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* The time at which women develop obesity during their life may be a key factor for increased risk for epithelial ovarian cancer. Multiple studies indicate that increased BMI in adolescence and/or early adulthood may confer a greater risk for developing epithelial ovarian cancer.
* The time at which women develop obesity during their life may be a key factor for increased risk for epithelial ovarian cancer. Multiple studies indicate that increased BMI in adolescence and/or early adulthood may confer a greater risk for developing epithelial ovarian cancer.
* Another study postulates that duration and severity of obesity is also associated with increased risk for epithelial ovarian cancer and few others postulate that association of obesity with epithelial ovarian cancer is greater in premenopausal women than post-menopausal.
* Another study postulates that duration and severity of obesity is also associated with increased risk for epithelial ovarian cancer and few others postulate that association of obesity with epithelial ovarian cancer is greater in premenopausal women than post-menopausal.
* Another meta-analysis demonstrated that obesity is associated with not only an increased risk for epithelial ovarian cancer but also with decrease in overall survival and ovarian-cancer specific survival. Another study also showed an increase in ovarian cancer- related mortality in obese women.
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*  


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 14:36, 1 March 2019


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2]

An attempt to explain the origin of carcinogenesis in sporadic epithelial carcinoma

Proposed

hypothesis

Proposed

Mechanism

For Against
Incessant ovulation[1][2][3][4][5][6]
  • Every ovulatory cycle leads to epithelial injury and resultant repairs make cells more susceptible to mutations
  • Increased incidences of ovarian epithelial cancers in advanced age (increased number of cycles)
  • Factors that decrease ovulatory cycles such as oral contraceptive use, pregnancy and breast-feeding decrease the risk for ovarian epithelial cancer
  • Progesterone only oral contraceptives do not inhibit ovulatory cycles but still decrease the risk for ovarian epithelial cancers
  • Polycystic ovarian syndrome (PCOS) decreases the number of ovulatory cycles but increases the risk for ovarian epithelial cancer.
Gonadotropins[1][6][7][8][9][10][11]
  • Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and human chorionic gonadotropin stimulate ovarian epithelial cells proliferation
  • Resultant increased mitotic activity make cells more susceptible to mutations
  • Higher incidences of epthelial ovarian cancers in women taking infertility drugs in some studies
  • Polycystic ovarian syndrome (PCOS) and infertility increase the risk for ovarian epithelial cancers
  • Progesterone only oral contraceptives decrease the risk for ovarian epithelial cancers
  • Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are shown to increase cell proliferation in some studies
  • Up-regulation of Cox-1 and Cox-2 and resultant increase in PGE2 by follicle-stimulating hormone (FSH) and luteinizing hormone (LH) has been observed
  • Up-regulation of potential oncogenes in vitro such as EGFR, HER-2, and c-myc, cyclin G2, Meis-1, β-catenin, β-1 integrin, and IGF-1 by Follicle-stimulating hormone (FSH) receptor over-expression
  • Some studies suggest that infertility, rather than gonadotropin drugs treatment, increases the susceptibility to epithelial ovarian cancers
  • No concrete linkage of gonadotropins to malignant transformation of surface epithelial cells of ovaries
  • Proposed hypothesis of gonadotropin role in tumor cell growth and survival rather than origin
Hormonal influence[1][5][6][12][13][14]
  • Androgens confer greater risk to epithelial ovarian cancer while progesterone decreases the rik
  • Conditions that result in androgenic excess such as Polycystic ovarian syndrome (PCOS), hirsutism, and acne have been shown to increase the risk for epithelial ovarian cancer
  • Andorgens can stimulate cellular proliferation (androgens are are thought to be pre-dominant in ovarian inclusion cysts)
  • Progesterone only oral contraceptives decrease the risk for ovarian epithelial cancers, possibly through decreased androgens
  • No concrete linkage of androgens to malignant transformation of surface epithelial cells of ovaries
  • No evidence of androgens and their precursors affecting cancer cells growth
Inflammation[1][10][15][16]
  • Cytokines and inflammatory cells are involved in ovulation and repair and increase susceptibility to mutations and carcinogenesis
  • Non-steroidal anti-inflammatory drugs (NSAIDS) and Aminosalicylic acid (ASA) are thought to decrease the risk for epithelial ovarian cancer
  • Chemicals that cause inflammation such as talc and asbestos are shown to be associated with an increased risk for epithelial ovarian cancer
  • Inflammatory pathways and mediators have been observed in tumor pathogenesis and tumor micro-environment
  • No established linkage between talc and asbestos with pathogenesis of epithelial ovarian cancers in animal studies

Obesity a risk factor for epithelial cancer

  • A British study comprising of 1.2 million women found that incidences of epithelial ovarian cancer were higher among women with BMI >30 as compared to women with normal BMI, with risk increasing with incremental increase in BMI. A meta-analysis conducted Olsen et al.also found an increase risk for epithelial ovarian cancer in obese women.
  • It has been hypothesized that waist to hip ratio provides a better risk determination for epithelial ovarian cancer because of more accuracy in assessing true visceral fat deposition but remains to be validated.
  • The time at which women develop obesity during their life may be a key factor for increased risk for epithelial ovarian cancer. Multiple studies indicate that increased BMI in adolescence and/or early adulthood may confer a greater risk for developing epithelial ovarian cancer.
  • Another study postulates that duration and severity of obesity is also associated with increased risk for epithelial ovarian cancer and few others postulate that association of obesity with epithelial ovarian cancer is greater in premenopausal women than post-menopausal.
  • Another meta-analysis demonstrated that obesity is associated with not only an increased risk for epithelial ovarian cancer but also with decrease in overall survival and ovarian-cancer specific survival. Another study also showed an increase in ovarian cancer- related mortality in obese women.

References

  1. ↑ 1.0 1.1 1.2 1.3 Saad AF, Hu W, Sood AK (December 2010). "Microenvironment and pathogenesis of epithelial ovarian cancer". Horm Cancer. 1 (6): 277–90. doi:10.1007/s12672-010-0054-2. PMC 3199131. PMID 21761359.
  2. ↑ Riman T, Dickman PW, Nilsson S, Correia N, Nordlinder H, Magnusson CM, Persson IR (August 2002). "Risk factors for invasive epithelial ovarian cancer: results from a Swedish case-control study". Am. J. Epidemiol. 156 (4): 363–73. PMID 12181107.
  3. ↑ Gwinn ML, Lee NC, Rhodes PH, Layde PM, Rubin GL (1990). "Pregnancy, breast feeding, and oral contraceptives and the risk of epithelial ovarian cancer". J Clin Epidemiol. 43 (6): 559–68. PMID 2348208.
  4. ↑ Nasca PC, Greenwald P, Chorost S, Richart R, Caputo T (May 1984). "An epidemiologic case-control study of ovarian cancer and reproductive factors". Am. J. Epidemiol. 119 (5): 705–13. PMID 6539067.
  5. ↑ 5.0 5.1 Risch HA (December 1998). "Hormonal etiology of epithelial ovarian cancer, with a hypothesis concerning the role of androgens and progesterone". J. Natl. Cancer Inst. 90 (23): 1774–86. PMID 9839517.
  6. ↑ 6.0 6.1 6.2 Schildkraut JM, Schwingl PJ, Bastos E, Evanoff A, Hughes C (October 1996). "Epithelial ovarian cancer risk among women with polycystic ovary syndrome". Obstet Gynecol. 88 (4 Pt 1): 554–9. PMID 8841217.
  7. ↑ Choi KC, Kang SK, Tai CJ, Auersperg N, Leung PC (May 2002). "Follicle-stimulating hormone activates mitogen-activated protein kinase in preneoplastic and neoplastic ovarian surface epithelial cells". J. Clin. Endocrinol. Metab. 87 (5): 2245–53. doi:10.1210/jcem.87.5.8506. PMID 11994371.
  8. ↑ Lau MT, Wong AS, Leung PC (July 2010). "Gonadotropins induce tumor cell migration and invasion by increasing cyclooxygenases expression and prostaglandin E(2) production in human ovarian cancer cells". Endocrinology. 151 (7): 2985–93. doi:10.1210/en.2009-1318. PMID 20392831.
  9. ↑ Choi JH, Choi KC, Auersperg N, Leung PC (November 2004). "Overexpression of follicle-stimulating hormone receptor activates oncogenic pathways in preneoplastic ovarian surface epithelial cells". J. Clin. Endocrinol. Metab. 89 (11): 5508–16. doi:10.1210/jc.2004-0044. PMID 15531506.
  10. ↑ 10.0 10.1 Ness RB, Cottreau C (September 1999). "Possible role of ovarian epithelial inflammation in ovarian cancer". J. Natl. Cancer Inst. 91 (17): 1459–67. PMID 10469746.
  11. ↑ Zheng W, Lu JJ, Luo F, Zheng Y, Feng Y, Felix JC, Lauchlan SC, Pike MC (January 2000). "Ovarian epithelial tumor growth promotion by follicle-stimulating hormone and inhibition of the effect by luteinizing hormone". Gynecol. Oncol. 76 (1): 80–8. doi:10.1006/gyno.1999.5628. PMID 10620446. Vancouver style error: initials (help)
  12. ↑ Rosenberg L, Palmer JR, Zauber AG, Warshauer ME, Lewis JL, Strom BL, Harlap S, Shapiro S (April 1994). "A case-control study of oral contraceptive use and invasive epithelial ovarian cancer". Am. J. Epidemiol. 139 (7): 654–61. PMID 8166126.
  13. ↑ Edmondson RJ, Monaghan JM, Davies BR (March 2002). "The human ovarian surface epithelium is an androgen responsive tissue". Br. J. Cancer. 86 (6): 879–85. doi:10.1038/sj.bjc.6600154. PMC 2364138. PMID 11953818.
  14. ↑ Seeger H, Wallwiener D, Mueck AO (2006). "Is there a protective role of progestogens on the proliferation of human ovarian cancer cells in the presence of growth factors?". Eur. J. Gynaecol. Oncol. 27 (2): 139–41. PMID 16620055.
  15. ↑ Altinoz MA, Korkmaz R (2004). "NF-kappaB, macrophage migration inhibitory factor and cyclooxygenase-inhibitions as likely mechanisms behind the acetaminophen- and NSAID-prevention of the ovarian cancer". Neoplasma. 51 (4): 239–47. PMID 15254653.
  16. ↑ Heller DS, Westhoff C, Gordon RE, Katz N (May 1996). "The relationship between perineal cosmetic talc usage and ovarian talc particle burden". Am. J. Obstet. Gynecol. 174 (5): 1507–10. PMID 9065120.
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