Discussion Questions

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  Why is this study question important?

  
  
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  What was the study design?

  
  
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  What were the results?

  
  
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  What were the study’s strengths and limitations?

  
  
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  What is the clinical impact of this study?

Clear cell cancers appear to present at earlier stages and are associated with endometriosis; it is said that if one looks long enough, a component of endometriosis will always be associated with clear cell cancer at pathology review. The genetics of these cancers also differ from usual garden-variety carcinomas. Additionally, there is concern that these tumors are not as responsive to platinum-based chemotherapy as their serous counterpart. Given the many clinical questions regarding clear cell cancer of the ovary and its relative rarity, all studies of these tumors are valuable.

Uniformity, please

This month, Journal Club members discussed a retrospective review of ovarian cancer patients over a 1-year period. Wang and colleagues set out to determine the relationship between endometriosis-associated ovarian cancer and “typical” epithelial carcinoma of the ovary. From March 2011 to March 2012, 226 patients, a fairly large population of women with ovarian cancer, were identified. Of these, 17 had cancer that was related to endometriosis; 209 did not.

Endometriosis-associated ovarian carcinoma (EAOC) was defined as the presence of ovarian cancer and endometriosis, and the disease could be identified in the same ovary or in the contralateral ovary. The researchers also included patients in this group if they had extra-ovarian pelvic endometriosis. Journal Club members were concerned that the third group might not truly qualify as having EAOC, since this definition is not uniformly accepted. While clinically it makes sense to include women with extra-ovarian pelvic endometriosis in the EAOC group, the concept should be reviewed in order to standardize the definition of EAOC. Unfortunately, given the small number of patients with EAOC, it was difficult to determine whether the authors’ observations would hold up if they had eliminated patients who had only extra-ovarian manifestations of endometriosis from analysis.