Evidence for the Relationship Between Endometriosis and Epithelial Ovarian Cancer

Endometriosis may be a precursor lesion for some epithelial ovarian cancers (EOCs), especially those of clear cell and endometrioid histologies. The causality of this relationship remains controversial and in need of further investigation because the high prevalence of endometriosis and high mortality of EOC carry significant public health implications if the association is real. Endometriosis-associated ovarian cancer (EAOC) often presents at an earlier stage and with lower-grade lesions than non-EAOC. After surgical resection, these patients also tend to have less residual disease than do patients with non-EAOC. Survival has been reported to be better for women with EAOC. The tumor suppression gene, ARID1A, is frequently disrupted in EAOC. The ARID1A mutation has been reported in preneoplastic lesions and may be an early marker in the transformation of endometriosis into cancer. The current evidence in respect to critical molecular pathways underscores the need to investigate possible role of targeted therapies in the treatment of EAOC. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives Endometriosis may be a precursor lesion for some EOCs, especially those of clear cell and endometrioid histologies. We review the epidemiology, pathology, pathogenesis, clinical presentation, and management of patients with EAOC. After completing this CME, physicians should be able to able to discuss the epidemiologic data supporting the association of endometriosis to certain histological subtypes of EOC, as well as describe the pathogenesis of this association. In addition, they should be able to discuss the clinical presentation and optimal management of these patients.