Steroidhormone und Ovarialkarzinom: Risiken und Nutzen

Zusammenfassung

Die Exposition mit Steroidhormonen beeinflusst das Karzinomrisiko von Zielorganen wie Brust, Endometrium und Ovar. Eine Vielzahl von epidemiologischen Studien unterstreicht die Zusammenhänge zwischen der ovariellen Hormonproduktion und dem Ovarialkarzinomrisiko. Die exogene Hormonapplikation in Form der oralen Kontrazeptiva und der Hormontherapie (HT) wird im Rahmen der Ovarialkarzinomprävention und als möglicher Risikofaktor für die Entstehung von Ovarialkarzinomen diskutiert. Aufgrund der vorliegenden Daten ist anzunehmen, dass die kombinierte Östrogen-Gestagen-Substitutionstherapie über längere Zeiträume die Erkrankungsinzidenzen an Ovarialkarzinomen - im Gegensatz zur reinen Östrogensubstitution - nicht signifikant erhöht. Die Hormontherapie wird bei Patientinnen mit Karzinomen oftmals als kontraindiziert angesehen. In mehreren Studien konnte allerdings durch den Einsatz der HT eine Verlängerung des Rezidiv- und Gesamtüberlebens und eine Verbesserung der Lebensqualität von Patientinnen mit Ovarialkarzinom gezeigt werden. Aussagen über die Möglichkeit und Unbedenklichkeit einer HT bei Patientinnen mit Ovarialkarzinom bleiben allerdings weiterhin individuell, bis weitere und größere randomisierte Studien vorliegen.

Abstract

The exposure to steroid hormones during different phases of a woman's life can influence the risk of cancer in the main target organs, i.e. the breast, endometrium and ovary. Numerous epidemiological studies report associations between markers of ovarian hormone production and ovarian cancer risk. In recent decades, also exogenous hormones - as in oral contraceptives and hormonal therapy - have been implicated as risk factors for ovarian cancer and also as preventive agents. Despite this substantial body of epidemiological evidence there is only limited indication that steroid hormones seem to play a growth regulating role in ovarian cancer.

Hormonal therapy (HT) is discussed to have positive and negative effects. Cancer fear is an important obstacle to use of HT. From our literature review, there is a weak association between HT and ovarian cancer risk. Individual risk of cancer should be considered before HT use. The second issue in this review is HT in patients with ovarian cancer. HT is considered by many physicians to be contraindicated in patients with cancer. However, there is evidence that HT in selected ovarian cancer patients may be of benefit for survival and quality of life.

Schlüsselwörter

Hormontherapie - Ovarialkarzinomrisiko - genetische Prädisposition - Prävention

Key words

Hormonal therapy (HT) - ovarian cancer risk - genetic predisposition - prevention

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