Endometriosis & Woman for Life

Endometriosis is defined as the presence of endometrial glands and stroma outside of the endometrial cavity. It is a chronic gynaecological disorder that is the leading cause of pelvic pain and infertility. In the vast majority of people, it is a single / once-off Scan.

Symptoms usually arise from cyclical bleeding into the surrounding tissue causing inflammation and scarring. It may present with a variety of symptoms which can mimic irritable bowel syndrome and in some cases Crohn’s disease.

Endometriosis lesions can be found anywhere in the pelvic cavity:

  • on the ovaries
  • the fallopian tubes
  • on the pelvic side-wall
  • the uterosacral ligaments,
  • the cul-de-sac,
  • the Pouch of Douglas
  • the rectal-vaginal septum

In addition, it can be found in:

  • caesarian-section scars
  • laparoscopy/laparotomy scars
  • on the bladder
  • on the bowel
  • on the intestines, colon, appendix, and rectum

Bowel (intestinal) endometriosis affects 4-37% of woman with endometriosis. It may present with bowel obstruction, rectal bleeding and abdominal distention / bloating. These symptoms may be exacerbated during menstruation.

It is now well established that deep infiltrating endometriosis of the bowel is best treated surgically. The surgical candidacy and surgical approach will depend on the ability to accurately diagnose the stage and quantify the extent of the disease process. This is challenging. In 2005 the standard Virtual Colonoscopy (VC) Scan was modified by Van der Wat and Kaplan (1) working out of the The Parklane Clinic Johannesburg and Scan For Life® South Africa, to specifically diagnose endometriosis of the bowel, reproductive organs, abdominal organs and urinary tract. Further studies have subsequently appeared in the literature and indications are that this scan can enhance our ability to diagnose advanced endometriosis. This Endometriosis scan is known as the Modified Virtual Colonoscopy for Endometriosis. It is an advanced CT scan.

Van der Wat and Kaplan won the international Carlo Romanini Award First Prize at the Global congress of Minimally Invasive Gynecology, AAGL in the USA for developing this scan technique.

(24) Van der Wat j, Kaplan M. Modified virtual colonoscopy: a noninvasive technique for the diagnosis of rectovaginal

septum and deep infiltrating pelvic endometriosis. J Mimim Invasive Gynecol 2007; 14: 638-43

The Endometriosis Scan (Modified Virtual Colonoscopy for Endometriosis Scan)

This is a non-invasive, highly accurate, safe and rapid scan for the diagnosis and extent / staging of deep infiltrating endometriosis.

The Scan also detects other colon abnormalities such as polyps, early bowel cancers and diverticulosis (and diverticulitis), colon redundancy and an abnormal position or distribution of the colon.

Additionally, the Scan assesses all the other abdominal and pelvic organs simultaneously, excluding significant pathology such as tumours, aneurysms, cysts, kidney stones etc.

The scan is non-invasive, safe and rapid. The scans are breath-hold scans, and the

entire process takes less than 40 minutes.

Preparation for the Scan:

The day before the scan you begin a liquid diet with a safe and gentle laxative prep to cleanse the colon and rectum of stool. Small volumes of completely safe tagging (labelling) liquids are also taken. The complete prep kit with instructions is provided by Scan For Life prior to the Scan. It is a milder low-volume prep, different to the usual highvolume preps of other colonic examinations.

Requirements for the Scan:

Just before the scan, a special tampon is provided, which you insert privately.

During the Scan, harmless CO2 gas is introduced into the colon via a very thin tube inserted painlessly just into the anus, which allows gentle distension of the colon. Uncomfortable room air is not pumped into the colon. The CO2 is absorbed and breathed out as soon as the Scan is over, so there is no residual bloating or discomfort.

The Pelvis MRI Scan is the other scan performed by Scan For Life® to assess the pelvic contents, and screen for tumours or cysts of the ovaries and tumours of the uterus. The Scan is non-invasive, rapid, safe and painless. The entire process takes less than half an hour.

Preparation for the Scan:

A full bladder is preferred. This is obtained by drinking four glasses of liquid an hour before the Scan.

Requirements for the Scan:

For the MRI Scans, you may require safe oral or short acting IV sedation if you are very claustrophobic. There is no X-ray “dye” (contrast) administration.

Endometriosis:

Endometriosis affects more than 70 million woman world wide.
Between 2 and 10 % of women of reproductive age are afflicted.
Endometriosis renders between 30 and 40 % of them infertile.
It is the leading cause of pelvic pain and infertility.
Bowel (intestinal) endometriosis affects 4-37% of woman with endometriosis.

Source: endometriosis.org

Female Cancers:

Cancer is the number two killer of women, after cardiovascular disease.
The probability of dying of cancer at birth is 23%.
The lifetime probability of a woman developing cancer is 33%.

Ovarian Cancer:

Ovarian cancer is the seventh most common cancer among women, but ranks fourth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system.

Ovarian cancer accounts for about 3% of all cancers in women. A woman’s risk of getting ovarian cancer during her lifetime is 1.7% or about 1 in 58. Her lifetime chance of dying from ovarian cancer is 1.0% or 1 in 98.

About 77% of women with ovarian cancer survive 1 year after diagnosis, and 44% survive longer than 5 years after diagnosis.

Women younger than age 65 have better 5-year survival rates than older women.

If diagnosed and treated while the cancer has not spread outside the ovary, the 5-year survival rate is 90-95%. However, only 19% of all ovarian cancers are found at this early stage.

Colon Cancer:

Colorectal Cancer is the third most common cancer diagnosed in Western men and women.

Colorectal Cancer is the second leading cause of cancer deaths in men, accounting for 10% of total mortality and the third leading cause of cancer deaths in women, accounting for 10% of total mortality.

The 5-year relative survival rate is 90% for people whose colorectal cancer is diagnosed in an early stage, before it has spread. But only 39% of colorectal cancers are found at that early stage. Once the cancer has spread to nearby organs or lymph nodes, the 5-year relative survival rate drops to 66%. The 5-year survival rate for people with spread to distant organs and lymph nodes is 5 to 10%.

 

Source: The American Cancer Society

Who should consider the Endometriosis for Life Scan?

This is scan is appropriate when deep infiltrating endometriosis and potential surgical management is being considered.

This scan is appropriate in a diagnostic (referral) situation.

Scan For Life® also performs the Pelvic MRI scan, which exposes you to zero X-rays or other radiation, and uses a harmless magnetic field. This Scan visualises the organs and vascular structures, excluding growths (tumours, cysts), arterial aneurysms, hernias etc., with particular reference to the ovaries and uterus.

This scan is appropriate in the diagnostic (referral) situation.

Scan For Life® will further arrange for your annual screening mammogram, breast ultrasound, and DEXA bone mineral density scan, as complementary service.

Scan For Life® recommends the appropriate Targeted Scans on various vital organs such as the heart,

bowel (colon / rectum), lung, brain etc. depending on your particular medical risk factors. Scan For

Life® screens responsibly and appropriately, complying with international best medical practice. Please refer to the Heart For Life, Colon For Life, Lung For Life and Brain For Life Scans. Scan For Life® does not recommend The Whole (Total) Body CT Scan, which is a simple and non-specific body scan performed at other centres. These scans expose you to a relatively high X-ray (radiation) dose without a significant, proven medical benefit.