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BioMed Research International
Volume 2015 (2015), Article ID 751571, 10 pages
http://dx.doi.org/10.1155/2015/751571
Review Article

The Association between Endometriomas and Ovarian Cancer: Preventive Effect of Inhibiting Ovulation and Menstruation during Reproductive Life

1Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena, Via del Pozzo 71, 41124 Modena, Italy
2Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero Universitaria Policlinico of Modena, Via del Pozzo 71, 41124 Modena, Italy
3Department of Laboratory Medicine and Pathology, Azienda Ospedaliero Universitaria Policlinico of Modena, Via del Pozzo 71, 41124 Modena, Italy

Received 3 April 2015; Accepted 18 August 2015

Academic Editor: Ivo Meinhold-Heerlein

Copyright © 2015 Giovanni Grandi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.