Are Endometriosis and Cancer Linked?

Endometriosis itself does not cause cancer. However, increasing evidence shows that patients with endometriosis may be at a greater risk of developing certain types of cancer.

What is cancer?

Cancer refers to uncontrolled cell division leading to the formation of a mass of cells called a tumor.

The relationship between endometriosis and cancer risk is still a matter of ongoing research. Some researchers think that cancer may develop as a secondary effect of endometriosis.

Does endometriosis increase the risk of ovarian cancer?

Ovarian cancer is the formation of tumors in the ovaries. This can occur when the cancerous cells originate in the ovary or spread to the ovary from the fallopian tubes or the peritoneum. Several genetic changes, including mutations in the BRCA1 and BRCA2 genes, greatly increase the risk of ovarian and breast cancers.

The evidence so far suggests that there is a risk of developing endometriosis-associated ovarian cancer. However, this risk remains low at less than 1%. There is also a possibility that women with endometriosis develop endometriosis-associated adenocarcinoma later in life.

What factors add to the risk of ovarian cancer?

Endometriosis is an estrogen-dependent disorder. Estrogen is also can contribute to the development of several cancer types including breast, ovarian, and uterine cancers. According to a 2017 review, genetic factors such as mutations in the ARID1A gene, loss of BAF250a expression, and upregulation of the HNF-1beta protein can all contribute to the malignant transformation of endometriosis lesions. The presence of iron in the fluid of endometriotic cysts may cause oxidative stress, which is one of the main promoting factors for malignancy.

Can endometriosis increase the risk of other cancer types?

Types of cancer that may be associated with endometriosis include ovarian cancer, breast cancer, non-Hodgkin’s lymphoma, and brain tumors.

A 2019 meta-analysis found 39 key genes responsible for both endometriosis and the progression of breast, cervical, ovarian, and endometrial cancers. The study also identified a linker gene called C3AR1. However, the role of this gene in endometriosis is not clear.

Endometrial cancer shares many of the same symptoms as endometriosis. But it is important to note that endometriosis itself is not cancerous. A 2021 study found a strong link between endometriosis/adenomyosis and endometrial cancer. Many of these women had had hysterectomies owing to poor response to hormonal treatment.

Further, a 2022 study among 376 endometrial cancer patients with 51 having concomitant endometriosis found that such an occurrence poses a higher risk of developing simultaneous endometrial and ovarian cancer.

How can laparoscopic deep excision surgery help minimize the risk of cancer?

Laparoscopic deep excision surgery is the only gold standard for confirmed diagnosis and treatment of endometriosis. An ovarian mass that appears that it is an endometrioma, very rarely, may actually be a clear cell carcinoma or an endometrial cell carcinoma, and surgical confirmation is the only way to catch the diagnosis to prevent further growth and initiate appropriate treatment. Other lesions that may characteristically appear as endometriosis, may have other components to them as well. A proper histological examination is the only way to distinguish between endometriosis and cancer.

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