Endometrial and ovarian cancer: beyond the clinical significance of hormonal carcinogenesis and the promising biomarkers

Endometrial cancer （EC is one of the most common invasive gynecologic malignancy,represents the fourth most frequent diagnosed cancer among European women and it involves atypical growth of the endometrium;United States and Canada are the countries with the major incidence of this tumor, while Japan and India have the minor risk. 　　This cancer is typical of post-menopausal age,being the age of major incidence between 50 and 70;increasing evidence indicates that different factors play relevant roles in the onset of this cancer,although the majority of women with endometrial cancer are postmenopausal,5%~30% are under the age of 50 years at the time of diagnosis. 　　Risk factors for endometrial cancer include obesity,diabetes,late menopause,unopposed estrogen therapy and nulliparity;the majority of these factors are associated with excess estrogen,which may cause continued stimulation of the endometrium leading to endometrial hyperplasia and possible progression to cancer. 　　Biological and genetic factors are parameters that can be used as indicators of normal or pathological progression and this review will focus on those factors whom have been shown to be a contribution to increase the risk of EC. 　　Ovarian cancer （OC） is one of the female neoplastic forms with the poorest prognosis and with the bad overall and disease-free survival rates;despite enormous progress in cancer research,OC represents one of the principal causes of death worldwide;it accounts for more deaths than any other gynecologic malignancy:an estimated 25,600 new cases will be diagnosed in the United States,and 16,100 deaths will ensue in 2004 alone. 　　Currently,more than 50% of the women diagnosed with ovarian cancer survive 5 years,but less than 30% of women with advanced stage disease can be cured;when diagnosed in Stage I,but,unfortunately,at present,less than 25% of ovarian cancer cases in the U.S.are diagnosed in stage Ⅰ. 　　However,patients with advanced ovarian cancer are living longer with aggressive cytoreductive surgery and the availability of a rapidly expanding menu of chemotherapeutic agents:the cure rate can approach 90% with currently available cytoreductive surgery and combination chemotherapy. 　　For many types of cancer,the stage at the moment of diagnosis is relevant for the successive treatment;therefore,there is a need for the identification of molecules which can act as indicators of an early malignant process,when disease burden is localized. 　　The evidence that different histological subtypes of OC can be distinguished by some microarray profiling,and that these subtypes might be partly reflected by a different aetiology through the deregulation and activation of different pathways. 　　This neoplasm heterogeneity could also account for different ovarian tumor behaviours and it could be revealed by specific biomarkers;for this evidence,it is reported by authors that gene expression profiling could be a useful prognostic tool,predicting chemosensitivity to the standard treatment combination of paclitaxel and platinum chemotherapy for advanced ovarian cancer,but more knowledge about chemosensitivity could eventually lead to a more tailored cancer therapy. 　　Genomic and proteomics researches have increased the dates either on the potential clinical significance of the increase of plasmatic estrogens and the EC genesis,either on the OC gene expression profiling,focusing on the steroid biosynthesis and hormonal pathways and on the use of novel molecules,developed on the proteomics and genomics researches,as potential biomarkers in the discovering and management of these tumors.