The role of bariatric and metabolic surgery in the development, diagnosis, and treatment of endometrial cancer

Abstract

The obesity pandemic continues to contribute to a worsening burden of disease worldwide. The link between obesity and diseases such as diabetes, cardiovascular disease, and cancer has been well established, yet most patients living with obesity remain untreated or undertreated. Metabolic and bariatric surgery is the most effective and durable treatment for obesity, is safe, and may have a protective benefit with respect to cancer incidence. In this review, an overview of the link between obesity, metabolic surgery, and cancer is discussed with emphasis on indications for endometrial cancer, the malignancy most strongly associated with obesity. Considerable evidence from retrospective and prospective cohort studies supports a decreased risk of endometrial cancer in patients with obesity who undergo bariatric surgery compared with nonsurgical controls. Survivors of endometrial cancer are at increased risk of poor health outcomes associated with obesity, and women with endometrial cancer are more likely to die of cardiovascular disease and other obesity-related illnesses than of the malignancy itself. Recent advances in anticancer drug therapies have targeted pathways that may also be therapeutically altered with metabolic surgery. Metabolic surgery has significant potential to enter the treatment paradigm for endometrial cancer, and gynecologic oncologist visits present an opportunity to identify patients who may benefit the most.

Gynecologic counseling for patients undergoing bariatric surgery: a scoping review

“…AUB is the most common presentation for endometrial cancer, which is one of the most closely associated malignancies to obesity [3 ▪ ,28]. A retrospective cohort study published in 2022 that examined the risk factors for endometrial hyperplasia or malignancy found that BMI was more predictive of endometrioid intraepithelial neoplasm or malignancy than age in premenopausal women [29 ▪ ].…”

Endometrial Cancer in Reproductive Age: Fertility-Sparing Approach and Reproductive Outcomes

“…Authors have demonstrated that weight loss can decrease the recurrence of EC [ 79 ]. Investigators are starting to assess interest and utility in bariatric surgery as a tool for weight loss and its impact on HT for EC among young patients ( Table 1 , NCT04008563) [ 80 ]. Obesity is also an independent risk factor for infertility, [ 81 ] as well as a known risk factor in pregnancy [ 82 ].…”

Immunometabolism at the crossroads of obesity and cancer—a Keystone Symposia report

“…For example, a recent meta-analysis showed that several recent retrospective cohort studies consistently demonstrate a reduction in cancer incidence among those who undergo metabolic surgery. 78,79 There are several potential ways by which weight loss may positively impact outcomes in endometrial cancer. First, epidemiologic data support a protective biological role for weight loss.…”

“…Endometrial cancer has a strong association with obesity, and data indicate that weight loss may reduce this risk. For example, a recent meta‐analysis showed that several recent retrospective cohort studies consistently demonstrate a reduction in cancer incidence among those who undergo metabolic surgery 78,79 . There are several potential ways by which weight loss may positively impact outcomes in endometrial cancer.…”