Perimenopausal management of ovarian endometriosis and associated cancer risk: When is medical or surgical treatment indicated?

Paolo Vercellini, Viganò P, Paola Viganò, Laura Buggio, Buggio L, Sofia Makieva, Giovanna Scarfone, Scarfone G, Fulvia Milena Cribiù, Cribiù FM, Fabio Parazzini, Parazzini F, Somigliana E, Edgardo Somigliana
Best practice & research. Clinical obstetrics & gynaecology · 2018 · vol. 51 , pp. 151–168 · doi:10.1016/j.bpobgyn.2018.01.017 · PMID:29551389 · W2794270388
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This review addresses the management of ovarian endometriosis during perimenopause, detailing when medical or surgical interventions are indicated and considering associated cancer risks.

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Abstract

In women with endometriosis, the lifetime risk of ovarian cancer is increased from 1.4% to about 1.9%. The risk of clear cell and endometrioid ovarian cancer is, respectively, tripled and doubled. Atypical endometriosis, observed in 1-3% of endometriomas excised in premenopausal women, is the intermediate precursor lesion linking typical endometriosis and clear cell/endometrioid tumors. Prolonged oral contraceptive use is associated with a major reduction in ovarian cancer risk among women with endometriosis. Surveillance ± progestogen treatment or surgery should be discussed in perimenopausal women with small, typical endometriomas. In most perimenopausal women with a history of endometriosis but without endometriomas, surveillance instead of risk-reducing bilateral salpingo-oophorectomy seems advisable. Risk-reducing salpingo-oophorectomy might benefit patients at particularly increased risk, but the evidence is inconclusive. Risk profiling models and decision aids may assist patients in their choice. Screening of the general perimenopausal population to detect asymptomatic endometriomas is unlikely to reduce disease-specific mortality.

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Condition tags

endometriosis

MeSH descriptors

Adenocarcinoma, Clear Cell Carcinoma, Endometrioid Endometriosis Ovarian Neoplasms Perimenopause Precancerous Conditions Adenocarcinoma, Clear Cell Adenocarcinoma, Clear Cell Adenocarcinoma, Clear Cell Adenocarcinoma, Clear Cell Carcinoma, Endometrioid Carcinoma, Endometrioid Carcinoma, Endometrioid Carcinoma, Endometrioid Case-Control Studies Endometriosis Endometriosis Endometriosis Female Humans

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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Cited by (50)

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