Endometrial%20Cancer

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Endometrial Cancer

• Faina Linkov, PhD
• Research Assistant Professor
• University of Pittsburgh Cancer Institute

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GENERAL OVERVIEW OF GYNECOLOGIC CANCERS

• 79,480 new cases/yr of female genital system
  cancers in the U.S.
• 28,910 deaths in U.S. from genital system cancers
  in 2005
• Diet, exercise and lifestyle choices play
  important roles in the prevention of cancer
• Knowledge of family history also increases
  prevention and early diagnosis rates
• Regular screening and self-examinations for
  appropriate cancers ? early detection ?early
  intervention therapy

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Endometrial Cancer

• Strong association with excess weight

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Adipose tissue Consequences of Obesity on Cancer
Development

• Obesity has been implicated in the development of
  
• Type 2 diabetes
• Heart disease
• Stroke
• Hypertension
• Gallbladder disease
• Osteoarthritis
• Sleep apnea
• Asthma
• Psychological disorders or difficulties
• Some cancers, including ovarian,
  cervical, breast, and
  endometrial
• Dyslipidemia
• Complications of pregnancy
• Hirsuitism
• Menstrual abnormalities
• Stress incontinence
• Increased surgical risk

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Endometrial Cancer and Lifestyle
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Important Definitions

• Obesity having a very high amount of body fat in
  relation to lean body mass, or Body Mass Index
  (BMI) of 30 or higher for adults.
• Body Mass Index (BMI) a measure of weight in
  relation to height, specifically weight in
  kilograms divided by the square of his or her
  height in meters.
• Morbid Obesity-100 pounds above ideal weight or
  BMI over 40 (indication for bariatric surgery)
• Bariatric surgery is the term for operations to
  help promote weight loss.

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Obesity Trends Among U.S. AdultsBRFSS, 2005
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014 1519
2024 2529 30
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ENDOMETRIAL CANCER

• Cancer of the uterine endometrial lining
• Most common female reproductive cancer
• 40,000 new cases/year
• 7,000 deaths/year
• Most of these malignancies are adenocarcinoma

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Incidence and Prevalence

• Most common gynecologic cancer
• 4th most common in women (US)
• 2nd most common in women (UK)
• 5th most common in women (worldwide)
• Western developed gt Southeast Asia
• Increase in the 1970s
• Increased use of menopausal estrogen therapy

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RISK FACTORS FOR ENDOMETRIAL CANCER

• Early menarche
• (ltage 12)
• Late menopause
  (gtage 52)
• Infertility or nulliparous
• Obesity
• Treatment with tamoxifen for breast cancer
• Estrogen replacement therapy (ERT) after
  menopause
• Diet high in animal fat

• Diabetes
• Age greater than 40
• Caucasian women
• Family history of endometrial cancer or
  hereditary nonpolyposis colon cancer (HNPCC)
• Personal history of breast or ovarian cancer
• Prior radiation therapy for pelvic cancer

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Endometrial Carcinoma

• Etiology
• Unnoposed estrogen hypothesis exposure to
  unopposed estrogens
• Pathology
• Spreads through uterus, fallopian tubes, ovaries
  and out into peritoneal cavity
• Metastasizes via blood and lymphatic system

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SYMPTOMS OFENDOMETRIAL CANCER

• Symptoms
• Non-menstrual bleeding or discharge
• Especially post-menopausal bleeding
• Heavy bleeding
• Dysuria
• Pain during intercourse
• Pain and/or mass in pelvic area
• Weight loss
• Back pain

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ENDOMETRIAL CANCER

• Diagnosis
• Pelvic examination
• Pap smear (detect cancer spread to cervix)
• Endometrial biopsy
• Dilation and curettage
• Transvaginal ultrasound

• Treatment
• Surgery
• Hysterectomy
• Salpingo-oophorectomy
• Pelvic lymph node dissection
• Laparoscopic lymph node sampling
• Radiation therapy
• Chemotherapy
• Hormone therapy
• Progesterone
• Tamoxifen

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Endometrial hyperplasia

• Overgrowth of the glandular epithelium of the
  endometrial lining
• Usually occurs when a patient is exposed to
  unopposed estrogen, either estrogenically or
  because of anovulation
• Rates of neoplasm
• simple hyperplasia 1.
• complex hyperplasia with atypia 30

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Endometrial Hyperplasia

• Complex hyperplasia with atypia
• One study found incidence of concomitant
  endometrial cancer in 40 of cases
• Hysterectomy or high dose progestin tx
• Simple
• Often regress spontaneously
• Progestin treatment used for treating bleeding
  may help in treating hyperplasia as well

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• Estrogen dependent disease
• Prolonged exposure without the balancing effects
  of progesterone
• Premalignant potential
• Endometrial hyperplasia
• Simple gt 1
• Complex gt 3
• Simple with atypia gt 8
• Complex with atypia gt 29

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Reduced Risk

• Oral Contraceptives
• Combined OC gt 50 reduced rate
• Actual reduction number small because uncommon in
  women of child bearing age
• Long term offers protection
• Reduced risk presumably gt progesterone
• Tobacco Smoking
• Some evidence that it reduces the rate
• Smokers have lower levels of estrogen and lower
  rate of obesity

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Prevention and Survival

• Early detection is best prevention
• Treating precancerous hyperplasia
• Hormones (progestin)
• DC
• Hysterectomy
• 10 30 untreated develop into cancer
• Average 5 year survival
• Stage I gt 72 90
• Stage IIgt 56 60
• Stage III gt 32 40
• Stage IV gt 5 11

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Potentially modifiable risk factors

• Dietary factors
• Isoflavones
• Phytoestrogens that have properties similar to
  selective estrogen receptor modulators

Soy, beans, chick peas
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Dietary fiber

• Increases estrogen excretion and decreases
  estrogen reuptake whole grains, vegetables,
  fruits, and seaweeds

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Exercise?
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Summary points

• Endometrial cancer is one of the leading
  gynecological cancers in the US
• Obesity is one of the key factors involved in
  Endometrial cancer development
• More research is needed to explore modifiable
  risk factors in endometrial cancer development