Endometrial cancer and obesity

Abstract

Key content Of the 20 most common tumour types, endometrial cancer has the strongest association with obesity. Endometrial cancer should be considered in young, obese women with irregular or heavy menstrual bleeding. To reduce the risk of postoperative complications, surgery for endometrial cancer should be performed using minimal access techniques whenever possible. For women who are unfit for, or who decline, surgery, alternative treatments include progestins or radiotherapy, but these have lower efficacy and are associated with a higher risk of disease relapse. Obesity is associated with reduced overall survival following endometrial cancer because of increased cardiovascular mortality; it may also affect disease‐specific survival. Learning objectives To further understanding of the mechanisms through which obesity drives endometrial carcinogenesis. To improve understanding of the potential difficulties associated with the management of endometrial cancer in obese women. To increase knowledge of alternative treatment options for women who are unfit for, or who decline, standard endometrial cancer management. Ethical issues The number of young, premenopausal women with endometrial cancer is increasing – how should these women be managed? Should super‐obese women with endometrial cancer only be treated in cancer centres? After treating a woman's endometrial cancer, how should she be counselled her about her weight and cardiovascular disease risk?

Impact of socio‐economic deprivation on endometrial cancer survival in the North West of England: a prospective database analysis

“…In our study, women from the most deprived neighbourhoods were more obese than women from less deprived neighbourhoods, in keeping with the literature 35–37 . Obesity‐driven endometrial cancer is usually low‐grade, early‐stage disease with good survival outcomes when compared with aggressive, non‐endometrioid histological subtypes 38,39 . Despite advantages in tumour biology, however, obesity is linked to unfavourable survival outcomes through a high prevalence of related comorbid health conditions 40 .…”

Detecting endometrial cancer

“…After menopause, a lack of endogenous progesterone leaves the endometrium unprotected from the effects of estrogen 3 . Thus, obesity confers a higher risk of endometrial cancer, 4 with every additional 5 kg/m 2 of body mass index (BMI) associated with a 50% (95% confidence interval [CI] 40–60%) increased risk 5 . Around 85% of EC is diagnosed in women older than 55 years of age 6 .…”

Metabolomic Biomarkers for the Detection of Obesity-Driven Endometrial Cancer

“…The strong dose-response relationship portends a 10-15% lifetime risk of endometrial cancer in women with class III obesity (BMI ≥ 40 kg/m 2 ) compared with a population average of 2% [4]. Whilst its aetiological importance is clear, the biology underpinning obesity-driven endometrial carcinogenesis is incompletely understood [5]. Adipose tissue is a rich source of oestrogens that stimulate endometrial proliferation, particularly when unopposed by progesterone in postmenopausal and anovulatory states [6].…”