Endometriosis, hormonal therapy and oncological risks

Literature review

Authors

DOI:

https://doi.org/10.18370/2309-4117.2021.59.61-65

Keywords:

endometriosis, cancer risks, ovarian cancer

Abstract

Endometriosis is now considered as benign disease. However, a correlation was found between endometriosis and several types of cancer. Endometriomas are found in 17–44% of patients with endometriosis and can be frequent precursors of ovarian cancer (endometrioid and clear cell ovarian tumors are more common). This process can be realized through several mechanisms: predominance of certain cytokines, oxidative stress and local hyperestrogenia, genetic mutations including PTEN, PIK3CA, ARID1A, Wnt/β-catenin, microsatellite instability, Src and KRAS.
There are no generally accepted approaches to non-invasive early diagnosis of ovarian cancer, especially in borderline tumors and early stages of malignancy. The lack of accurate screening programs for ovarian cancer emphasizes the importance of identifying high-risk, moderate-risk, and low-risk groups. Screening is not recommended in the general population in the low-risk group. Annual CA125 evaluation and transvaginal pelvic ultrasound with general and special gynecological examination are recommended in the moderate-risk group in postmenopause. Transvaginal ultrasound of the pelvic organs with CA125 evaluation is performed every 6 months in the high-risk group, starting from 30 years or 5–10 years before the youngest age of ovarian cancer onset in relatives. The main method of diagnosing tumors is expert ultrasound of the pelvic organs (simultaneously with transabdominal ultrasound). The main tumor markers are CA125 (single evaluation has low diagnostic value), risk malignancy index (RMI) and HE4.
Clinical trials are going on and various methods of prevention, screening and treatment of these diseases are being developed. Probably, dienogest can help to solve the problem. Existing results of research are promising, but insufficient since they show both the positive effects of progestin therapy and minor cases of cancer detection during therapy that are not related to the use of progestins, but probably indicate unknown mechanisms of transformation in endometriosis.

Author Biography

A.M. Grigorenko, National Pirogov Memorial Medical University; Medical Center “Innomed – Center for Endosurgery”, Vinnytsia

MD, professor, head of the course of oncogynecology and operative gynecology, Department of Obstetrics and Gynecology No. 2;

Oncogynecologist

References

Kovacs, P. “Endometriosis: 5 Things to Know.” Available from: [https://www.medscape.com/viewarticle/898403], last accessed June 19, 2021.

Lee, A.W., Templeman, C., Stram, D.A.; Ovarian Cancer Association Consortium. “Evidence of a genetic link between endometriosis and ovarian cancer.” Fertil Steril 105 (2016): 35–43.

The Royal College of Obstetrician and Gynaecologists. The Management of Ovarian Cysts in Postmenopausal Women. RGOG Greentop Guideline No. 34 (2016).

Shamarakova, M.V., Adamyan, L.V., Asaturova, A.V. “Seromucinous ovarian tumors and endometriosis in women of reproductive age.” Journal: Obstetrics and gynecology 7.4 (2015): 40–50. DOI: 10.18565/aig.2018.7.84-91

Brinton, L.A., Gridley, G., Persson, I., et al. “Cancer risk after a hospital discharge diagnosis of endometriosis.” Am J Obstet Gynecol 176 (1997): 572–9.

Melin, A., Sparen, P., Persson, I., et al. “Endometriosis and the risk of cancer with special emphasis on ovarian cancer.” Hum Reprod 21 (2006): 1237–42.

Pearce, C.L., Templeman, C., Rossing, M.A., et al.; Ovarian Cancer Association Consortium. “Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case-control studies.” Lancet Oncol 13 (2012): 385–94.

Vercellini, P., Viganò, P., Somigliana, E., Fedele, L. “Endometriosis: pathogenesis and treatment.” Nat Rev 10 (2014): 261–75.

Stern, R.C., Dash, R., Bentley, R.C., et al. “Malignancy in endometriosis: frequency and comparison of ovarian and extraovarian types.” Int J Gynecol Pathol 20 (2001): 133–9.

Zaino, R., Whitney, C., Brady, M.F., et al. “Simultaneously detected endometrial and ovarian carcinomas – a prospective clinicopathologic study of 74 cases: a gynecologic oncology group study.” Gynecol Oncol 83 (2001): 355–62.

Nezhat, F., Shoma, D.M., Hanson, V. “The relationship of endometriosis and ovarian malignancy: a review.” Fertil Steril 90 (2008): 1559–70.

Honda, M., Isono, W., Tsuchiya, A., et al. “Significant Risk Factors for Malignant Transformation of Ovarian Endometrioma During Dienogest.” Treatment J Med Case Reports 13.314 (2019).

Stewart, B.W., Wild, С.Р. World cancer report. Lyon. IARC (2014): 916 p.

Clinical gynecological oncology, 3 vol. Ed. by F.J. Disai, U.T. Chrisman, E.G. Novikova. Moscow. Practical medicine (2012). Vol. 3.

U.S. Preventive Services Task Force (USPSTF). Final Recommendation Statement: Ovarian Cancer: Screening (2016).

British Gynaecological Cancer Society (BGCS). Epithelial Ovarian/Fallopian Tube/Primary Peritoneal Cancer Guidelines: Recommendations I for Practice (2017).

Grossman, D.C., Curry, S.J., Owens, D.K., et al. “Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement.” JAMA 13.319 (2018): 6V588 – 594.

Clark-Pearson, D., Soper, J. Gynecological Cancer Management. Identification, diagnosis and treatment (2010): 196 p.

Hannaford, P.C., Selvaraj, S., Elliott, A.M., et al. “Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner’s oral contraception study.” BMJ 335 (2007): 651.

Frank, G.A., Moskvina, L.V., Andreeva, Y.Y. “New classification of ovarian tumors.” Journal: Archive of pathology 7.4 (2015): 40–50. DOI: 10.17116/patol201577440-50

Brown, D.L., Andreotti, R.F., Lee, S.I., et al. “ACR appropriateness criteria ovarian cancer screening.” Ultrasound Q 26.4 (2010): 219–23.

Timmerman, D.V.L., Bourne, Т.Н., Collins, W.P., et al. “Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) group.” Ultrasound Obstet Gynecol 16 (2000): 500–5.

Tu, F.F., Du, H., Goldstein, G.P., et al. “The influence of prior oral contraceptive use on risk of endometriosis is conditional on parity.” Fertil Steril online (2014).

The National Institute for Health and Care Excellence. Ovarian cancer: recognition and initial management. Clinical guideline (2011). Available from: [https://www.nice.org.uk/terms-and-conditions#notice-ofiights].

The American College of Obstetricians and Gynecologists. The Role of the Obstetrician-Gynecologist in the Early Detection of Epithelial Ovarian Cancer in Women at Average Risk. ACOG Committee Opinion. SGO No. 716 (2017).

Vessey, M., Painter, R. “Oral contraceptive use and cancer. Findings in a large cohort study, 1968—2004.” Br J Cancer 95 (2006): 385–9.

Katsuki, Y., Takano, Y., Futamura, Y., et al. “Effects of dienogest, a synthetic steroid, on experimental endometriosis in rats.” Eur J Endocrinol 138.2 (1998): 216–26. DOI: 10.1530/eje.0.1380216

Attia, G.R., Zeitoun, K., Edwards, D., et al. “Progesterone receptor isoform A but not B is expressed in endometriosis.” J Clin Endocrinol Metab 85 (2000): 2897–902.

Matsuzaki, S., Murakami, T., Uehara, S., et al. “Expression of estrogen receptor alpha and beta in peritoneal and ovarian endometriosis.” Fertil Steril 75 (2001): 1198–205.

Seeger, H., Wallwiener, D., Kraemer, E., Mueck, A.O. “Estradiol metabolites are potent mitogenic substances for human ovarian cancer cells.” Eur J Gynaecol Oncol 26 (2005): 383–5.

Tatarchuk, T.F. “A rational approach to the use of combined oral contraceptives for endometriosis.” Zhinochiy likar 5.61 (2015): 24–31.

Berlanda, N., Somigliana, E., Viganò, P., Vercellini, P. “Safety of medical treatments for endometriosis.” Expert Opin Drug Saf 15.1 (2016): 21–30. DOI: 10.1517/14740338.2016.1121991

Morotti, M., Sozzi, F., Remorgida, V., et al. “Dienogest in women with persistent endometriosis-related pelvic pain during norethisterone acetate treatment.” Eur J Obstet Gynecol Reprod Biol 183 (2014): 188–92. DOI: 10.1016/j.ejogrb.2014.10.036

Gedeon Richter Plc. Randomized, open-label, 2-way crossover bioequivalence study of dienogest 2 mg film-coated tablet and visanne (reference) following a 2 mg dose in healthy subjects under fasting conditions. Final Integrated Clinical and Statistical Report, Version 01 (2015).

Fedotcheva, T.A., Shimanovskiy, N.L. “Gestagens in the treatment of endometriosis.” Endocrinology problems 64.1 (2018): 54–61. DOI: 10.14341/probl8742

Andres, M.P., Lopes, L.A., Baracat, E.C., Podgaec, S. “Dienogest in the treatment of endometriosis: systematic review.” Arch Gynecol Obstet 292.3 (2015): 523–9. DOI: 10.1007/s00404-015-3681-6

Bizzarri, N., Remorgida, V., et al. “Dienogest in the treatment of endometriosis.” Expert Opin Pharmacother 15.13 (2014): 1889–902. DOI: 10.1517/14656566.2014.943734

McCormack, P.L. “Dienogest: a review of its use in the treatment of endometriosis.” Drugs 70.16 (2010): 2073–88. DOI: 10.2165/11206320-000000000-00000

Practice Committee of the American Society for Reproductive Medicine. “Treatment of pelvic pain associated with endometriosis: a committee opinion.” Fertil Steril 101 (2014): 927–35. DOI: 10.1016/j.fertnstert.2014.02.012

Olive, D.L., ed. Seminars in Reproductive Medicine. N.Y. Thieme Medical Publishers (2003).

Laschke, M.W., Menger, M.D. “Anti-angiogenic treatment strategies for the therapy of endometriosis.” Hum Reprod Update 18.6 (2012): 682–702. DOI: 10.1093/humupd/dms026

Miyashita, M., Koga, K., Takamura, M., et al. “Dienogest reduces proliferation, aromatase expression and angiogenesis, and increases apoptosis in human endometriosis.” Gynecol Endocrinol 30.9 (2014): 644–8. DOI: 10.3109/09513590.2014.911279

Hayashi, A., Tanabe, A., Kawabe, S., et al. “Dienogest increases the progesterone receptor isoform B/A ratio in patients with ovarian endometriosis.” J Ovarian Res 5.1 (2012): 31. DOI: 10.1186/1757-2215-5-31

Römer, T. “Long-term treatment of endometriosis with dienogest: retrospective analysis of efficacy and safety in clinical practice.” Arch Gynecol Obstet 298.4 (2018): 747–53. DOI: 10.1007/s00404-018-4864-8.

Barbieri, R.L. “Hormone treatment of endometriosis: the estrogen threshold hypothesis.” Am J Obstet Gynecol 166.2 (1992): 740–5.

Strowitzki, T., Faustmann, T., Gerlinger, C., Seitz, C. “Dienogest in the treatment of endometriosis-associated pelvic pain: a 12-week, randomized, double-blind, placebo-controlled study.” Eur J Obstet Gynecol Reprod Biol 151.2 (2010): 193–8. DOI: 10.1016/j.ejogrb.2010.04.002

Petraglia, F., Hornung, D., Seitz, C., et al. “Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment.” Arch Gynecol Obstet 285.1 (2012): 167–73. DOI: 10.1007/s00404-011-1941-7

Kim, S.E., Lim, H.-H., Lee, D.-Y., Choi, D.S. “The Long-Term Effect of Dienogest on Bone Mineral Density After Surgical Treatment of Endometrioma.” Reprod Sci 28.5 (2021): 1556–62. doi: 10.1007/s43032-020-00453-7

Mettler, L., Ruprai, R., Alkatout, I. “Impact of medical and surgical treatment of endometriosis on the cure of endometriosis and pain.” Biomed Res Int 2014 (2014): 264653. DOI: 10.1155/2014/264653

Yap, C., Furness, S., Farquhar, C. “Pre and post operative medical therapy for endometriosis surgery.” Cochrane Database Syst Rev 140 (2004): CD003678.

Vercellini, P., Buggio, L., Somigliana, E. “Role of medical therapy in the management of deep rectovaginal endometriosis.” Fertil Steril 108.6 (2017): 913–30. DOI: 10.1016/j.fertnstert.2017.08.038

Yamanaka, A., Hada, T., Matsumoto, T., et al. “Effect of dienogest on pain and ovarian endometrioma occurrence after laparoscopic resection of uterosacral ligaments with deepin filtrating endometriosis.” Eur J Obstet Gynecol Reprod Biol 216 (2017): 51–5. DOI: 10.1016/j. ejogrb.2017.07.014

Ruderman, R., Pavone, M.E. “Ovarian cancer in endometriosis: an update on the clinical and molecular aspects.” Minerva Ginecol 69.3 (2017): 286–94. DOI: 10.23736/S0026-4784.17.04042-4

Published

2021-07-22

Issue

Section

Tumors and pretumoral pathology