Thursday, October 30, 2014

Endometriosis and cancer risk

"Related to a number of hereditary, environmental, epigenetic, and menstrual characteristics and alterations, some sharing certain common processes with cancer,28 endometriosis remains the third leading cause of gynecologic hospitalization in United States29 and is considered a leading cause of female primary and secondary infertility, prevalent in 0.5% to 5.0% in fertile and 25% to 40% of infertile women.30 ...

Endometriosis, more than simply "killer cramps" as it is so often trivialized, may be related to a number of hereditary, environmental, epigenetic, and menstrual characteristics, some sharing certain common processes with cancer.28 Indeed, it is important to note that endometriosis is not cancer. The disease does, however, correspond to a variety of co-morbid conditions, ranging from autoimmune disease to food and environmental allergies to malignant concerns. Multiple prior studies have indicated an association between endometriosis and a number of autoimmune diseases, multiple chemical sensitivities, inflammatory bowel disease, food intolerances, allergies, and chronic fatigue.3,63,64

Less clear is the potential link between endometriosis and certain cancers. Much debate continues to surround the cancer-endometriosis link, with researchers calling the "histogenesis of endometriosis and endometriosis-associated ovarian cancer [one of the] most mysterious aspects of pathology."65 Current evidence is insufficient to draw any definitive conclusions whether this association represents causality or the sharing of similar risk factors and/or antecedent mechanisms.66 Nonetheless, it has been well established that the disease is indeed associated with an increased risk for non-Hodgkin lymphoma and certain malignant tumors, notably ovarian, with 15% to 40% of endometrioid ovarian carcinoma cases being associated with endometriosis. Based on this frequent association, many reports implicate endometriosis as a precursor lesion to ovarian cancer.

The risk of ovarian cancer among those patients with endometriosis is higher than those without the disease by 30% to 40%. One analysis of benign ovarian endometrioid tumors found frequent coexistence of endometriosis and endometrioid neoplasms, supporting a genetic link between the two. In an estimated 60% of endometriosis-associated ovarian cancers, the cancer is adjacent to or directly arising from the endometriotic tissue, lending credence to the fact that malignant transformation can and does occur.19

Animal studies suggest that common molecular genetic pathways, specifically K-RAS/MAPK and PTEN/PI13, are involved in the pathogenesis of both endometriosis and endometrioid ovarian carcinoma. Separate studies have identified upregulation of multiple genes within the RAS/RAF/MAPK and P13K pathways in endometriosis patients, as compared to controls. Of note, PTEN and K-RAS mutations were found to play a role in the development of low-grade ovarian endometrioid carcinomas; synchronous mutations were also identified in uterine and ovarian endometrioid carcinomas associated specifically with endometriosis. Moreover, loss of the PTEN tumor suppressor gene has been implicated in progression from endometriosis to endometrioid ovarian cancer.19

Endometriosis does present serious risk factors that can accelerate the development
of ovarian cancer by 5.5 years.19 Still, epidemiological findings on the association between endometriosis and cancer remain elusive, with modifications to the standard treatment regimens for the disease unjustified at this time.67 Nonetheless, providers from all disciplines should be aware of this increased risk profile and strive for early detection." <<<<<< A lot of good pearls from this so check it out!