Diagnostic challenges in the diagnosis and treatment of ovarian cancer in Lynch syndrome
DOI:
https://doi.org/10.12775/JEHS.2025.77.56840Keywords
Lynch syndrome, ovarian cancer, mismatch repair, microsatallite instability, cancer vaccinesAbstract
Introduction and purpose
Lynch syndrome (LS), also known as hereditary nonpolyposis colorectal cancer (HNPCC), is an autosomal dominant genetic disorder characterized by a significantly increased risk of developing various malignancies, including ovarian cancer. This study aims to analyse the risk of ovarian cancer development in patients with Lynch syndrome and to compare the diagnostic and therapeutic approaches for this neoplasm in the context of sporadic cases.
Description
This discussion explores the genetic mechanisms underlying mutations in mismatch repair (MMR) genes, such as MLH1, MSH2, MSH6, and PMS2, which are essential for maintaining genomic stability. The diagnostic criteria, including the Amsterdam Criteria and the Bethesda Guidelines, are reviewed. The paper highlights the diagnostic challenges posed by the nonspecific symptoms of ovarian cancer and emphasizes the importance of early detection and monitoring.
A comprehensive review of treatment modalities is also provided, covering surgical cytoreduction, chemotherapy, and emerging therapies, such as immunotherapy and cancer vaccines. The importance of interdisciplinary care for patients is underscored, along with the need for preventive measures and health education to manage cancer risk.
Summary
Despite the challenges associated with diagnosis and treatment, the prognosis for patients with ovarian cancer linked to Lynch syndrome is generally more favourable than for those with sporadic cancers. This can be attributed to earlier diagnosis and the favourable histopathological characteristics of tumours associated with Lynch syndrome.
References
1. Seppälä TT, Latchford A, Negoi I, Sampaio Soares A, Jimenez-Rodriguez R, Sánchez-Guillén L, Evans DG, Ryan N, Crosbie EJ, Dominguez-Valentin M, Burn J, Kloor M, Knebel Doeberitz MV, Duijnhoven FJBV, Quirke P, Sampson JR, Møller P, Möslein G; European Hereditary Tumour Group (EHTG) and European Society of Coloproctology (ESCP). European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender. Br J Surg. 2021 May 27;108(5):484-498. doi: 10.1002/bjs.11902. PMID: 34043773; PMCID: PMC10364896.
2. Zhao S, Chen L, Zang Y, Liu W, Liu S, Teng F, Xue F, Wang Y. Endometrial cancer in Lynch syndrome. Int J Cancer. 2022 Jan 1;150(1):7-17. doi: 10.1002/ijc.33763. Epub 2021 Sep 9. PMID: 34398969.
3. Yurgelun MB, Hampel H. Recent Advances in Lynch Syndrome: Diagnosis, Treatment, and Cancer Prevention. Am Soc Clin Oncol Educ Book. 2018 May 23;38:101-109. doi: 10.1200/EDBK_208341. PMID: 30231390.
4. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Genetic/Familial High-Risk Assessment: Colorectal, Endometrial, and Gastric
Version 3.2024 — October 31, 2024
5. International Mismatch Repair Consortium. Variation in the risk of colorectal cancer in families with Lynch syndrome: a retrospective cohort study. Lancet Oncol. 2021 Jul;22(7):1014-1022. doi: 10.1016/S1470-2045(21)00189-3. Epub 2021 Jun 7. PMID: 34111421; PMCID: PMC8934577.]
6. Bhattacharya P, Leslie SW, McHugh TW. Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer) [Updated 2024 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431096/
7. Ryan NA, McMahon RF, Ramchander NC, Seif MW, Evans DG, Crosbie EJ. Lynch syndrome for the gynaecologist. Obstet Gynaecol. 2021 Jan;23(1):9-20. doi: 10.1111/tog.12706. Epub 2021 Jan 18. PMID: 33679238; PMCID: PMC7898635.
8. Bui QM, Lin D, Ho W. Approach to Lynch Syndrome for the Gastroenterologist. Dig Dis Sci. 2017 Feb;62(2):299-304. doi: 10.1007/s10620-016-4346-4. Epub 2016 Dec 18. PMID: 27990589
9. Vindigni SM, Kaz AM. Universal Screening of Colorectal Cancers for Lynch Syndrome: Challenges and Opportunities. Dig Dis Sci. 2016 Apr;61(4):969-76. doi: 10.1007/s10620-015-3964-6. Epub 2015 Nov 24. PMID: 26602911.
10. Ryan NAJ, Evans DG, Green K, Crosbie EJ. Pathological features and clinical behavior of Lynch syndrome-associated ovarian cancer. Gynecol Oncol. 2017 Mar;144(3):491-495. doi: 10.1016/j.ygyno.2017.01.005. Epub 2017 Jan 6. PMID: 28065618; PMCID: PMC5345899
11. Berek JS, Renz M, Kehoe S, Kumar L, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum: 2021 update. Int J Gynecol Obstet. 2021; 155(Suppl. 1): 61–85. https://doi.org/10.1002/ijgo.13878]
12. Ran X, Jing H, Li Z. The clinical features and management of Lynch syndrome-associated ovarian cancer. J Obstet Gynaecol Res. 2022 Jul;48(7):1538-1545. doi: 10.1111/jog.15273. Epub 2022 Apr 27. PMID: 35478369.
13. Engel C, Loeffler M, Steinke V, Rahner N, Holinski-Feder E, Dietmaier W, Schackert HK, Goergens H, von Knebel Doeberitz M, Goecke TO, Schmiegel W, Buettner R, Moeslein G, Letteboer TG, Gómez García E, Hes FJ, Hoogerbrugge N, Menko FH, van Os TA, Sijmons RH, Wagner A, Kluijt I, Propping P, Vasen HF. Risks of less common cancers in proven mutation carriers with lynch syndrome. J Clin Oncol. 2012 Dec 10;30(35):4409-15. doi: 10.1200/JCO.2012.43.2278. Epub 2012 Oct 22. PMID: 23091106.
14. Leclerc J, Vermaut C, Buisine MP. Diagnosis of Lynch Syndrome and Strategies to Distinguish Lynch-Related Tumors from Sporadic MSI/dMMR Tumors. Cancers (Basel). 2021 Jan 26;13(3):467. doi: 10.3390/cancers13030467. PMID: 33530449; PMCID: PMC7865821.
15. Crosbie EJ, Ryan NAJ, Arends MJ, Bosse T, Burn J, Cornes JM, Crawford R, Eccles D, Frayling IM, Ghaem-Maghami S, Hampel H, Kauff ND, Kitchener HC, Kitson SJ, Manchanda R, McMahon RFT, Monahan KJ, Menon U, Møller P, Möslein G, Rosenthal A, Sasieni P, Seif MW, Singh N, Skarrott P, Snowsill TM, Steele R, Tischkowitz M; Manchester International Consensus Group; Evans DG. The Manchester International Consensus Group recommendations for the management of gynecological cancers in Lynch syndrome. Genet Med. 2019 Oct;21(10):2390-2400. doi: 10.1038/s41436-019-0489-y. Epub 2019 Mar 28. PMID: 30918358; PMCID: PMC6774998.
16. Ali FT, Soliman RM, Hassan NS, Ibrahim AM, El-Gizawy MM, Mandoh AAY, Ibrahim EA. Sensitivity and specificity of microRNA-204, CA125, and CA19.9 as biomarkers for diagnosis of ovarian cancer. PLoS One. 2022 Aug 3;17(8):e0272308. doi: 10.1371/journal.pone.0272308. PMID: 35921382; PMCID: PMC9348731.
17. Kwiatkowska Agnieszka, Krawczyk Dominika, Kułak Krzysztof, Makuch Sylwester, Sapko Klaudia. What is currently known about endometrial cancer in Lynch syndrome? - review. Journal of Education, Health and Sport. 2019;9(9):190-203. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3387437
18. J.M. Helder-Woolderink, E.A. Blok, H.F.A. Vasen, H. Hollema, M.J. Mourits, G.H. De Bock, Ovarian cancer in Lynch syndrome; a systematic review, European Journal of Cancer, Volume 55, 2016, Pages 65-73, ISSN 0959-8049, https://doi.org/10.1016/j.ejca.2015.12.005.
19. Zhang R, Siu MKY, Ngan HYS, Chan KKL. Molecular Biomarkers for the Early Detection of Ovarian Cancer. Int J Mol Sci. 2022 Oct 10;23(19):12041. doi: 10.3390/ijms231912041. PMID: 36233339; PMCID: PMC9569881.
20. Ghose A, McCann L, Makker S, Mukherjee U, Gullapalli SVN, Erekkath J, Shih S, Mahajan I, Sanchez E, Uccello M, Moschetta M, Adeleke S, Boussios S. Diagnostic biomarkers in ovarian cancer: advances beyond CA125 and HE4. Ther Adv Med Oncol. 2024 Feb 29;16:17588359241233225. doi: 10.1177/17588359241233225. PMID: 38435431; PMCID: PMC10908239.
21. Gao Y, Zhou N, Liu J. Ovarian Cancer Diagnosis and Prognosis Based on Cell-Free DNA Methylation. Cancer Control. 2024 Jan-Dec;31:10732748241255548. doi: 10.1177/10732748241255548. PMID: 38764160; PMCID: PMC11104031.
22. The Lancet Digital Health. Digital transformation of ovarian cancer diagnosis and care. Lancet Digit Health. 2024 Mar;6(3):e145. doi: 10.1016/S2589-7500(24)00027-X. PMID: 38395530.
23. He X, Bai XH, Chen H, Feng WW. Machine learning models in evaluating the malignancy risk of ovarian tumors: a comparative study. J Ovarian Res. 2024 Nov 6;17(1):219. doi: 10.1186/s13048-024-01544-8. PMID: 39506832; PMCID: PMC11539702.
24. Practical Gynecology and Perinatology 2016 vol. 1, no. 4, pages 152–161 Copyright © 2016 Via Medica ISSN 2451–0122
25. Cohen SA, Pritchard CC, Jarvik GP. Lynch Syndrome: From Screening to Diagnosis to Treatment in the Era of Modern Molecular Oncology. Annu Rev Genomics Hum Genet. 2019 Aug 31;20:293-307. doi: 10.1146/annurev-genom-083118-015406. Epub 2019 Mar 8. PMID: 30848956.
26. Sambasivan S. Epithelial ovarian cancer: Review article. Cancer Treat Res Commun. 2022;33:100629. doi: 10.1016/j.ctarc.2022.100629. Epub 2022 Sep 8. PMID: 36127285.
27. Underkofler KA, Ring KL. Updates in gynecologic care for individuals with lynch syndrome. Front Oncol. 2023 Mar 1;13:1127683. doi: 10.3389/fonc.2023.1127683. PMID: 36937421; PMCID: PMC10014618.
28. Roudko V, Cimen Bozkus C, Greenbaum B, Lucas A, Samstein R, Bhardwaj N. Lynch Syndrome and MSI-H Cancers: From Mechanisms to "Off-The-Shelf" Cancer Vaccines. Front Immunol. 2021 Sep 24;12:757804. doi: 10.3389/fimmu.2021.757804. PMID: 34630437; PMCID: PMC8498209.
29. Bolivar AM, Duzagac F, Sinha KM, Vilar E. Advances in vaccine development for cancer prevention and treatment in Lynch Syndrome. Mol Aspects Med. 2023 Oct;93:101204. doi: 10.1016/j.mam.2023.101204. Epub 2023 Jul 19. PMID: 37478804; PMCID: PMC10528439.
30. Sei S, Ahadova A, Keskin DB, Bohaumilitzky L, Gebert J, von Knebel Doeberitz M, Lipkin SM, Kloor M. Lynch syndrome cancer vaccines: A roadmap for the development of precision immunoprevention strategies. Front Oncol. 2023 Mar 22;13:1147590. doi: 10.3389/fonc.2023.1147590. PMID: 37035178; PMCID: PMC10073468.
31. Møller P, Seppälä T, Bernstein I, Holinski-Feder E, Sala P, Evans DG, et al. Cancer incidence and survival in Lynch syndrome patients receiving colonoscopic and gynaecological surveillance: first report from the prospective Lynch syndrome database. Gut. 2017;66(3):464-72.
32. Valle A, Lopez-Köstner F, Gluck N, Katz LH, Heinimann K, Vaccaro CA, Büttner R, Görgens H, Holinski-Feder E, Morak M, Holzapfel S, Hüneburg R, Knebel Doeberitz MV, Loeffler M, Rahner N, Schackert HK, Steinke-Lange V, Schmiegel W, Vangala D, Pylvänäinen K, Renkonen-Sinisalo L, Hopper JL, Win AK, Haile RW, Lindor NM, Gallinger S, Le Marchand L, Newcomb PA, Figueiredo JC, Thibodeau SN, Wadt K, Therkildsen C, Okkels H, Ketabi Z, Moreira L, Sánchez A, Serra-Burriel M, Pineda M, Navarro M, Blanco I, Green K, Lalloo F, Crosbie EJ, Hill J, Denton OG, Frayling IM, Rødland EA, Vasen H, Mints M, Neffa F, Esperon P, Alvarez K, Kariv R, Rosner G, Pinero TA, Gonzalez ML, Kalfayan P, Tjandra D, Winship IM, Macrae F, Möslein G, Mecklin JP, Nielsen M, Møller P. Cancer risks by gene, age, and gender in 6350 carriers of pathogenic mismatch repair variants: findings from the Prospective Lynch Syndrome Database. Genet Med. 2020 Jan;22(1):15-25. doi: 10.1038/s41436-019-0596-9. Epub 2019 Jul 24. Erratum in: Genet Med. 2020 Sep;22(9):1569. doi: 10.1038/s41436-020-0892-4. PMID: 31337882; PMCID: PMC7371626.
33. Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK, Amso NN, Apostolidou S, Benjamin E, Cruickshank D, Crump DN, Davies SK, Dawnay A, Dobbs S, Fletcher G, Ford J, Godfrey K, Gunu R, Habib M, Hallett R, Herod J, Jenkins H, Karpinskyj C, Leeson S, Lewis SJ, Liston WR, Lopes A, Mould T, Murdoch J, Oram D, Rabideau DJ, Reynolds K, Scott I, Seif MW, Sharma A, Singh N, Taylor J, Warburton F, Widschwendter M, Williamson K, Woolas R, Fallowfield L, McGuire AJ, Campbell S, Parmar M, Skates SJ. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet. 2016 Mar 5;387(10022):945-956. doi: 10.1016/S0140-6736(15)01224-6. Epub 2015 Dec 17. Erratum in: Lancet. 2016 Mar 5;387(10022):944. Erratum in: Lancet. 2016 Mar 5;387(10022):944. doi: 10.1016/S0140-6736(16)00228-2. PMID: 26707054; PMCID: PMC4779792.
34. Møller P, Seppälä TT, Bernstein I, et al. Cancer risk and survival inpath_MMRcarriers by gene and gender up to 75 years of age: a report from the Prospective Lynch Syndrome Database. Gut. 2017;67:1306–1316.
35. Ryan NAJ, Morris J, Green K, et al. Association of Mismatch Repair Mutation With Age at Cancer Onset in Lynch Syndrome: Implications for Stratified Surveillance Strategies. JAMA Oncol. 2017;3:1702–1706.
36. Dillon JL, Gonzalez JL, DeMars L, Bloch KJ, Tafe LJ. Universal screening for Lynch syndrome in endometrial cancers: frequency of germline mutations and identification of patients with Lynch-like syndrome. Hum Pathol. 2017 Dec;70:121-128. doi: 10.1016/j.humpath.2017.10.022. Epub 2017 Oct 28. PMID: 2910766
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Agnieszka Protasiuk, Agata Żak, Rafał Sierzpowski, Patrycja Tymoszuk, Bartosz Kasperek, Katarzyna Augustowska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 37
Number of citations: 0