Ovarian cancer in endometriosis: epidemiology, natural history, and clinical diagnosis

Hiroshi Kobayashi, Kobayashi H
International journal of clinical oncology · 2009 · vol. 14(5) , pp. 378–382 · doi:10.1007/s10147-009-0931-2 · PMID:19856043 · W2011247385
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-12 ⓘ

Ovarian endometrioma significantly elevates ovarian cancer risk, particularly in women over 40 with large cysts, while some lesions predispose to specific subtypes, and benign masses can precede diagnosis.

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This paper reviews whether endometriosis-associated ovarian cancer is a distinct clinical entity versus ovarian cancer not associated with endometriosis, using an English-language literature review focused on epidemiology, natural history, and clinical diagnosis. It highlights a prospective Japanese cohort study of 6398 women with ovarian endometrioma followed up to 17 years, in which 46 incident ovarian cancers occurred and risk was significantly elevated (SIR 8.95), with age >40 and endometrioma size >9 cm as independent predictors; it also reports that benign-appearing masses and mildly elevated CA125 often precede diagnosis by years, while serous cancers may progress rapidly de novo. The major limitation is that conclusions are based on a literature review rather than a new systematic comparative analysis within a single study. This paper is centrally about endometriosis — it specifically synthesizes evidence on ovarian cancer risk, development, and diagnosis in the setting of ovarian endometrioma/endometriosis.

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Abstract

We review whether endometriosis-associated ovarian cancer is a specific entity compared with ovarian cancer not associated with endometriosis, with respect to epidemiology, natural history, and clinical diagnosis; we present a review of the English-language literature for ovarian cancer in endometriosis with respect to these three features. A recent prospective study in Japan directly showed that, during a follow-up of up to 17 years of an ovarian endometrioma cohort (n = 6398), 46 incident ovarian cancers were identified, showing that the ovarian cancer risk was significantly elevated in patients with ovarian endometrioma (standardized incidence ratio [SIR], 8.95; 95% confidence interval [CI], 4.12 to 15.3). Advancing age (>40 years) and the size of the endometriomas (>9 cm) were independent predictors of the development of ovarian cancer among the women with ovarian endometrioma. Although some endometriosis lesions may predispose to clear cell carcinoma (CCC) and endometrioid adenocarcinoma (EAC) of the ovary, both of these cancers differ from the other histological types with respect to their clinical characteristics and carcinogenesis. In patients with endometriosis-associated ovarian cancer, benign-appearing ovarian masses are typically present several years before the diagnosis of the cancer. A slightly elevated carbohydrate antigen [CA] 125 level is also typically present many years before the diagnosis in these patients. However, serous-type ovarian cancer may exhibit a rapid progression possibly through de-novo carcinogenesis. Ovarian endometrioma could be viewed as a neoplastic process, particularly in perimenopausal women. Understanding the mechanisms of the development of endometriosis and elucidating its pathogenesis and pathophysiology are intrinsic to the prevention of endometriosis-associated ovarian cancer and the search for effective therapies.
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Abstract

We review whether endometriosis-associated ovarian cancer is a specific entity compared with ovarian cancer not associated with endometriosis, with respect to epidemiology, natural history, and clinical diagnosis; we present a review of the English-language literature for ovarian cancer in endometriosis with respect to these three features. A recent prospective study in Japan directly showed that, during a follow-up of up to 17 years of an ovarian endometrioma cohort (n = 6398), 46 incident ovarian cancers were identified, showing that the ovarian cancer risk was significantly elevated in patients with ovarian endometrioma (standardized incidence ratio [SIR], 8.95; 95% confidence interval [CI], 4.12 to 15.3). Advancing age (>40 years) and the size of the endometriomas (>9 cm) were independent predictors of the development of ovarian cancer among the women with ovarian endometrioma. Although some endometriosis lesions may predispose to clear cell carcinoma (CCC) and endometrioid adenocarcinoma (EAC) of the ovary, both of these cancers differ from the other histological types with respect to their clinical characteristics and carcinogenesis. In patients with endometriosis-associated ovarian cancer, benign-appearing ovarian masses are typically present several years before the diagnosis of the cancer. A slightly elevated carbohydrate antigen [CA] 125 level is also typically present many years before the diagnosis in these patients. However, serous-type ovarian cancer may exhibit a rapid progression possibly through de-novo carcinogenesis. Ovarian endometrioma could be viewed as a neoplastic process, particularly in perimenopausal women. Understanding the mechanisms of the development of endometriosis and elucidating its pathogenesis and pathophysiology are intrinsic to the prevention of endometriosis-associated ovarian cancer and the search for effective therapies. Similar content being viewed by others

References

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Condition tags

endometriosis

MeSH descriptors

Cell Transformation, Neoplastic Cell Transformation, Neoplastic Endometriosis Endometriosis Ovarian Neoplasms Ovarian Neoplasms Precancerous Conditions Precancerous Conditions Adult Age Factors Disease Progression Endometriosis Endometriosis Evidence-Based Medicine Female Humans Japan Japan Mass Screening Mass Screening

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