Managing cancer of the uterus and ovary: BC has the right approach

Issue: BCMJ, vol. 58 , No. 2 , March 2016 , Pages 91 News

Scientists at the BC Cancer Agency, Vancouver Coastal Health Research Institute, and UBC have come to a new understanding of the origin and development of cancer that occurs in the uterus and ovary simultaneously. Known as synchronous endometrial and ovarian (SEO) cancer, tumors on the endometrial lining of the uterus appear simultaneously with tumors on the ovary, and vice versa. SEO cancers have been reported in 5% to 10% of endometrial or ovarian cancers.

The spread of a tumor from one organ to another is virtually always an indication of an advanced-stage cancer that requires aggressive treatment with chemotherapy, radiation therapy, or both. However, SEO tumors behave as if they are independent, localized early-stage tumors that often respond well to surgery alone. 

Controversy regarding whether SEO cancer is metastatic has led to widely differing treatments. A new study provides evidence that each pair of SEO tumors are genetically related clones and confirms for researchers that the right approach to SEO cancers is being taken in BC, where SEO cancer patients have generally been treated conservatively by surgically removing the tumors. The findings may also influence treatment of the disease elsewhere. Worldwide, many women with SEO tumors receive aggressive treatment designed to fight late-stage metastatic cancer.

Scientists point to pseudo-metastasis to explain the apparent paradox of the same cancer appearing simultaneously as two independent early-stage tumors on two different organs and propose that the process is distinct from usual metastasis in that the cancer likely spreads through the fallopian tube, not the bloodstream, and the host organs (ovary and uterus) provide a unique environment where these cancers are initially constrained. Researchers in the Department of Molecular Oncology at the BC Cancer Agency are now investigating whether the initial event takes place in the ovary or the endometrium, and what keeps cells temporarily restricted to these organs without metastasizing to the rest of the body.

The article “Synchronous Endometrial and Ovarian Carcinomas: Evidence of Clonality” is published in the June 2016 issue of the Journal of the National Cancer Institute (available online now at http://jnci.oxfordjournals.org/content/108/6). A complementary study from the Memorial Sloan Kettering Cancer Center is published in the same issue along with an editorial about the two studies.

. Managing cancer of the uterus and ovary: BC has the right approach. BCMJ, Vol. 58, No. 2, March, 2016, Page(s) 91 - News.



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