed a reduction in adhesion formation compared to patients treated with classical technique.
Lastly, we evaluated the positive effects of THLOD on the ovulation and ultrasound follicles monitoring, in PCOS CC-resistant patients undergone THL ovarian drilling (THLOD).
Our study shows that THLOD improve ovulation and pregnancy rate in women with CC-resistant PCOS; based on our data and previous studies, we believe that THLOD should mean an option in the management of anovulatory CC-PCOS patients and should be offered as second-line therapy at all women who fail the medical methods of ovulation induction. Prospective, comparative studies including more patients should be undertaken to confirm our results.
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