Download Endometrial Cancer - University of Pittsburgh

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
• 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 Cancer
• Strong association with
excess weight
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
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Dyslipidemia
Complications of pregnancy
Hirsuitism
Menstrual abnormalities
Stress incontinence
Increased surgical risk
Endometrial Cancer and Lifestyle
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
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14% 15%–19%
20%–24%
25%–29%
≥30%
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
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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
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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
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
– 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 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
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 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
• Estrogen dependent disease
– Prolonged exposure without the balancing effects
of progesterone
• Premalignant potential
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Endometrial hyperplasia
Simple => 1%
Complex => 3%
Simple with atypia => 8%
Complex with atypia => 29%
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
• Early detection is best prevention
• Treating precancerous hyperplasia
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Hormones (progestin)
D&C
Hysterectomy
10 ~ 30% untreated develop into cancer
• Average 5 year survival
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Stage I => 72 ~ 90%
Stage II=> 56 ~ 60%
Stage III => 32 ~ 40%
Stage IV => 5 ~ 11%
Potentially modifiable risk factors
Dietary factors
Isoflavones:
Phytoestrogens that
have properties
similar to selective
estrogen receptor
modulators
Soy, beans, chick peas…
Dietary fiber
Increases estrogen
excretion and
decreases estrogen
reuptake: whole
grains, vegetables,
fruits, and seaweeds
Exercise?
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