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

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endometrial cancer

Endometrial Cancer

Faina Linkov, PhD

Research Assistant Professor

University of Pittsburgh Cancer Institute

general overview of gynecologic cancers
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
endometrial cancer3
Endometrial Cancer
  • Strong association with excess weight
adipose tissue consequences of obesity on cancer development
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
important definitions
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.
obesity trends among u s adults brfss 2005
Obesity Trends* Among U.S. AdultsBRFSS, 2005

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data<10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

endometrial cancer8
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
incidence and prevalence
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 > Southeast Asia
  • Increase in the 1970’s
    • Increased use of menopausal estrogen therapy
risk factors for endometrial cancer
Early menarche

(<age 12)

Late menopause (>age 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

RISK FACTORS FOR ENDOMETRIAL CANCER
endometrial carcinoma
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
symptoms of endometrial cancer
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
endometrial cancer13
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

ENDOMETRIAL CANCER
endometrial hyperplasia
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%
endometrial hyperplasia15
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
slide16
Estrogen dependent disease
    • Prolonged exposure without the balancing effects of progesterone
  • Premalignant potential
    • Endometrial hyperplasia
    • Simple => 1%
    • Complex => 3%
    • Simple with atypia => 8%
    • Complex with atypia => 29%
reduced risk
Reduced Risk
  • Oral Contraceptives
    • Combined OC => 50% reduced rate
    • Actual reduction number small because uncommon in women of child bearing age
    • Long term offers protection
    • Reduced risk presumably => progesterone
  • Tobacco Smoking
    • Some evidence that it reduces the rate
    • Smokers have lower levels of estrogen and lower rate of obesity
prevention and survival
Prevention and Survival
  • Early detection is best prevention
  • Treating precancerous hyperplasia
    • Hormones (progestin)
    • D&C
    • Hysterectomy
    • 10 ~ 30% untreated develop into cancer
  • Average 5 year survival
    • Stage I => 72 ~ 90%
    • Stage II=> 56 ~ 60%
    • Stage III => 32 ~ 40%
    • Stage IV => 5 ~ 11%
potentially modifiable risk factors
Potentially modifiable risk factors

Dietary factors

Isoflavones:

Phytoestrogens that have properties similar to selective estrogen receptor modulators

Soy, beans, chick peas…

dietary fiber
Dietary fiber

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

summary points
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