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

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

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 1970s
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

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

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

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

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