The Link Between Endometriosis and Cancer
We all know that Endometriosis is a debilitating disease, but many people don’t realise the possible future implications of this disease, mixed with our highly inflammatory diets and lifestyle. It is a recipe for an inflammatory disease to actually turn into cancerous states. There have been many studies to date showing the link between inflammation and cancer and endometriosis is definitely an inflammatory disease that needs to be treated and prevented before it could turn to cancer.
We need to really take this disease more seriously than our patients, and many in the medical community probably realise. Prevention is always the key to any disease, and endometriosis could possibly be prevented through proper education, looking into family history and looking into the parental mode of inheritance and knowing more about gene expression and expression of disease states in the body. This is why I think all young girls should be educated about what a proper menstrual cycle should be like and that period pain is not normal. Through proper education about diet and lifestyle inflammatory diseases, such as endometriosis, could be prevented from happening and early intervention with herbal medicines and other natural anti-inflammatories, medical treatments, interventions and education could also help to prevent it from becoming worse than it already is. We also need to educate all that young girls can have endometriosis and that early intervention and treatment is their best chance for their future health and fertility too.
Endometriosis, like cancer, is characterised by cell invasion and unrestrained growth. Furthermore, endometriosis and cancer are similar in other aspects, such as the development of new blood vessels and a decrease in the number of cells undergoing apoptosis. In spite of these similarities, endometriosis is not considered a malignant disorder.
The possibility that endometriosis could, however, transform and become cancer has been debated in the literature since 1925. Mutations in the genes that encode for metabolic and detoxification enzymes, such as GALT and GSTM, have been implicated in the pathogenesis of endometriosis and in the progression to carcinoma of the ovary (Swiersz 2006). PTEN, a tumour suppressor commonly mutated (50%) in endometrial carcinoma, is found mutated in endometrioid carcinoma of the ovary, but not in other forms of ovarian cancer. There are data to support that ovarian endometriosis could have the potential for malignant transformation. Epidemiologic and genetic studies support this notion. It seems that endometriosis is associated with specific types of ovarian cancer (endometrioid and clear cell) (Vlahos et al, 2010). The relationship between endometriosis and ovarian cancer is an intriguing and still poorly investigated issue. Specifically, histological findings indicate a definitive association between endometriosis and endometrioid/clear cell carcinoma of the ovary (Parihar&Mirge 2009).
A recent study has shown that somatic mutations in the PTEN gene were identified in 20% of endometrioid carcinomas and 20.6% of solitary endometrial cysts, suggesting that inactivation of the PTEN tumor suppressor gene is an early event in the development of ovarian endometrioid carcinoma. In addition to cancerous transformation at the site of endometriosis, there is recent evidence to indicate that having endometriosis itself may increase a woman’s risk of developing non-Hodgkin’s lymphoma, malignant melanoma, and breast cancer (Swiersz 2006).
Women with endometriosis appear to be more likely to develop certain types of cancer. Brinton, PhD, Chief of the Hormonal and Reproductive Epidemiology branch at the National Cancer Institute has studied the long-term effects of endometriosis, which led her to Sweden about 20 years ago. Using the country’s national inpatient register, she identified more than 20,000 women who had been hospitalised for endometriosis. After an average follow-up of more than 11 years, the risk for cancer among these women was elevated by 90% for ovarian cancer, 40% for hematopoietic cancer (primarily non-Hodgkin’s lymphoma), and 30% for breast cancer. Having a longer history of endometriosis and being diagnosed at a young age were both associated with increased ovarian cancer risk (Brinton et al, 1997).
Farr Nezhat, MD, Chief of Gynecologic Minimally Invasive Surgery and Robotics at St. Luke’s and Roosevelt Hospitals in New York City and Professor of Obstetrics and Gynecology at Columbia University, spoke on the pathogenesis of endometriosis and ovarian cancer. He said studis suggest that alterations in bcl-2 and p53 may be associated with the malignant transformation of endometriotic cysts (Nezhat et al, 2002). Dr.Nezhat also cited research on the link between epithelial ovarian cancer and endometriosis. According to a 2000 study of women with ovarian cancer by Hiroyuki Yoshikawa and colleagues, endometriosis was present in 39% of the women with clear cell tumours and 21% of those with endometrioid tumours, vs just 3% of those with serous or mucinous tumours. Endometriosis may be the precursor of clear cell or endometrioid ovarian cancer (Yoshikawa et al, 2000).
If you combine inflammation with oestrogen as with both endometriosis and ovarian or uterine cancers, it’s going to be a vicious circle, as the 2 diseases share numerous other characteristics. For example, both are related to early menarche and late menopause, infertility, and nulliparity. Factors that relieve or offer protection against both conditions include tubal ligation, oral contraceptives, hysterectomy, and progesterone exposure.
Some authors also suggest that there is an also increased risks of colon cancer, ovarian cancer, thyroid cancer non-Hodgkin’s lymphoma and malignant melanoma in women with endometriosis when compared with the general population (Brinton et al, 2005).
If you do have patients with endometriosis you do need to take into consideration the future implications of this disease, not only the pain and turmoil it causes on the way, but also the future possibility that endometriosis could also lead to cervical cancer, ovarian cancer, or many of the other cancers that can be found in the body.
There are complementary medicine treatments that can also help to suppress and treat microscopic endometriosis implants, but they also help to treat the inflammation fuelling the disease as well. There are also complementary medicines to increase circulation and improve the lining of the uterus and surrounding structures and also help suppress cancerous cells seen with CIN. We need to combine these with medical treatments, interventions and investigations to give patients the best possible chance with beating this disease. The Royal College of Obstetricians & Gynaecologists now recommend using complementary medicines such as Chinese Herbal Medicine, Acupuncture and Naturopathy, alongside medical approaches, for endometriosis in their guidelines for the treatment of this disease.
Obviously we all need to get our patients onto a grain free, anti-inflammatory diet to also help with the prevention of these diseases such as endometriosis, plus supplements such as omega 3 oils and antioxidants that also offer protection and prevention against inflammatory diseases too.
Hope this helps everyone to understand a bit more about endometriosis and expand your learning about this disease state a bit more. Gets you thinking doesn’t it.