Is semen an etiologic factor in the development of primary peritoneal carcinoma and epithelial ovarian cancer?

The existing medical literature was searched for epidemiologic and clinical observations that could point to the etiology of primary peritoneal carcinoma and epithelial ovarian cancer (EOC) using MEDLINE, hand searching of the most important gynecologic oncology journals and looking up all relevant cross references. Primary peritoneal carcinoma does not occur in males (only two cases reported in the literature) despite their possessing the same peritoneal surface as females. It is hypothesized that exposure of the peritoneal surface to components of semen (which occurs only in females) is important in the etio-pathogenesis of primary peritoneal carcinoma and the closely related sporadic EOC. The lack of an equivalent malignancy in pleura and pericardium (which have similar embryological derivations as peritoneum but never exposed to semen) in either sex and in tunica vaginalis (which is similar to the epithelial lining of ovary in females) in males lends credence to this hypothesis. Several other observations explained in detail in the paper are consistent with this line of reasoning. Case-control studies in patients of EOC/primary peritoneal carcinoma will clarify this issue. Experimental studies to study the carcinogenic potential of components of the semen on peritoneal surfaces in animal models are also in order.