Cited by 51Endometriosis Research and TreatmentOvarian cancer diagnosis and treatmentEndometrial and Cervical Cancer Treatments

The Endometriotic Tumor Microenvironment in Ovarian Cancer

Open access
Wendel, Jillian R. Hufgard, Wang, Xiyin, Hawkins, Shannon M.·2018·Cancers

Abstract

Women with endometriosis are at increased risk of developing ovarian cancer, specifically ovarian endometrioid, low-grade serous, and clear-cell adenocarcinoma. An important clinical caveat to the association of endometriosis with ovarian cancer is the improved prognosis for women with endometriosis at time of ovarian cancer staging. Whether endometriosis-associated ovarian cancers develop from the molecular transformation of endometriosis or develop because of the endometriotic tumor microenvironment remain unknown. Additionally, how the presence of endometriosis improves prognosis is also undefined, but likely relies on the endometriotic microenvironment. The unique tumor microenvironment of endometriosis is composed of epithelial, stromal, and immune cells, which adapt to survive in hypoxic conditions with high levels of iron, estrogen, and inflammatory cytokines and chemokines. Understanding the unique molecular features of the endometriotic tumor microenvironment may lead to impactful precision therapies and/or modalities for prevention. A challenge to this important study is the rarity of well-characterized clinical samples and the limited model systems. In this review, we will describe the unique molecular features of endometriosis-associated ovarian cancers, the endometriotic tumor microenvironment, and available model systems for endometriosis-associated ovarian cancers. Continued research on these unique ovarian cancers may lead to improved prevention and treatment options.

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Crossref · 10.3390/cancers10080261

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  • The inflammatory tumor microenvironment and its main components play an impact on endometriosis and tumor and malignancy development.

    “The inflammatory tumor microenvironment and its main components, non-tumoral cells (different immune cell types, fibroblasts tumor-associated), soluble factors secreted by both tumoral and non-tumoral cells, such as VEGF, FGF, EGF, IL-6, TNFα and immune checkpoint molecules, play an impact on endometriosis and tumor and malignancy development [45,46].”

    From Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review (2024) · cites this paper as [45]

    Section 3 describes immune cells, fibroblasts and inflammatory mediators in the endometriotic microenvironment, and Section 3.3 links macrophages, IL-6 and TNFα to endometriosis or potential tumor promotion. The cited paper also discusses VEGF, but the passages found do not support the sentence’s specific inclusion of FGF, EGF or immune-checkpoint molecules. Its Abstract says whether the microenvironment causes endometriosis-associated ovarian cancers remains unknown. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • The hypoxic microenvironment of endometriosis causes excessive oxidative stress.

    “This effect is promoted by the hypoxic microenvironment of endometriosis, which is known to cause excessive oxidative stress.”

    From Malignancy in Abdominal Wall Endometriosis: Is There a Way to Avoid It? A Systematic Review (2024) · cites this paper as [45]

    Section 3.1, “Hypoxia and Endothelial Cells” (page unavailable), describes a hypoxic endometriotic microenvironment. Section 3.4, “Altered Metabolism” (page unavailable), says excessive oxidative stress results from high iron in endometriotic cysts, not from hypoxia. The source supports both features of the microenvironment but not the claimed causal link between them. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • The high iron content present in endometriotic lesions may contribute to excessive oxidative stress, which may favor the induction of mutations.

    “The high iron content present in endometriotic lesions may also contribute to this excessive oxidative stress, which may favor the inductions of mutations [45,49].”
  • Angiogenesis promoted by VEGF can establish a local vascular network within endometriotic lesions.

    “An additional important role is played by the angiogenesis promoted by the vascular endothelial growth factor (VEGF) which can establish a local vascular network within endometriotic lesions.”

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Authors
Wendel, J. R. H., Wang, X., & Hawkins, S. M.
Affiliations
Indiana University Indianapolis (US)
Corresponding author
Hawkins, Shannon M.
Venue
Cancers
Publisher
MDPI AG
Published
2018-08-07
Volume
10
Issue
8
Pages
261
ISSN
2072-6694 (ISSN-L)
OpenAlex
W2885482298
Cited by
51
References
221
Citations by year
2026: 2 · 2025: 2 · 2024: 4 · 2023: 8 · 2022: 7 · 2021: 10 · 2020: 6 · 2019: 8 · 2018: 4
FWCI
1.06
Type
journal article
Language
en
Open access
Locations
  • Cancers (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • IUScholarWorks (Indiana University) (submittedVersion, cc-by)
  • Publisher
Funders
  • National Cancer Institute (R03CA19127)
  • Rivkin Center for Ovarian Cancer (Pilot Award)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
Keywords
endometriosis-associated ovarian cancer, endometrioid ovarian cancer, low-grade serous carcinoma, clear cell adenocarcinoma, hypoxia, iron metabolism, estrogen, inflammatory cytokines, chemokines, tumor stroma, immune cells, precision therapy, cancer prevention, animal models

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