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Women with endometriosis have about a four-fold increased risk of developing ovarian cancer compared to those without the condition, according to a new study published in JAMA. The risk projection highlights the need for regular screening.
Endometriosis, affecting a large number of women in the 15-44 age group, is a condition in which cells similar to the lining of the uterus, or endometrium, grow outside the uterus. This tissue overgrowth can envelop ovaries, fallopian tubes and even affect nearby organs, including the bowel and bladder.
“The risk increases when women have deep-infiltrating or ovarian endometriosis (chocolate cysts). The study is now putting a figure to that risk, saying it goes up by approximately 9.7 times,” says Dr Sonal Kumta, senior consultant obstetrician and gynaecologist, Fortis Hospital. Excerpts:
What’s deep infiltrating endometriosis?
Deep-infiltrating endometriosis differs significantly from surface endometriosis in its severity and location. Unlike surface endometriosis, which is confined to the tissue lining the abdominal wall and pelvic cavity, deep infiltrating endometriosis goes 5 mm beneath that lining and covers deeper tissues and surrounding organs. This form of endometriosis often causes more intense symptoms, such as chronic pain and significant organ dysfunction. The increased risk of ovarian cancer associated with deep infiltrating endometriosis may be due to the chronic inflammation and cellular changes that occur in these deeply embedded tissues, creating an environment conducive to the development of malignancies.
Endometriosis is known to be difficult to diagnose accurately. What are diagnostic tools to do so?
Endometriosis is challenging to diagnose due to its varied symptoms and similarities to other conditions. Laparoscopy remains the gold standard for diagnosis, offering direct visualisation of lesions. However, it is impractical to perform laparoscopy on every patient. Instead, a preliminary diagnosis often relies on pelvic ultrasound and measuring CA 125 levels, which can indicate endometriosis. In cases where further investigation is necessary, MRI (magnetic resonance imaging) of the pelvis is done.
What preventive measures or early detection strategies do you recommend for women with endometriosis to mitigate the risk of developing ovarian cancer?
Given the lack of reliable screening tests for ovarian cancer, I recommend that they undergo annual gynaecological examinations. This includes both trans-abdominal and trans-vaginal pelvic ultrasounds to monitor for abnormalities. Additionally, a blood test and measuring CA 125 levels can help identify potential issues early. These preventive measures, while not foolproof, can potentially minimise the risk of developing ovarian cancer.
How do you determine when surgery is necessary?
That’s based on several factors: symptom severity, particularly pain, the desire to enhance fertility and the extent and degree of the endometriosis. Surgical interventions vary according to the patient’s needs. For fertility enhancement, procedures such as ovarian cystectomy, drainage of endometriotic cysts and cauterization of endometrial lesions are considered. In more severe cases, or for older patients with extensive disease, radical procedures like hysterectomy (removal of uterus) and bilateral oophorectomy (removal of ovaries) may be necessary. The involvement of a gynaecologic oncologist is crucial if cancer is suspected.
