Endometriosis is a common disease (7-15%) in all woman of reproductive age, while the incidence of ovarian cancer (0.72-3.92%) in patients with endometriosis is higher than that in the general population. The coexistence of endometriosis and cancer has been estimated to occur in 0.7-5.0% of all cases with ovarian endometriosis, especially ovarian cancer. Woman with endometriosis have an increased risk for several types of malignancies : overall cancer (RR 1.04-1.20), breast cancer (RR 1.30), ovarian cancer (RR 1.43-1.90), endocrine tumour (RR 1.36), hematologic malignancies (RR 1.40), non-hodgkin lymphoma (RR 1.24), and brain tumour (RR 1.22).
Several reports support the theory that endometrioid epithelial ovarian cancer (EEOC) and Ovarian clear cell carcinoma (OCCC) arise in endometriosis. There are two postulated explanations. First, direct transformation, a transition from benign to malignant epithelium, is often evident. Second, iron released by hemorrhage in the endometrial cysts induces persistent oxidative stress and frequent DNA mutations. Molecular investigations on the transformation of endometriosis to ovarian cancer have attributed it to various genetic mutations.
Endometriosis as a prognostic factor for cancer Survival
Although endometriosis cannot be termed a premalignant condition, epidemiologic, histopathologic, and molecular data suggest that this disease does have malignant potential. An imbalance in local estrogen production regulation and sensitivity to progesterone and local inflammatory response modulation through cytokines and growth factors and multiple other molecular alterations seem to favor the invasion and growth of the disease and its progression to carcinoma. In the future, larger studies will be required to elucidate the biological behavior of the malignant transformation of endometriotic lesions, the histological pattern of disease progression and the genetic alterations which associates the two diseases. In the light of the evidence produced by molecular pathology research and epidemiological studies, modifications in currant diagnostic and treatment options for endometriosis information of cancer prevention strategies are needed to be discussed in order to prevent unnecessary medical interventions but not to miss the diagnosis of cancer.
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