Ovarian Cancer and Its Association with Endometriosis: A Narrative Review.

Abstract

Background: Ovarian cancer is a prevalent and highly lethal gynaecological cancer. Among its various subtypes, epithelial ovarian cancer predominates, comprising ten distinct subtypes and contributing significantly to the overall burden of ovarian malignancies. Concurrently, endometriosis, characterized by the ectopic growth of endometrial tissue within the pelvis, affects a substantial number of women of reproductive age.

Summary: Notably, atypical endometriosis serves as the precursor lesion to endometriosis-associated ovarian cancer, with endometrioid and clear-cell ovarian cancers being the most common prevalent histologic subtypes in this context. These exhibit a more favourable prognosis compared to ovarian cancers unrelated to endometriosis. The progression from endometriosis to atypical endometriosis and ultimately to ovarian cancer is influenced by multiple factors, including mutations in tumour suppressor genes and oncogenes, hyperestrogenism, ovarian inflammation resulting from cyclical bleeding of the ectopic endometrium, and oxidative stress from accumulated iron of ruptured erythrocytes. Conventional treatment for endometriosis-associated ovarian cancer involves macroscopic resection of the tumour combined with chemotherapy. The emergence of targeted therapies including immunotherapy has notably improved outcomes, particularly in cases of chemotherapy-resistant tumours. Despite these advancements, management poses numerous challenges, necessitating the development of more effective treatments.

Key message: The current review provides an overview of our current knowledge regarding the intricate relationship between ovarian cancer and endometriosis, illuminating the multifaceted aspects of their interplay and underscoring the imperative for continued research in this field.