Risk factors of epithelial ovarian carcinomas among women with endometriosis: a systematic review

Abstract

Introduction. The objective of this review was to evaluate the published literature on epidemiologic risk factors for epithelial ovarian cancer among women with a diagnosis of endometriosis. Material and methods. A systematic literature search was conducted in PubMed and Scopus. Studies comparing epidemiologic risk factors of epithelial ovarian cancer among women with endometriosis were included. A quality assessment was conducted using the Newcastle-Ottawa Scale. Results. Eight of 794 articles met the inclusion criteria. A lower risk of epithelial ovarian cancer was observed in women with documented complete surgical excision of endometriotic tissue and suggested among women with unilateral oophorectomy. The use of oral contraceptives (≥10 years) may be associated with a lower risk of epithelial ovarian cancer among women with endometriosis, whereas older age at endometriosis diagnosis (≥45 years, pre-or postmenopausal), nulliparity, hyperestrogenism (endogenous or exogenous), premenopausal status at endometriosis diagnosis, solid compartments as well as larger size of endometrioma (≥9 cm in diameter at endometriosis diagnosis) were all associated with an increased risk of ovarian cancer. Conclusions. A subgroup of women with endometriosis characterized by endometriosis observed through surgery or imaging after the age of 45 years, nulliparity, postmenopausal status at endometriosis diagnosis, larger size of endometrioma (>9 cm) at endometriosis diagnosis, hyperestrogenism (endogenous or exogenous) and/or cysts with solid compartments may have an elevated risk of epithelial ovarian cancer. However, due to the limited number and size of studies in this area we cannot draw definitive conclusions. Further research into a risk factor profile among women with endometriosis is needed before clear recommendations can be made.

Three cases of clear‐cell adenocarcinoma arising from endometrioma during hormonal treatments

“…Low estradiol status induced with the GnRH analogue are known to suppress the activity of endometriosis, an estrogen‐dependent disease. But we can speculate that, although low estrogen status can suppress endometriosis activity, the chance of occurrence of ovarian cancer might not be suppressed completely because the frequency of occurrence of ovarian cancer from endometrioma is high in menopause women with lower estrogen status . In cases #2 and #3, the occurrence of carcinoma was observed in the endometrioma during LEP and dienogest therapy, respectively.…”

“…But we can speculate that, although low estrogen status can suppress endometriosis activity, the chance of occurrence of ovarian cancer might not be suppressed completely because the frequency of occurrence of ovarian cancer from endometrioma is high in menopause women with lower estrogen status. 3 In cases #2 and #3, the occurrence of carcinoma was observed in the endometrioma during LEP and dienogest therapy, respectively. Oral contraceptive or LEP treatment decreases the risk of ovarian cancer by one sixth in women, 10 but its inhibitory effect on canceration in endometrioma patients is unclear.…”

Chitosan is a potential inhibitor of ovarian cancer: Molecular aspects

“…However, findings in this article implied that there is no specific dietary factor that can be consistently related to the risk of ovarian cancer . Moreover, increased risk of EOC has been associated with nulliparity, diagnosed endometriosis, early age at menarche, and late age at menopause …”

“…29 Moreover, increased risk of EOC has been associated with nulliparity, diagnosed endometriosis, early age at menarche, and late age at menopause. 30,31…”

Demographic, Clinical, and Prognostic Factors of Ovarian Clear Cell Adenocarcinomas According to Endometriosis Status

“…Likewise, the risk of developing CCC in women with known endometriosis seems to be reduced by extensive surgical treatment of endometriosis cases. 17 Interestingly, a significantly higher proportion of CCC patients without endometriosis as compared with patients with endometriosis had a component of serous adenocarcinoma.To our knowledge, only one former study examined the histologic characteristics of CCC (that is proportion of pure clear cell carcinomas and proportion of mixed CCC [serous, mucionous, and endometrioid components]) according to coexistence of endometriosis. Although small in size, this study also found that 0 (0%) of 6 cases of endometriosis-associated CCC had serous features in addition to their CCC histology.…”