Endometriosis often is a consequence of a cesarean section, but in rare cases it can transform into a cancer in the abdomen wall. Because of that possibility, and because C-section deliveries are on the rise, researchers argue this cancer type might become more common and urge fellow physicians to remain vigilant as they treat endometriosis.
A case report of a woman who developed such a cancer in the wall of her belly illustrates the issue.
The case study, “Clear cell carcinoma arising from abdominal wall endometriosis – Brief report and review of the literature,” was published in the journal Gynecologic Oncology Reports.
Researchers at the University of Coimbra Hospital Center in Portugal described a 47-year-old woman who developed pain in a scar from an earlier C-section delivery. Doctors noted that a tumor-like mass had formed under the scar. The woman had gone through three C-sections, but had been healthy otherwise.
Examinations revealed a tumor, about 11 cm in size, that seemed to be attached to the abdominal wall. Physicians removed the tumor by surgery. During the procedure they noted the woman also had a bleeding ovarian cyst.
An analysis of the tumor showed it was a clear cell carcinoma. Since this cancer originates in endometrial tissue, researchers suggested that the tumor had formed as a consequence of endometriosis of the abdominal wall.
Positron emission tomography (PET) imaging of her belly six weeks after the surgery showed she had an area with high metabolic activity on the same side where the tumor was removed. Such increased metabolic activity could be suggestive of tumor development. But magnetic resonance imaging (MRI), however, did not identify more cancer lesions.
The woman was, nevertheless, treated with six cycles of chemotherapy.
Nine months later, however, a new tumor had formed at the same spot. This time, a more extensive surgery was performed. Physicians removed her entire uterus and a large part of the abdominal wall. She again received chemotherapy.
After the surgery, she was treated with antibiotics for the appearance of abscesses, and 36 months after the second surgery, she had no more evidence of tumor growth.
Endometriosis of the abdominal wall typically occurs in women who have C-sections sections or other surgical procedures, when endometrial cells accidentally contaminate subcutaneous tissue.
Cancer in the abdominal wall resulting from endometriosis, however, is rare, with only 27 cases described in scientific literature until 2014. But when it occurs, the cancer is highly aggressive.
Researchers argued that since the use of C-sections is on the rise, it is very likely this cancer type will become more common. But since little is known about the processes causing an endometriosis lesion to turn into a tumor, the team suggested that identification and monitoring of at-risk patients, along with proper treatment of endometriosis, are needed to prevent the development of the cancer, or detect it at early stages.