Endometriosis and an increased risk of malignancies

Endometriosis is a common gynaecological disorder associated with pelvic pain and sub-fertility, affecting 7–15% of women of reproductive age. The disease is defined as the presence of endometrial-like tissue outside the uterine cavity, primarily on pelvic organs. The aetiology of endometriosis is still uncertain. The disease rarely causes mortality, however, it may have a significant impact on a patient's quality of life. Moreover, several studies have consistently shown that endometriosis is associated with a higher risk of some types of malignancies.

Endometriosis shares several molecular characteristics with invasive cancer, such as inflammation, tissue invasion, angiogenesis, dysfunction of immune cells and pro-survival features. Studies have shown that ovarian cancer, especially clear cell, endometrioid and serous, has been associated with endometriosis. Furthermore, the risk of cancer of the uterine cervix has shown to be decreased and the results on the risk of the cancers of uterine corpus or breast are inconsistent. Among non‐gynecological cancers, melanoma of the skin, non‐Hodgkin‐lymphoma, brain and thyroid cancers have also been associated with endometriosis.

Research results indicate that women with endometriosis have an increased risk for some types of malignancies, therefore, they should be under strict gynecological control, even many years after menopause. Further research is needed to prove the real risk of different types of malignant tumors among women with endometriosis. In addition, it is necessary to establish periodic examination schedules among these patients in order to prevent certain types of malignancies.

G. Bręborowicz, Położnictwo i ginekologia (tom II), Wydawnictwo Lekarskie PZWL Warszawa 2015, Wydanie II Dawson A, Fernandez ML, Anglesio M, Yong PJ, Carey MS, Endometriosis and endometriosis-associated cancers: new insight into the molecular mechanism of ovarian cancer development, Ecancermedicalscience. 2018 Jan 25;12:803 Torng PL, Clinical implication for endometriosis associated with ovarian cancer, Gynecol Minim Invasive Ther. 2017 Oct-Dec; 6(4): 152–156 Bukulmez O, Hardy DB, Carr BR, Word RA, Mendelson CR, Inflammatory Status Influences Aromatase and Steroid Receptor Expression in Endometriosis, Endocrinology. 2008 Mar;149(3):1190-204 Han SJ, O'Malley BW, The dynamics of nuclear receptors and nuclear receptor coregulators in the pathogenesis of endometriosis, Hum Reprod Update. 2014 Jul; 20(4): 467–84 Toyokuni S, Role of iron in carcinogenesis: Cancer as a ferrotoxic disease, Cancer Sci. 2009 Jan;100(1):9-16 Sampson JA, Endometrial carcinoma of the ovary, arising in endometrial tissue in that organ, Arch Surg. 1925;10(1):1-72 Pearce CL, Templeman C, Rossing MA, Lee A, Near AM, Webb PM, Nagle CM, Doherty JA, Cushing-Haugen KL, Wicklund KG, Chang-Claude J, Hein R, Lurie G, Wilkens LR, Carney ME, Goodman MT, Moysich K, Kjaer SK, Hogdall E, Jensen A, Goode EL, Fridley BL, Larson MC, Schildkraut JM, Palmieri RT, Cramer DW, Terry KL, Vitonis AF, Titus LJ, Ziogas A, Brewster W, Anton-Culver H, Gentry-Maharaj A, Ramus SJ, Anderson AR, Brueggmann D, Fasching PA, Gayther SA, Huntsman DG, Menon U, Ness RB, Pike MC, Risch H, Wu AH, Berchuck A; Ovarian Cancer Association, Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies. Lancet Oncol. 2012 Apr; 13(4):385-94 Vercellini P, Viganò P, Buggio L, Makieva S, Scarfone G, Cribiù FM, Parazzini F, Somigliana E, Perimenopausal management of ovarian endometriosis and associated cancer risk: When is medical or surgical treatment indicated?, Best Pract Res Clin Obstet Gynaecol. 2018 Aug;51:151-168 Kurman RJ, Shih IeM The Dualistic Model of Ovarian Carcinogenesis: Revisited, Revised, and Expanded, Am J Pathol. 2016 Apr;186(4):733-47 Karneziz AN, Cho KR, Gilks CB, Pearce CL, Huntsman DG, The disparate origins of ovarian cancers: pathogenesis and prevention strategies, Nat Rev Cancer. 2017 Jan;17(1):65-74 Kommoss F, Gilks CB, Pathology of Ovarian Cancer: Recent Insights Unveiling Opportunities in Prevention, Clin Obstet Gynecol. 2017 Dec;60(4):686-696 Saavalainen L, Lassus H, But A, Tiitinen A, Härkki P, Gissler M, Pukkala E, Heikinheimo O, Risk of Gynecologic Cancer According to the Type of Endometriosis, Obstet Gynecol. 2018 Jun;131(6):1095-1102 Scarfone G, Bergamini A, Noli S, Villa A, Cipriani S, Taccagni G, Vigano' P, Candiani M, Parazzini F, Characteristics of clear cell ovarian cancer arising from endometriosis: a two center cohort study, Gynecol Oncol. 2014 Jun;133(3):480-4 Ayhan A, Mao TL, Seckin T, Wu CH, Guan B, Ogawa H, Futagami M, Mizukami H, Yokoyama Y, Kurman RJ, Shih IeM, Loss of ARID1A expression is an early molecular event in tumor progression from ovarian endometriotic cyst to clear cell and endometrioid carcinoma, Int J Gynecol Cancer. 2012 Oct;22(8):1310-5 Wiegand KC, Shah SP, Al-Agha OM, Zhao Y, Tse K, Zeng T, Senz J, McConechy MK, Anglesio MS, Kalloger SE, Yang W, Heravi-Moussavi A, Giuliany R, Chow C, Fee J, Zayed A, Prentice L, Melnyk N, Turashvili G, Delaney AD, Madore J, Yip S, McPherson AW, Ha G, Bell L, Fereday S, Tam A, Galletta L, Tonin PN, Provencher D, Miller D, Jones SJ, Moore RA, Morin GB, Oloumi A, Boyd N, Aparicio SA, Shih IeM, Mes-Masson AM, Bowtell DD, Hirst M, Gilks B, Marra MA, Huntsman DG, ARID1A mutations in endometriosis-associated ovarian carcinomas, N Engl J Med. 2010 Oct 14;363(16):1532-43 Shigetomi H, Tsunemi T, Haruta S, Kajihara H, Yoshizawa Y, Tanase Y, Furukawa N, Yoshida S, Sado T, Kobayashi H, Molecular mechanisms linking endometriosis under oxidative stress with ovarian tumorigenesis and therapeutic modalities, Cancer Invest. 2012 Jul;30(6):473-80 Lu Y, Cuellar-Partida G, Painter JN, Nyholt DR; Australian Ovarian Cancer Study; International Endogene Consortium (IEC), Morris AP, Fasching PA, Hein A, Burghaus S, Beckmann MW, Lambrechts D, Van Nieuwenhuysen E, Vergote I, Vanderstichele A, Doherty JA, Rossing MA, Wicklund KG, Chang-Claude J, Eilber U, Rudolph A, Wang-Gohrke S, Goodman MT, Bogdanova N, Dörk T, Dürst M, Hillemanns P, Runnebaum IB, Antonenkova N, Butzow R, Leminen A, Nevanlinna H, Pelttari LM, Edwards RP, Kelley JL, Modugno F, Moysich KB, Ness RB, Cannioto R, Høgdall E, Jensen A, Giles GG, Bruinsma F, Kjaer SK, Hildebrandt MA, Liang D, Lu KH, Wu X, Bisogna M, Dao F, Levine DA, Cramer DW, Terry KL, Tworoger SS, Missmer S, Bjorge L, Salvesen HB, Kopperud RK, Bischof K, Aben KK, Kiemeney LA, Massuger LF, Brooks-Wilson A, Olson SH, McGuire V, Rothstein JH, Sieh W, Whittemore AS, Cook LS, Le ND, Gilks CB, Gronwald J, Jakubowska A, Lubiński J, Gawełko J, Song H, Tyrer JP, Wentzensen N, Brinton L, Trabert B, Lissowska J, Mclaughlin JR, Narod SA, Phelan C, Anton-Culver H, Ziogas A, Eccles D, Gayther SA, Gentry-Maharaj A, Menon U, Ramus SJ, Wu AH, Dansonka-Mieszkowska A, Kupryjanczyk J, Timorek A, Szafron L, Cunningham JM, Fridley BL, Winham SJ, Bandera EV, Poole EM, Morgan TK, Risch HA, Goode EL, Schildkraut JM, Webb PM, Pearce CL, Berchuck A, Pharoah PD, Montgomery GW, Zondervan KT, Chenevix-Trench G, MacGregor S, Shared genetics underlying epidemiological association between endometriosis and ovarian cancer, Hum Mol Genet. 2015 Oct 15;24(20):5955-64 Fritzer N, Haas D, Oppelt P, Renner S, Hornung D, Wölfler M, Ulrich U, Fischerlehner G, Sillem M, Hudelist G. More than just bad sex: sexual dysfunction and distress in patients with endometriosis, Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(2):392-6 Melin A, Sparén P, Persson I, Bergqvist A, Endometriosis and the risk of cancer with special emphasis on ovarian cancer, Hum Reprod. 2006 May;21(5):1237-42 Poole EM, Lin WT, Kvaskoff M, De Vivo I, Terry KL, Missmer SA, Endometriosis and risk of ovarian and endometrial cancers in a large prospective cohort of U.S. nurses, Cancer Causes Control. 2017 May;28(5):437-445 Rowlands IJ, Nagle CM, Spurdle AB, Webb PM; Australian National Endometrial Cancer Study Group; Australian Ovarian Cancer Study Group, Gynecological conditions and the risk of endometrial cancer, Gynecol Oncol. 2011 Dec;123(3):537-41 Mogensen JB, Kjær SK, Mellemkjær L, Jensen A Endometriosis and risks for ovarian, endometrial and breast cancers: A nationwide cohort study, Gynecol Oncol. 2016 Oct;143(1):87-92 Kvaskoff M, Mu F, Terry KL, Harris HR, Poole EM, Farland L, Missmer SA, Endometriosis: a high-risk population for major chronic diseases? Hum Reprod Update. 2015 Jul-Aug;21(4):500-16 Cole SW, Chronic inflammation and breast cancer recurrence, J Clin Oncol. 2009 Jul 20;27(21):3418-9 Brinton LA, Brogan DR, Coates RJ, Swanson CA, Potischman N, Stanford JL, Breast cancer risk among women under 55 years of age by joint effects of usage of oral contraceptives and hormone replacement therapy, Menopause. 2018 Nov;25(11):1195-1200 Harris RE, Chlebowski RT, Jackson RD, Frid DJ, Ascenseo JL, Anderson G, Loar A, Rodabough RJ, White E, McTiernan A; Women's Health Initiative, Breast cancer and nonsteroidal anti-inflammatory drugs: prospective results from the Women's Health Initiatsive, Cancer Res. 2003 Sep 15;63(18):6096-101 Farland LV, Tamimi RM, Eliassen AH, Spiegelman D, Hankinson SE, Chen WY, Missmer SA, Laparoscopically Confirmed Endometriosis and Breast Cancer in the Nurses’ Health Study II, Obstet Gynecol. 2016 Nov;128(5):1025-1031 Kvaskoff M, Mesrine S, Fournier A, Boutron-Ruault MC, Clavel-Chapelon F, Personal history of endometriosis and risk of cutaneous melanoma in a large prospective cohort of French women, Arch Intern Med. 2007 Oct 22;167(19):2061-5 Farland LV, Lorrain S, Missmer SA, Dartois L, Cervenka I, Savoye I, Mesrine S, Boutron-Ruault MC, Kvaskoff M, Endometriosis and the risk of skin cancer: a prospective cohort study, Cancer Causes Control. 2017 Oct;28(10):1011-1019 Olson JE, Cerhan JR, Janney CA, Anderson KE, Vachon CM, Sellers TA, Postmenopausal cancer risk after self-reported endometriosis diagnosis in the Iowa Women's Health Study, Cancer. 2002 Mar 1;94(5):1612-8 Lebovic DI, Mueller MD, Taylor RN, Immunobiology of endometriosis, Fertil Steril. 2001 Jan;75(1):1-10 Lessey BA, Medical management of endometriosis and infertility, Fertil Steril.2000 Jun;73(6):1089-96 Saavalainen L, Lassus H, But A, Tiitinen A, Härkki P, Gissler M, Heikinheimo O, Pukkala E, A Nationwide Cohort Study on the risk of non-gynecological cancers in women with surgically verified endometriosis, Int J Cancer. 2018 Dec 1;143(11):2725-2731 Zahid M, Goldner W, Beseler CL, Rogan EG, Cavalieri EL, Unbalanced estrogen metabolism in thyroid cancer, Int J Cancer. 2013 Dec 1;133(11):2642-9 Melin A, Sparén P, Bergqvist A, The risk of cancer and the role of the parity among women with endometriosis, Hum Reprod. 2007 Nov;22(11):3021-6. Claus EB, Calvocoressi L, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Family and personal medical history and risk of meningioma, J Neurosurg. 2011 Dec;115(6):1072-7 Downloads Published How to Cite Issue Section License The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Stats Number of views and downloads: 1343 Number of citations: 0