Synchronous Primary Endometrial and Ovarian Cancers : A Critical Update

The pathogenesis of synchronous primary endometrial and ovarian cancers, remains unclear[2,6,16]. The theory of the secondary Müllerian system has been proposed to explain the development of synchronous primary cancers in the female genital tract [5,6,16-18] According to this theory, the epithelia of the upper female genital tract have common embryologic origin and respond as a morphologic unit to a carcinogenic stimulus (hormone, radiation, other) [2,5,16, 17]. Perhaps shared hormone receptors (estrogen receptors) are responsible for the development of synchronous primary cancers in the female genital tract [5,6,18].

The pathogenesis of synchronous primary endometrial and ovarian cancers, remains unclear [2,6,16].The theory of the secondary Müllerian system has been proposed to explain the development of synchronous primary cancers in the female genital tract [5,6,[16][17][18] According to this theory, the epithelia of the upper female genital tract have common embryologic origin and respond as a morphologic unit to a carcinogenic stimulus (hormone, radiation, other) [2,5,16,17].Perhaps shared hormone receptors (estrogen receptors) are responsible for the development of synchronous primary cancers in the female genital tract [5,6,18].
Moreover it is possible that those patients have a more fragile genome and prior genetic damage may predispose them to the development of synchronous primary cancers [16,[19][20][21][22][23] Especially in patients with Lynch syndrome, there is a predisposition to multiple synchronous primary cancers (colon, endometrium, ovary, stomach, small bowel, ureter and renal pelvis) [24].
Thus embryologic, hormonal, genetic or other phenomena may be associated with the development of synchronous primary cancers of the female genital tract [5,6,16-19,21 24].

Georgios Androutsopoulos * and Georgios Decavalas
Department of Obstetrics and Gynecology, University of Patras, Medical School, Rion, Greece appropriate surgical staging facilitates targeted therapy that maximize survival and minimize the morbidity of overtreatment (radiation injury, chemotherapy toxicity) and the effects of undertreatment (recurrent disease, increased mortality) [1,2,33].
Pelvic and para-aortic lymphadenectomy is essential for surgical staging in patients with synchronous primary endometrial and ovarian cancers [1,2,31,32].It has diagnostic, therapeutic and prognostic value.It defines accurately the extent of disease and determines the prognosis of patients [1,2].Undoubtedly, pelvic and para-aortic lymphadenectomy is the only way to identify patients with stage III disease [1,2,31,32].However, the extension of pelvic and para-aortic lymph node dissection (more than 14 lymph nodes) is an independent risk factor for postoperative complications [1,2,29,30,[34][35][36] Moreover in elderly patients and in patients with relevant comorbidities (obesity, diabetes, coronary artery disease), morbidity must be carefully weighed against any survival advantage [1,2,33,37,38].
The significance of postoperative adjuvant treatment in patients with synchronous primary endometrial and ovarian cancers, remains controversial [14,15,39].However in most cases, postoperative adjuvant treatment should be individualized according to the risk of relapse of each primary cancer [2,39,40] Moreover, the treatment of one primary cancer does not compromise the treatment of the other primary cancer [2,41].
Postoperative adjuvant radiotherapy includes: external pelvic radiotherapy and/or brachytherapy.It is the appropriate treatment for high risk primary endometrial cancer [1,2,29,30].
Postoperative adjuvant chemotherapy is the appropriate treatment for advanced stage primary endometrial and ovarian cancers [1,2 ,40].The most active chemotherapeutic agents for those patients, are: taxanes, anthracyclines and platinum compounds [11,15].Prognostic factors for synchronous primary endometrial and ovarian cancers are: age, stage of ovarian cancer, grade of endometrial cancer and adjuvant treatment [43][44][45].Patients with synchronous primary endometrial and ovarian cancers have 5-year overall survival 85.9% and 10 year overall survival 80.3%.14 Patients with synchronous primary endometrial and ovarian cancers have better overall survival than patients with single primary ovarian or endometrial cancer [1,2,9,39,41,43,46].Moreover, patients with synchronous primary endometrial and ovarian cancers endometrioid type have better overall survival than patients with non-endometrioid or mixed histologic types [1,2,9,39,43].