A tiny lung nodule can be difficult to find during surgery. Now, Mayo Clinic surgeons are using fluorescent imaging technology to help locate suspicious nodules with greater precision while preserving healthy lung tissue.

The imaging contrast substance is administered before surgery and travels through the body, binding to certain lung cancer cells. During the procedure, surgeons use a specialized camera to detect the fluorescent signal, causing the cancerous tissue to glow. This allows the surgical team to easily identify and remove targeted tissue.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:06) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

"Using this fluorescent agent is really helpful because it hones to the cancer cells and binds to one of the receptors on cancer cells," says Dr. Jonathan D'Cunha, a Mayo Clinic cardiothoracic surgeon. "When you're in the operating room, you can use your advanced fluorescent imaging to see the tumor light up."

The technology can help surgeons identify tiny nodules that may be difficult to see or feel during minimally invasive procedures. It also helps distinguish cancerous tissue from healthy lung tissue, allowing for greater precision during surgery.

"We're always looking for tools to be more precise in what we do," says Dr. D'Cunha. "The earlier we can identify and resect, the better chances and better outcomes for patients."

Learn more: Mayo Clinic Lung Cancer Program

The post Mayo Clinic Minute: Lighting up lung nodules during surgery appeared first on Mayo Clinic News Network.

PHOENIX — Researchers at Mayo Clinic, in collaboration with the Terasaki Institute for Biomedical Innovation, have developed a real-time monitoring system designed to give transplant teams a more complete picture of a donor liver's health during machine perfusion. Published in Nature Communications, the study represents an important step toward more accurate evaluation of donor livers, laying the groundwork for future advances in organ preservation and transplantation.

During machine perfusion, a donor liver is connected to a device that pumps oxygen-rich fluid through the organ while outside the body.

"Machine perfusion is opening the door to a future where we don't just evaluate organs, we treat them and even improve them before transplant," says Michelle Nguyen, M.D., a transplant surgeon at Mayo Clinic in Arizona and co-corresponding author of the study. "But to get there, we first need better ways to understand how an organ is performing in real time. That's what this technology is built to provide."

Today's monitoring methods rely on manually collecting fluid samples from the organ every 30 to 60 minutes, testing them on point-of-care devices or sending them to a laboratory for analysis. Those periodic snapshots may miss important changes occurring between samples. Detecting biochemical changes or signs that organ health is declining early allows clinicians and perfusionists to intervene before permanent damage occurs.

To address this challenge, researchers developed a new wireless sensor platform that continuously measures glucose, lactate and pH in both the perfusion fluid and bile; streaming results to the care team in real time.

In the study, the sensor's measurements closely matched standard laboratory testing while also detecting brief biochemical changes between routine sampling intervals. The findings suggest that real-time monitoring of bile, in addition to perfusion fluid, may provide valuable information about the health of the donated liver that current approaches may be unable to detect.

"Every organ donated is incredibly valuable," Dr. Nguyen says. "By giving transplant teams a clearer understanding of an organ's health, we're working toward a future where more donated livers can safely reach the patients who need them most."

Researchers note that larger studies will be needed to further evaluate the technology and its potential to improve donor organ assessment. Looking ahead, the team is working to expand the sensor platform to capture additional markers of organ health, creating a more comprehensive assessment panel. Researchers also plan to adapt the technology for other organs, including the kidney, heart and lung.

The study was co-led by Dr. Nguyen and Yangzhi Zhu, Ph.D., of the Terasaki Institute for Biomedical Innovation.

For a complete list of authors and disclosures, review the study.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

About Mayo Clinic Transplant Center
Mayo Clinic Transplant Center is one of the largest and most comprehensive transplant programs in the world. With programs in Arizona, Florida and Minnesota, Mayo Clinic provides seamless, coordinated care across adult heart, lung, liver, kidney and pancreas transplantation. Guided by a commitment to innovation, research and education, Mayo Clinic Transplant Center delivers world-leading outcomes, compassionate patient care and advances that shape the future of transplantation worldwide.

Media contact:

• Kelley Luckstein, Mayo Clinic Communications, newsbureau@mayo.edu

The post New technology could improve donor liver evaluation before transplantation appeared first on Mayo Clinic News Network.

New educational programs are helping clinicians and trainees turn everyday healthcare challenges into solutions 

Innovation is often viewed as the domain of entrepreneurs, engineers and technology companies. Mayo Clinic is challenging that notion by teaching innovation as a practical skill that healthcare professionals can learn, apply and use to improve patient care.  

Through its growing Biodesign educational initiatives, Mayo Clinic College of Medicine and Science is training clinicians, trainees and students to identify unmet needs in healthcare and develop solutions using a structured, evidence-based methodology.  

"When people hear the word innovation, it's kind of confusing. It's a fun word to use, but it's nebulous," says Aman Verma, D.O., a hospitalist and innovation educator at Mayo Clinic. "My passion is showing clinicians that innovation can be taught."  

As an established framework, Biodesign follows three phases — identify, invent and implement — guiding participants from recognizing challenges in healthcare delivery to developing and implementing solutions.  

"Biodesign is a framework. It's a validated, repeatable process. Biodesign is transforming innovation from an abstract concept into a teachable skill, one that Mayo clinicians, trainees and staff can learn and apply in their daily work," Dr. Verma says.  

Mayo Clinic's approach focuses on embedding innovation training directly into healthcare education. Leaders believe clinicians are uniquely positioned to recognize opportunities for improvement because they experience healthcare challenges firsthand.  

Recent educational offerings have included multidisciplinary workshops bringing together physicians, trainees, nurses and other health professionals to solve real-world healthcare problems.  

Participants report that the training helps make innovation more accessible and actionable.  

"Prior to the course, Biodesign innovation felt somewhat abstract and intimidating, but this workshop made it accessible and energizing," says Viet Do, D.O., a Mayo Clinic hospitalist and recent participant in Mayo's Biodesign workshop. “I now feel empowered to evaluate my clinical environment through a lens of innovation and improvement, and more confident in pursuing new ideas. It has also ignited my interest in innovation and entrepreneurship."  

Dr. Do plans to incorporate innovation education as a core part of a proposed hospital medicine fellowship program.  

Mayo Clinic is also expanding innovation education through graduate medical education programs, undergraduate medical education opportunities and a master's degree program developed in collaboration with Arizona State University focused on innovations in medical and patient care technologies, or IMPACT.  

That program, with a foundation in biomedical engineering, combines academic training with extensive clinical immersion, allowing students to observe patient care environments, identify unmet needs and develop healthcare solutions.  

"Clinicians aren't just the best people to drive innovation in medicine — they're the ones who see the problems every single day," says Pankaj Pasricha, M.B.B.S., M.D. Dr. Pasricha is a pioneer in Biodesign education, chair of the Department of Internal Medicine at Mayo Clinic in Arizona, and co-developer of the IMPACT program. "We don't have to imagine where healthcare falls short. We see it, we feel it, and now we can fix it." 

By teaching innovation as a repeatable skill rather than an innate talent, Mayo Clinic aims to create a new generation of healthcare professionals equipped to improve patient care, advance medical practice and accelerate the development of healthcare solutions. 

Another Biodesign workshop is scheduled for Mayo clinicians and learners in Phoenix on Nov. 5–6. While current efforts are centered in Arizona, Mayo Clinic leaders envision broader expansion of the Biodesign framework across the organization.  

"Education powers the engine of innovation," says Devyani Lal, M.D., dean of Education at Mayo Clinic in Arizona. "With support from our executive leaders, we are building an ecosystem of programs and platforms that give clinicians, trainees, and teams the skills, structure, and support to transform unmet patient needs into meaningful solutions."  

The post Mayo Clinic uses Biodesign to teach innovation as a clinical skill   appeared first on Mayo Clinic News Network.

World Brain Day is July 22

SCOTTSDALE, Ariz. — The same lifestyle choices that reduce your risk of heart disease, diabetes and cancer also can reduce your risk of cognitive decline. Bryan Woodruff, M.D., a cognitive neurologist at Mayo Clinic in Arizona, explains the brain-body connection, lifestyle changes to foster brain health and why work to make earlier detection of Alzheimer's disease and other dementias is important.

“What’s good for your overall health is good for your brain too,” Dr. Woodruff says.

You may have heard that Alzheimer’s disease is caused, in part, by the buildup of beta-amyloid plaques and twisted tau proteins in the brain. While true, other brain changes also are likely involved, Dr. Woodruff says.

“When scientists look at the brains of people with Alzheimer’s disease after they’ve died, they find more than just plaques and tangles,” he adds.

They often find a buildup of fats, cholesterol and other substances in the vessels that supply blood to the brain. They also discover evidence of microscopic strokes — also called microinfarctions.

Unlike major strokes with noticeable symptoms such as facial drooping, physical numbness, a severe headache and trouble speaking, microscopic strokes are silent. As more occur, they can starve brain tissue of oxygen and nutrition. If enough microvascular changes occur, there may be symptoms like slowed thinking and trouble concentrating.

“Your brain, as with every other organ in your body, depends on your cardiovascular system,” Dr. Woodruff says: This is why it’s so important to care for your heart and blood vessels.

Lifestyle choices help reduce risk

Thanks to this connection, what benefits your heart also protects your brain. To get these benefits:

• Manage heart disease risk factors. Treat elevated blood sugar, high blood pressure and undesirable cholesterol levels. Don’t use tobacco products. Keep your weight in the healthy range. “The earlier you address these, the better the benefit is for your brain,” Dr. Woodruff says.

• Follow a heart-healthy diet. The Mediterranean diet's emphasis on minimally processed whole foods and fruits and vegetables may improve brain health by helping to keep body fat and chronic inflammation in check. The Mayo Clinic Diet takes a similar approach to establishing a healthy-eating lifestyle.

• Get enough sleep. Research has linked insomnia to cognitive decline. And poor sleep can also increase your risk of other diseases that can impact cognition, such as high blood pressure and diabetes.

• Maintain social connections. Social connections are thought to benefit the brain in many ways. Research suggests that social engagement triggers the release of chemicals such as serotonin and dopamine, which improve mood and outlook. Social connections may help to spur the growth of new connections between nerve cells.

• Treat hearing and vision loss. If you can’t see and hear what’s going on around you, you’ll find it more difficult to communicate and remain social. “Those sensory functions are integral to how we think and interact with the world,” Dr. Woodruff says. “If you don’t see or hear it, then you can’t encode and remember it.”

• Avoid chronic use of sedating medications. Some medicines used to treat pain, insomnia and other conditions can dull thinking, slow reaction time and make you feel sleepy. If you’re not sure of the side effects of the medications you take regularly, talk with your healthcare professional, who can look at what is on your medication list and suggest alternatives, Dr. Woodruff advises.

• Exercise. Physical and mental exercise can benefit brain health. A large study found rates of cognitive decline were twice as common in sedentary people.

Keeping your mind active through activities you find enjoyable, particularly trying new things, can also exercise your brain. When you have difficulty learning something new, your brain builds new connections between nerve cells. If you continually learn new skills and information over time, experts believe that these networks of nerve cell connections create a cognitive reserve, sort of like savings in a bank account.

“Cognitive reserve doesn’t mean you’re immune,” Dr. Woodruff says. “But it buys you some cushion against a neurodegenerative problem.”

The importance of early detection

Dr. Woodruff is among Mayo Clinic researchers working to make earlier diagnosis of dementia and its precursor mild cognitive impairment possible, to allow for earlier treatment. This will be essential if therapeutic advances eventually make it possible to slow or even halt progression, he says.

It is never too late to make lifestyle changes to protect and improve brain health, he adds: “I tell all my patients, regardless of the severity of their cognitive decline, to take care of their overall health."

For more information about brain health, visit Mayo Clinic Press and the Mayo Clinic News Network.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post Brain-body connection: Expert shares tips to reduce risk of cognitive decline, Alzheimer’s disease appeared first on Mayo Clinic News Network.

PHOENIX — Researchers have validated a genetic scoring tool that may help physicians diagnose idiopathic pulmonary fibrosis and identify which patients are at greatest risk for severe outcomes, including death or the need for a lung transplant. The findings come from a new international study of more than 570,000 people co-led by Mayo Clinic and Brigham and Women's Hospital.

Published in the American Journal of Respiratory and Critical Care Medicine, the study is one of the largest real-world evaluations of a polygenic risk score for idiopathic pulmonary fibrosis. The findings bring this genomic approach one step closer to clinical care.

"Polygenic risk scores add a new layer of biological insight into the prediction of pulmonary fibrosis and mortality outcomes, bringing us closer to a future where diagnosis, prognosis and treatment are informed by each patient's unique molecular signatures."

- Dr. Victor Ortega

Researchers analyzed genomic and electronic health record data from four major biobanks in the U.S. and U.K., including the Mayo Clinic Biobank and Mayo Clinic Tapestry. They calculated a polygenic risk score for each participant by combining the effects of more than 60,000 DNA variants associated with idiopathic pulmonary fibrosis. While each genetic variant contributes only a small amount of risk, together they reveal patterns of inherited susceptibility that would otherwise be difficult to detect.

The researchers then tested whether the score could identify patients with the disease and predict clinical outcomes.

People with high polygenic risk scores were nearly three times more likely to have the disease than those with lower scores. The genetic score became even more predictive as researchers applied increasingly specific definitions of the disease, suggesting the score may one day help distinguish idiopathic pulmonary fibrosis from other forms of interstitial lung disease.

Among patients with the disease, those with high genetic risk were 23% more likely to die or require a lung transplant, indicating the score may also help identify patients at greatest risk of poor outcomes.

"Every patient has a unique genetic blueprint that we can use to estimate risk for the development of disease," says Victor Ortega, M.D., Ph.D., a pulmonologist, associate director of Mayo Clinic's Center for Individualized Medicine in Arizona, and a co-senior author of the study. "Polygenic risk scores add a new layer of biological insight into the prediction of pulmonary fibrosis and mortality outcomes, bringing us closer to a future where diagnosis, prognosis and treatment are informed by each patient's unique molecular signatures."

"Showing that this approach works across more than half a million people receiving routine clinical care is an important step toward understanding how it can ultimately benefit patients."

- Dr. Christopher Grilli

Idiopathic pulmonary fibrosis causes irreversible scarring of the lungs that progressively limits a person's ability to breathe. More than 100,000 Americans are living with the disease, and an estimated 30,000 to 40,000 new cases are diagnosed each year, according to the National Institutes of Health.

Because its symptoms often resemble those of other interstitial lung diseases, diagnosis can be delayed until significant, irreversible lung damage has already occurred. Confirming the diagnosis sometimes requires an invasive lung biopsy to collect lung tissue. Researchers hope a noninvasive genetic test using DNA from a blood or saliva sample may help reduce the need for those procedures in selected patients.

"Most polygenic risk scores are developed in carefully selected research populations," says Christopher Grilli, Pharm.D., a researcher at Mayo Clinic's Center for Individualized Medicine and co-first author of the study. "Showing that this approach also works across more than half a million people receiving routine clinical care is an important step toward understanding how it can ultimately benefit patients."

If further validated, researchers envision genomic risk scores complementing imaging and other diagnostic tools to help physicians diagnose the disease with greater confidence.

This research aligns with Mayo Clinic's Precure Research initiative, which seeks to uncover the earliest biological changes associated with disease and translate those discoveries into clinical tools that improve diagnosis, personalize care and ultimately change the course of disease. As part of that effort, the Precure-Lung study, led by Dr. Ortega, is expanding Mayo Clinic's research into interstitial lung diseases, including idiopathic pulmonary fibrosis.

For a complete list of authors, disclosures and funding, review the study. 

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:  

• Kelley Luckstein, Mayo Clinic Communications, newsbureau@mayo.edu

The post Researchers chart a genetic path to diagnosing pulmonary fibrosis and predicting outcomes appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: A friend has had several small skin cancers removed, and that made me wonder if I'm at risk, too. What everyday habits can help reduce my risk of skin cancer?

ANSWER: Whether skies are clear or overcast, your skin is exposed to ultraviolet (UV) radiation from the sun. UVB rays are the primary cause of sunburn, while UVA rays penetrate more deeply, contributing to premature aging, such as fine wrinkles and sunspots. Both forms of UV radiation increase the risk of skin cancer.

A tan is not a sign of health; it's evidence of skin injury. There's no safe way to tan in the sun or with indoor tanning. Fortunately, daily habits can protect your skin and reduce your risk of skin cancer.

Use sunscreen consistently. Choose a broad-spectrum sunscreen that protects against both UVB and UVA rays with an SPF of at least 30. Be aware of the expiration date and replace your sunscreen regularly. Keep it out of the heat and direct sunlight, which can degrade its effectiveness.

Spray sunscreens are typically easier to apply to hairy skin. Makeup also can contain sun-protective ingredients, but it should meet the same minimum standard of a broad-spectrum sunscreen and an SPF of at least 30. Sunscreens may contain organic or inorganic ingredients, or a combination of both.

Inorganic (mineral) sunscreens contain minerals such as titanium dioxide and zinc oxide and provide excellent, broad-spectrum protection. These ingredients tend to be thicker and may leave a whitish residue on your skin.   

Organic (chemical) sunscreen filters are more common and tend to be lighter, easier to spread and less visible on the skin, but they may not have as much UVA protection as mineral options.

The Food and Drug Administration recently announced its proposal to add a new organic sunscreen ingredient, bemotrizinol (BEMT), to its approved list for use in the U.S. BEMT provides protection against both UVA and UVB, and it has low levels of absorption through the skin into the body. This is exciting news because the U.S. doesn't have as many approved filters compared to other countries.

Apply sunscreen whenever you're outdoors — even on cloudy days, when up to 80% of harmful rays penetrate the clouds. When applying sunscreen:

• Don't forget places like the tops of your ears and feet, the back of your neck, and areas where a beard might not be as thick. 
• Reapply sunscreen every two hours.
• Remember to reapply more often with water exposure or sweating because this reduces how long the sunscreen remains effective. Water-resistant sunscreen provides protection for about 40 to 80 minutes. 
• Apply more sunscreen than you think. Most people apply only a quarter to half of the amount needed to reach the advertised SPF on the product label. A simple strategy is to apply a full layer, then repeat to create a "double coat" to ensure adequate coverage. 

Wear photoprotective clothing. Long-sleeved shirts, pants, wide-brimmed hats and sunglasses provide consistent protection without the need for reapplying sunscreen. Not all clothing blocks the same amount of UV rays. Test it by holding it up to the light. If you can see the light through the clothing, you'll know that UV rays can pass through, too.

Many brands now offer lightweight, breathable clothing with built-in ultraviolet protection rated with an ultraviolet protection factor (UPF). For water activities, rash guards offer convenient, reliable sun protection. Tops are available in short- and long-sleeved styles, with or without hoods. 

Avoid intentional tanning. Indoor tanning significantly increases the risk of cancer. Tanning beds emit intense UV radiation and can increase melanoma risk by 20% with just one session. Using indoor tanning before age 35 can increase melanoma risk by 75%. Dermatologists see patients in their 30s with multiple skin cancers and advanced sun damage after extensive tanning bed use in their teens and 20s.

If you want a bronzed glow without the risk of UV rays, sunless tanning products are a safe alternative. Spray tans and lotions containing dihydroxyacetone can create the appearance of tanned skin without UV exposure.

Be mindful of peak sun hours. If you love being outdoors, whether it's hanging at the beach, working in the garden, hiking on a fall day or skiing down a mountain, it's wise to use a combination of sun-protective behaviors, including sunscreen, photoprotective clothing and seeking shade when possible. Consistent sun-protective behaviors will substantially reduce your risk of skin cancer while allowing you to enjoy time outdoors safely.

Steven Nelson, M.D., Dermatology, Mayo Clinic, Phoenix 

Related post:

• Mayo Clinic Q&A: Advances in staging and surgical treatment of melanoma 
• Mayo Clinic Minute: Tips for protecting babies from harmful UV rays

The post Mayo Clinic Q&A: What do I need to know about skin cancer protection? appeared first on Mayo Clinic News Network.

PHOENIX — Endometriosis and uterine fibroids are two of the most common gynecological conditions. While they have important differences, they also have things in common. Both can lead to serious complications, affect fertility and have symptoms related to the menstrual cycle. And both are the focus of medical innovations to give women better treatment options, explains Megan Wasson, D.O., a gynecologist and chair of gynecology at Mayo Clinic in Arizona.

 "They're both relatively common," Dr. Wasson says. "There can be some overlapping symptoms, but the majority of symptoms vary and the diseases progress differently. Fibroids and endometriosis can run in families. Neither condition is preventable."

Fibroids

Fibroids grow in the uterus. They are almost always noncancerous. You can have one or more. A fibroid may be too small to see with the eyes alone or it can grow as big as a grapefruit or larger, even filling the pelvis or stomach area and making someone appear pregnant.

"These are not just little inconveniences. These are very large, very significant masses and they can really impact quality of life," Dr. Wasson says.

Many people do not experience symptoms and only learn they have fibroids due to a pelvic exam or ultrasound. Others may have symptoms such as heavy, painful, longer or more frequent periods; pain in the pelvis, stomach area or lower back; frequent or difficult urination; constipation; or pain during sex.

"When fibroids become very enlarged, you can actually feel them through the abdominal wall. You can get to the point that your pants do not fit, you have significant abdominal bloating, and the fibroids are pushing on other organs such as the bladder, causing you to have to go to the bathroom all the time, among other symptoms," Dr. Wasson explains. "You can have constipation because the fibroids are pushing on the bowel and not allowing things to move."

In the past, women whose fibroids were problematic were commonly told that a hysterectomy — surgery that removes the uterus, also ending the ability to become pregnant — was the only treatment option.

Now, medical advances are minimizing the impact of fibroid removal surgery on patients, often preserving the uterus and fertility, Dr. Wasson says. Other fibroid treatment options include medications that shrink fibroids and procedures that do not require surgery, she adds.

For example, interventional radiologists can perform a uterine fibroid embolization to block the blood supply to fibroids, causing them to shrink. Patients can usually leave the same day. Reducing the size and alleviating symptoms can help significantly, Dr. Wasson explains.

Other minimally invasive procedures include radiofrequency ablation, which uses energy to cause fibroids to die. Minimally invasive surgeries include a robotic or laparoscopic myomectomy, a surgery to remove the fibroids and leave the uterus in place.

Endometriosis

In endometriosis, tissue similar to the inner lining of the uterus grows outside the uterus. Common symptoms are pelvic pain and cramping, including during menstruation; heavy periods or bleeding between periods; and pain during sex, bowel movements or urination. Sometimes people with endometriosis do not have symptoms and only learn they have it when they have difficulty becoming pregnant or they have surgery for another reason.

"Endometriosis symptoms usually start much earlier in life than fibroids," Dr. Wasson says. "Endometriosis increases the risk for ovarian cancer. It can also cause infertility."

Treatment for endometriosis often involves medication or surgery. Conservative surgery removes endometriosis tissue while aiming to preserve the uterus and ovaries and protect fertility. This surgery may be minimally invasive, using a laparoscope and a small cut. Sometimes a laparoscopic surgery is done with help from robotic devices.

Dr. Wasson is working with a Mayo research team to create a vaccine to prevent endometriosis. She and Mayo colleagues are also exploring ways to make endometriosis easier to detect with medical imaging. Potentially, a molecule could be given during imaging that causes endometriosis to light up, making it easy to see endometriosis tissue, Dr. Wasson explains.

To help detect endometriosis or fibroids as early as possible, Dr. Wasson recommends that, from the time  menstrual cycles start, girls and women pay attention to any irregularities, such as unusually heavy periods, abnormally long or short cycles, missing periods, or symptoms such as pain with periods.

"Your period should be no more than a minor inconvenience," she adds. "If you're missing work, school and other activities, if you're staying in bed because you're having your period, that's not normal. If there are any symptoms causing you to change anything in your life, that warrants a conversation with your healthcare professional. Don't assume a change is normal or is just something you should deal with."

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post Endometriosis and fibroids: Expert explains advances giving women less invasive treatment options appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My mom, older sisters and I have always had really painful menstrual periods. I recently read that this could be caused by endometriosis. Could you tell me more about it?

ANSWER: My rule of thumb for patients is that their periods should be no more than an inconvenience. If someone is missing time from work or school, not being able to get out of bed, or canceling plans due to period pain, this isn't typical and should be discussed with a healthcare professional.

It's not unusual that painful periods run in your family. Often, women think that debilitating pain and cramping are usual because they've seen their family members have the same experience. You don't need to suffer. If the cause is endometriosis, it can be treated, even if it can't be cured.

Endometriosis

Endometriosis is a condition where cells that are similar to those in the lining of the uterus — the endometrium — multiply outside of the uterus. Although typically found in the pelvis, these cells can be found throughout the body, including the abdominal and chest cavities. 

Endometriosis cells cause inflammation and are hormone-stimulated. So, with every menstrual cycle, inflammation flares up, causing scarring and tissue growth, which can fuse organs together and lead to significant symptoms, including pain.

This growth of tissue and binding together of organs, in addition to difficult periods, can lead women to experience: 

• Frequent and urgent urination with bladder pain.
• Bowel movement changes, including pain, constipation or diarrhea, blood in the stool, or a change in its shape or size.
• Pain during and after and after sexual intercourse.

Endometriosis also may interfere with fertility. While about 70% of women with endometriosis are able to get pregnant without assistance, about 50% who struggle with fertility are found to have endometriosis. 

Diagnosis

Despite all of these symptoms, endometriosis can be challenging to diagnose. It typically takes seven to 10 years from the onset of symptoms until a diagnosis is made. Suspected endometriosis may start with a conversation with your healthcare professional about your symptoms and concerns. 

The next step can be a physical exam to evaluate your pelvic floor and assess how the organs move in the pelvis. If they aren't sliding easily past each other, this is a key indication of possible endometriosis scarring.

Imaging following the physical exam can include:

• A screening pelvic ultrasound to determine if the uterus and bowel slide past each other.
• A specialized MRI that looks at the tissue growth caused by endometriosis.
• An advanced ultrasound to detect more advanced disease.

If nothing irregular is shown on imaging, that doesn't entirely rule out endometriosis. Not all disease can be seen on scans and can only be confirmed by surgery. That's why gathering family history and symptoms is so important in a diagnosis.

Treatment

With the information from the physical exam and imaging, your healthcare professional will discuss treatment options with you. There's no one treatment that fits every woman; treatments are customized to what each person is experiencing and will deliver the most benefit. 

Treatments range from more conservative to more aggressive and include:

• Doing nothing. This is a quality-of-life concern, and for some women, it's peace of mind to know that there's nothing worrisome about their health. If symptoms aren't overly bothersome, choosing to live with the symptoms is OK.
• Taking supplements. Various supplements, including vitamins C, E and N-acetylcysteine, have been studied extensively and can help minimize symptoms.
• Taking anti-inflammatories. Over-the-counter NSAIDs can help provide relief and are most effective when taken 24-48 hours before your period begins.
• Trying hormones. Progesterone-only or combination progesterone-estrogen birth control pills can stabilize the body's hormones, evening out the peaks and valleys in hormonal fluctuations and endometriosis-related symptoms. Using a progesterone-releasing IUD is another option.
• Taking medications to induce menopause. These can improve endometriosis symptoms, but the trade-offs are typical menopause symptoms: hot flashes, difficulty sleeping, mood swings and more.
• Undergoing surgery. This involves removing endometriosis tissue and separating organs that are fused together. It's an effective approach that helps many patients.  

Some women benefit from working with other specialists, including integrative medicine, acupuncture focused on women's health, pelvic floor physical therapy, gastroenterology, urology, interventional radiology and pain psychology.

While there's no cure for endometriosis, the condition is emerging from the shadows and being talked about and addressed more openly, which increases awareness, education and diagnosis. 

Ideally, awareness of endometriosis would begin with pediatricians. Many women diagnosed with endometriosis report experiencing symptoms with their first period. So, if a patient tells their pediatrician that they're having painful periods, discussing the possibility of endometriosis should become part of their conversation.

Research into understanding the immune response of endometriosis continues. One day, it may even lead to a vaccine that stops endometriosis before it starts.

Megan Wasson, D.O., Gynecology, Mayo Clinic, Phoenix

Related posts:

• Mayo Clinic Q and A: Postsurgery recovery for women, what to know with endometriosis
• Mayo Clinic Minute: When to seek care for pelvic pain

The post Mayo Clinic Q&A: Can menstrual pain be caused by endometriosis? appeared first on Mayo Clinic News Network.

PHOENIX — In a study published in the Liver Transplantation journal by the American Association for the Study of Liver Diseases, Mayo Clinic researchers found that a new proactive treatment protocol for alcohol use disorder after liver transplant resulted in a 0% heavy alcohol relapse rate among patients who followed the protocol, compared with a historical relapse rate of approximately 25%.

"The results were greater than we expected," says Channa Jayasekera, M.D., Mayo Clinic transplant hepatologist and senior author of the study. "Among the 21 patients in the study, none relapsed to heavy alcohol use within one year. Although this was a small cohort, having no relapses is incredibly encouraging that we have found an effective intervention."

Researchers defined heavy alcohol use as binge drinking — five or more drinks for men or four or more drinks for women on a single occasion — or drinking alcohol more than four days per week. This standard definition reflects a level of alcohol consumption associated with damage to the transplanted liver and other negative health outcomes.

New protocol aims to prevent alcohol relapse after liver transplant

Alcohol-associated liver disease is now the leading indication for liver transplantation in the U.S., and many patients requiring urgent transplantation do not have time to complete traditional alcohol treatment programs before surgery. Historically, transplant care has often focused on monitoring patients after transplant and intervening only after relapse occurs.

Patients who relapse after transplant face a higher risk of serious health complications and may not be eligible for another liver transplant, making relapse prevention a critical part of long-term care.

Researchers at Mayo Clinic in Arizona developed and studied preventing alcohol-related complications after transplantation, or PACT, a first-of-its-kind multidisciplinary protocol designed to proactively prevent alcohol relapse after transplant. The protocol combines anticraving medication, frequent patient follow-up, alcohol metabolite testing, and coordinated care from transplant hepatologists, surgeons, addiction counselors, psychiatrists and pharmacists.

Watch: Dr. Channa Jayasekera discusses Mayo Clinic PACT study

Journalists: Broadcast-quality sound bites with Dr. Channa Jayasekera are in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Name super/CG: Channa Jayasekera, M.D./Transplant Hepatology/Mayo Clinic.

"While a liver transplant can cure alcohol-related liver disease, it does not treat alcohol use disorder," says Dr. Jayasekera. "We increasingly understand alcohol use disorder as a chronic medical condition that deserves proactive treatment, just like other chronic diseases. Our goal is to give patients every possible tool to protect their health and preserve the gift of transplantation."

Researchers say the findings could help reshape how transplant centers nationwide approach addiction treatment after liver transplant and help reduce stigma surrounding alcohol use disorder.

"These patients are often young and have a long future ahead of them after transplant," says Dr. Jayasekera. "If these findings are replicated at other centers, this approach could become a game changer in transplant medicine."

Dr. Jayasekera notes that larger studies and replication at additional transplant centers will be important next steps.

For a complete list of authors and disclosures, review the study.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

About Mayo Clinic Transplant Center
Mayo Clinic Transplant Center is one of the largest and most comprehensive transplant programs in the world. With programs in Arizona, Florida and Minnesota, Mayo Clinic provides seamless, coordinated care across adult heart, lung, liver, kidney and pancreas transplantation. Guided by a commitment to innovation, research and education, Mayo Clinic Transplant Center delivers world-leading outcomes, compassionate patient care and advances that shape the future of transplantation worldwide.

Media contact:

• Kelley Luckstein, Mayo Clinic Communications, newsbureau@mayo.edu

The post Mayo Clinic study finds new post-liver transplant protocol results in 0% heavy alcohol relapse rate appeared first on Mayo Clinic News Network.

PHOENIX — An experimental drug combination may help overcome treatment resistance in advanced kidney cancer, according to early results from a first-in-human clinical trial led by Mayo Clinic researchers.

The study evaluated the investigational drug darlifarnib in combination with the targeted therapy cabozantinib, a standard treatment for clear cell renal cell carcinoma (ccRCC), the most common type of kidney cancer. Among patients whose disease had progressed despite prior treatment, 44% responded to the combination therapy, while disease control was achieved in 94% of participants.

"These early findings are encouraging, as more effective treatments are urgently needed for patients with advanced disease," says Yousef Zakharia, M.D., principal investigator of the study and a medical oncologist at Mayo Clinic in Arizona. He presented the findings at the 2026 International Kidney Cancer Symposium: Europe in Paris.

ccRCC accounts for most kidney cancer cases in adults, and many patients eventually experience disease progression despite treatment.

In the phase 1a/b study, researchers evaluated 18 patients who had previously received cabozantinib. About half had undergone at least three prior therapies.

"For many patients, the benefit of cabozantinib can be temporary. Tumors may develop resistance and activate alternative pathways that allow the cancer to continue growing," Dr. Zakharia says.

Researchers investigated whether adding darlifarnib, a next-generation targeted therapy designed to inhibit cancer growth signaling pathways, could help overcome treatment resistance.

The combination produced tumor shrinkage in 7 of 16 evaluable patients, corresponding to an overall response rate of 44%. Disease control, defined as either tumor stability or shrinkage, was achieved in 15 of 16 patients (94%).

"These findings require validation in a larger clinical trial to confirm the efficacy observed thus far; however, the early signal is intriguing," says Dr. Zakharia. "This study represents an important step forward and provides insight into how treatment resistance might be overcome."

The multicenter, international trial will further evaluate the benefit of the combination in a larger group.

For a complete list of trial and funding information, review the study.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

About Mayo Clinic Comprehensive Cancer Center
Designated as a comprehensive cancer center by the National Cancer Institute, Mayo Clinic Comprehensive Cancer Center is defining the cancer center of the future, focused on delivering the world's most exceptional patient-centered cancer care for everyone. At Mayo Clinic Comprehensive Cancer Center, a culture of innovation and collaboration is driving research breakthroughs in cancer detection, prevention and treatment to change lives.

Media contact:

• Julie Ferris-Tilman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post Experimental drug combination shows early effectiveness in advanced kidney cancer appeared first on Mayo Clinic News Network.