title: The Association between Endometriomas and Ovarian Cancer: Preventive Effect of Inhibiting Ovulation and Menstruation during Reproductive Life.
abstract: Although endometriosis frequently involves multiple sites in the pelvis, malignancies associated with this disease are mostly confined to the ovaries, evolving from an endometrioma. Endometriomas present a 2-3-fold increased risk of transformation in clear-cell, endometrioid, and possibly low-grade serous ovarian cancers, but not in mucinous ovarian cancers. These last cancers are, in some aspects, different from the other epithelial ovarian cancers, as they do not appear to be decreased by the inhibition of ovulation and menstruation. The step by step process of transformation from typical endometrioma, through atypical endometrioma, finally to ovarian cancer seems mainly related to oxidative stress, inflammation, hyperestrogenism, and specific molecular alterations. Particularly, activation of oncogenic KRAS and PI3K pathways and inactivation of tumor suppressor genes PTEN and ARID1A are suggested as major pathogenic mechanisms for endometriosis associated clear-cell and endometrioid ovarian cancer. Both the risk for endometriomas and their associated ovarian cancers seems to be highly and similarly decreased by the inhibition of ovulation and retrograde menstruation, suggesting a common pathogenetic mechanism and common possible preventive strategies during reproductive life.
authors.affiliation: Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena, Via del Pozzo 71, 41124 Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grandi
authors.affiliation: Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero Universitaria Policlinico of Modena, Via del Pozzo 71, 41124 Modena, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Toss
authors.affiliation: Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero Universitaria Policlinico of Modena, Via del Pozzo 71, 41124 Modena, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cortesi
authors.affiliation: Department of Laboratory Medicine and Pathology, Azienda Ospedaliero Universitaria Policlinico of Modena, Via del Pozzo 71, 41124 Modena, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Botticelli
authors.affiliation: Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena, Via del Pozzo 71, 41124 Modena, Italy.
authors.forename: Annibale
authors.initials: A
authors.lastname: Volpe
authors.affiliation: Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena, Via del Pozzo 71, 41124 Modena, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Cagnacci
mesh_terms: D004715:Endometriosis / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D008598:Menstruation / Q000502:physiology*; D010051:Ovarian Neoplasms / Q000378:metabolism / Q000503:physiopathology; D010060:Ovulation / Q000502:physiology*