Close-up on endometriosis at 40th AAGL Global Congress

October 25, 2011

Cypress, CA -- As many as 10 million American women of childbearing age suffer from chronic pelvic pain, gastrointestinal and urinary tract difficulties and infertility due to endometriosis, a puzzling condition where cells that normally form the lining of the uterus - the endometrium - begin to colonize other organs and tissues beyond the uterus. This year's annual meeting of gynecologic laparoscopic surgeons explores endometriosis from both the patient's and the physician's perspective in its Keynote session, 8:00 to 10:00 AM Tuesday, November 8, 2011, and offers the latest surgical insights in dozens of oral presentations, educational videos, surgical tutorials and poster sessions at the 40th AAGL Global Congress of Minimally Invasive Gynecology, November 6-11, 2011 at the Westin Diplomat in Hollywood, FL.

Keynote speaker and women's health advocate Padma Lakshmi puts a human face on the disease. "Endometriosis is one of the most treatable, but least treated of women's health problems," she said. "Like me, many women suffer debilitating pain and other symptoms for as long as a decade before receiving an accurate diagnosis and proper treatment."

Ms. Lakshmi, an internationally known supermodel and TV show host, co-founded the Endometriosis Foundation of America in an effort to encourage research that will help other women avoid her ordeal.

Often, women simply suffer in silence or take painkillers, sometimes for years. When they do seek medical care, proper treatment may be delayed further because endometriosis isn't always diagnosed right away. Pelvic pain can be caused by many disorders -- appendicitis, ovarian cysts, bowel obstruction, diverticulitis, pelvic inflammatory disease, ectopic pregnancy, fibroids, IBS and many others. If endometriosis is present on the intestines, for example, the symptoms may prompt a physician to recommend GI tests, which will not reveal the true problem.

"If a woman wants to have children, it's critical to get an accurate diagnosis and treatment as soon as possible," said Lakshmi. "Endometriosis is one of the top three causes of infertility. Many women are delaying childbearing into their 30s and even 40s these days, but if you have had untreated endometriosis for many years, it may be too late. And that is a real tragedy."

Since medical management options for endometriosis are extremely limited, laparoscopic excision surgery is the most effective treatment available at the present time.

The cause of endometriosis is not known. A strong genetic component is suspected - for example, risk is increased seven-fold in daughters of women with endometriosis. Presentations at the AAGL meeting include research on abnormal expression of Homeobox (HOX) genes (2:45 PM, Tuesday, November 8) in both the uterine lining and in the lesions in women with endometriosis. Better understanding of these genes, which play a major role in infertility and cancer, may shed light on how and why endometriosis occurs.

Endometriosis probably has many causes, just as it has many manifestations, according to Linda G. Griffith, PhD, Director of the Center for Gynepathology Research at the Massachusetts Institute of Technology. Dr. Griffith leads efforts in her lab to replicate human tissue as a research model for endometriosis. In her Keynote address (8:30 AM, Tuesday, November 8) she seeks to stimulate a dialogue between surgeons and basic scientists that will help frame new research questions about the factors involved in endometriosis.

"Endometriosis is non-malignant, but it is far from benign," says Griffith. "It can have devastating health consequences for a woman, such as losing a kidney or a section of bowel or becoming infertile. There is a continuum from benign to malignant, and our understanding of endometriosis at the molecular level may open opportunities to help us understand metastatic cancer, and vice versa."

There are parallels between endometriosis and cancer, for example the endometrial cells' ability to migrate, vascularize and invade other tissues, some quite distant from the uterus. "Through cell and tissue engineering we can begin to understand the behavior of these cells, such as the pathways they follow and why. That will help us develop therapies targeted precisely at the subcellular factors that lead cells astray," she explains.

Griffith and her colleagues at MIT are developing research models that enable investigators to manipulate constellations of the factors involved in endometriosis, for example the cytokines of the immune system, and study their roles in the disease process.

Endometriosis can affect any pelvic organ or extra-pelvic organ. When it travels beyond the reproductive organs it most often affects the bowel or bladder; however, it has also been found in atypical sites (Virtual Poster 414), even the lungs (Virtual Posters 406 and 418).

Deep and invasive endometriosis can be particularly challenging to excise while preserving the health and functionality of adjacent organs. Keynote speaker Grace M. Janik, M.D., Director of Reproductive Endocrinology and Infertility at St. Mary's Hospital in Milwaukee, will conduct live telesurgery of laparoscopic peritoneal resection of extensive endometriosis (9:00 AM, Tuesday, November 8). As the full extent of the disease is revealed during the surgery, Dr. Janik will discuss the actions the surgeon must take along the way, including possible treatment involving the bowel and urinary tract.

Sessions at the AAGL meeting offer training for the best means of eradicating endometriotic lesions using conservative approaches. A CME course, "Endometriosis Bowel Resection vs. Shaving," takes the form of a Video Challenge (12:05 PM, Tuesday, November 8) where surgeons must judge whether to treat endometriosis that has infiltrated the bowel by removing the diseased portion of the bowel itself (resection) or with a more conservative technique that attempts to remove only the endometriotic cells (shaving).

Advances in understanding of the etiology, diagnosis and treatment of endometriosis have necessitated a new classification system, which has been undertaken by the AAGL Special Interest Group on Endometriosis and will be introduced by keynote speaker Mauricio S. Abrão, MD (9:50 AM, Tuesday, November 8). Dr. Abrão will address the need for an improved classification system that includes deep infiltrating endometriosis and pelvic pain, so as to improve patient prognosis.

Dr. Abrão will also lead a specialized course, "Deep Endometriosis: Surgical Approach and Future Perspectives" (8:00 AM, Monday, November 7), which will review contemporary approaches for deep endometriosis from diagnosis to treatment and elucidate the relationship between endometriosis and cancer.

Bringing endometriosis into the spotlight at the 40th AAGL Global Congress will not only raise awareness about this "silent" disease, but also enhance the skill level of laparoscopic surgeons who are uniquely trained to provide minimally invasive treatment.

The Keynote session on endometriosis will be streamed online and can be viewed at http://www.aagl.org. For more information about the 40th AAGL Global Congress of Minimally Invasive Gynecology, visit http://www.aagl.org.
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Elsevier Health Sciences

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