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The Role of the Microenvironment in Endometriosis: Parallels and Distinctions to Cancer

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Biomarkers of the Tumor Microenvironment

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Abstract

Phenotypes viewed as distinctive to cancer are often recapitulated in benign disease and consideration of these diseases can inform our understanding of the cancer microenvironment. Endometriosis is an estrogen-dependent inflammatory disease characterized by the presence of “metastatic” endometrium-like glands and stroma, together with hemosiderin and (often) fibrosis outside the uterine lumen. It is most often diagnosed as a result of pain and/or infertility and results in substantial economic and personal costs. However, in contrast to cancer it is typically not dysplastic and rarely causes death, though it increases the risk of several ovarian cancer subtypes. Like cancers, the disease is angiogenesis-dependent and genetic studies demonstrate that the VEGFR2 signaling axis plays a key role in the disease. In addition, molecular studies demonstrate that the immune/inflammatory milieu of endometriosis lesions is more similar to that of endometriosis-associated ovarian cancers (EAOCs) than it is to eutopic endometrium. This is consistent with the dysregulation of a host of immune/inflammatory cells and cytokines in disease tissue in ways that often resemble dysregulation observed in ovarian cancer. However, in contrast to EAOC, pain is often a key early symptom of endometriosis and can accompany even very small lesions. Another key contrast with cancers is the very limited range of medical treatments available. This is partially driven by the much more limited range of side effects that is acceptable for treatment of a non-life-threatening illness in women of childbearing age, but is also a function of the limited study of endometriosis pathophysiology that has occurred thus far.

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  1. Vascular Biology Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Michael S. Rogers

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  1. Centre for Cancer Biomarkers CCBIO Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Lars A. Akslen

  2. Department of Surgery, Harvard Medical School, Vascular Biology Program, Boston Children’s Hospital, Boston, USA

    Randolph S. Watnick

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Rogers, M.S. (2022). The Role of the Microenvironment in Endometriosis: Parallels and Distinctions to Cancer. In: Akslen, L.A., Watnick, R.S. (eds) Biomarkers of the Tumor Microenvironment. Springer, Cham. https://doi.org/10.1007/978-3-030-98950-7_28

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