EFA Medical Conference 2017: "Ovarian Cancer" Presentation by  Dr. Jeannine Villella

Dr. Jeannine Villella gave a presentation at the 2017 EFA Medical Conference that looked at the relationship between endometriosis and ovarian cancer.

Key Points

Highlights:

• Dr. Jeannine Villella, the Chair of Gynecologic Oncology in the Department of OBGYN at Lenox Hill,  talked about the similarities, differences, and links between endometriosis and ovarian cancer, at the 2017 EFA Medical Conference.

Importance:

• It is essential to understand the relationship between endometriosis and ovarian cancer because it can lead to a better mechanistic understanding of the diseases. Additionally, research in this field can help clinicians determine the best way to treat these disorders in whichever form it appears.

Key points:

• An individual with endometriosis has a 1.6% risk of malignancy and a three-fold increased risk of clear cell carcinoma for the individual with endometrioma.
• Ovarian cancer is the 6th most common cancer to affect women, and clear cell ovarian carcinoma is most strongly associated with endometriosis.
• Endometriosis and ovarian cancer are similar in that they can be local or can travel to other parts of the body when metastasizing.
• Endometriosis and ovarian cancer progress through inflammatory mechanisms.
• Most common type "high-grade ovarian cancers" begin de novo in the fallopian tubes, not the ovaries as initially hypothesized.
• Endometriosis and ovarian cancer have similar risk factors (increased risk for those never given birth, early menstruation, and infertility).
• The main difference between endometriosis and ovarian cancer is that endometriosis is not as catabolic nor is it fatal.
• There has yet to be a determined causal link between endometriosis and ovarian cancer.
• Dr. Villella discussed a variety of studies that showed a positive association relationship between endometriosis and cancer. Only one study that was the exception to this rule.
• Ovarian cancer treatment has changed in that pathway analysis is used to determine the best course of treatment for the tumor and the patient at large. This is because the molecular basis of cancer can change from patient to patient. It is thought that this type of targeted therapy can be useful for those with endometriosis as well.
• The HER2 family (EGFR and HER2) are crucial for the development of many tumors and are expressed in higher quantities in clear cell carcinoma. EGFR amplification hypothesized to be essential for clear cell carcinoma growth. The PI3K gene is mutated, and if that mutation occurs in the early stages, the patient can quickly overcome its effects.
• One of the most significant issues with endometriosis surgery is preserving fertility that necessitates multiple multi-specialty operations. Patients need to be screened and diagnosed earlier.
• Endometriosis studies can take a long time to complete because of small sample sizes. Dr. Villella suggests combining the groups to reach conclusions more quickly.

Lay Summary

Dr. Jeannine Villella, the Chair of Gynecologic Oncology in the Department of OBGYN at Lenox Hill, presented at the 2017 EFA Medical Conference. Her presentation was titled “Ovarian Cancer, ” and she discussed the similarities, differences, and links between ovarian cancer and endometriosis.

Dr. Villella begins the presentation by discussing various statistics related to endometriosis and ovarian cancer. She then proceeds to delineate the similarities and differences between the two diseases. There were more similarities discussed than differences; however, there has yet to be a determined causal relationship between the two conditions. Dr. Villella talks about a variety of studies that showed an increased risk of ovarian cancer in individuals with endometriosis. She analyzes these studies for their strengths and limitations.

Dr. Villella then proceeds to talk about treatment for ovarian cancer as it is specialized based on the molecular pathways of the tumor itself. She believes that such specialized therapies could be pertinent to those suffering from endometriosis. While on the subject of molecular pathogenesis, Dr. Villella discusses the mechanisms driving tumor formation and growth.

In the last part of her presentation, Dr. Villella talks specifically about surgery. She states that those suffering from endometriosis who wish to preserve their fertility are often faced with the prospect of going through many operations. She also briefly discusses screening and diagnosis. Dr. Villella ends the presentation by offering suggestions for the betterment of future endometriosis research.

Dr. Villella’s full presentation can be found at the following URL: https://www.endofound.org/video/ovarian-cancer-jeannine-villella-do-facog-facs/1553.