Endometriosis and Ovarian Cancer: An Integrative Review (Endometriosis and Ovarian Cancer) Original paper

What was studied?

This review focuses on the relationship between endometriosis and ovarian cancer, specifically examining how endometriosis, particularly ovarian endometriomas, can lead to malignancy. The review synthesizes data from various studies published over the past five years that explore this association, highlighting genetic, molecular, and inflammatory mechanisms that could contribute to ovarian cancer development. Endometriosis is increasingly recognized not as a benign condition but as one that, under certain circumstances, could evolve into cancer, with epithelial ovarian cancers (EOC) of the endometrioid and clear-cell subtypes being the most common among women with endometriosis.

Who was studied?

The review analyzed studies on women diagnosed with endometriosis and ovarian cancer, particularly those with epithelial ovarian carcinoma (EOC) associated with endometriosis. Studies were included from various clinical trial cohorts, case-control studies, and cross-sectional research. These studies focused on patients with tissue-proven endometriosis, those with endometriosis-associated ovarian cancer (EAOC), and control groups without endometriosis. The review also considered histological subtypes such as endometrioid carcinoma (EC) and clear-cell carcinoma (CCC), which are the most commonly observed malignancies in endometriosis-associated ovarian cancer.

Most important findings

The review found that women with endometriosis are at an increased risk for developing ovarian cancer, particularly of the endometrioid and clear-cell subtypes. Key genetic alterations were identified, including mutations in the ARID1A gene, which leads to the loss of the BAF250a protein and is a frequent event in both ovarian clear-cell carcinoma (OCCC) and endometrioid carcinoma (EAEC). The study also highlighted the role of oxidative stress in malignant transformation, driven by the iron in the fluid of endometriotic cysts, which promotes genetic mutations. Loss of estrogen receptors in some cases of endometriosis-associated carcinoma was observed, possibly contributing to the neoplastic transformation of endometriotic lesions. Additionally, the review pointed to the importance of understanding the distinct histologic features of endometriosis-associated cancers compared to non-endometriosis ovarian cancers, with earlier diagnosis and better prognosis often seen in cases associated with endometriosis.

Key implications

The findings suggest that women with endometriosis, especially those with ovarian endometriomas, are at an increased risk for developing ovarian cancer, specifically the endometrioid and clear-cell subtypes. These insights emphasize the need for closer monitoring of women with endometriosis, particularly in younger women, who are more likely to develop these types of ovarian cancer. The review also underscores the importance of genetic testing, such as identifying mutations in ARID1A and other key genes like PIK3CA and β-catenin, which may help in early detection and provide targets for more personalized treatment strategies. The findings highlight the role of inflammation and oxidative stress in the progression of ovarian cancer in these patients, suggesting potential therapeutic avenues such as antioxidants or inhibitors targeting these pathways. Furthermore, the study calls for more research into the molecular underpinnings of this link to improve early detection, prognosis, and treatment strategies for women at risk.