Urgency in prevention, intervention, and treatment exists. Lifestyle interventions to reduce adiposity, surgical procedures to remove excess visceral adipose tissue, and medications to address the metabolic imbalances associated with obesity are preventative interventions.
“Most women don’t know of the association of endometrial cancer with obesity. We have to do better in the women’s health community to educate women,” said Dr Lu.
Once endometrial cancer has been diagnosed, obesity additionally increases both all-cause and disease-specific mortality. Body habitus of obese patients complicates total hysterectomy with bilateral salpingo-oophorectomy, the primary approach to treat early-stage disease. Comorbidities of obesity can cause perioperative complications and increase postoperative mortality.
Robotic surgery can be advantageous in this population. For the approximately 10% of patients too obese to undergo surgical procedures, radiotherapy and brachytherapy can be used.
Surgical procedures to remove cancerous tissues are less desirable in younger women, however, as many want to preserve the ability to reproduce.
“We are seeing more younger women with obesity-driven endometrial cancer, so one unmet need is to develop strategies for treatment that allow young women to preserve their ability to have children,” Lu explained.
“When endometrial cancer is caught in the pre-cancer or very early cancer stage, it can often be treated with medicines, rather than surgery.”
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MD Anderson Cancer Center is conducting a clinical trial to assess a more conservative approach of using everolimus in women with progestin-refractory endometrial cancer.
- Onstad MA, Schmandt RE, Lu KH. Addressing the role of obesity in endometrial cancer risk, prevention, and treatment. J Clin Oncol. 2016;34(35):4225-30. doi: 10.1200/JCO.2016.69.4638
- Sheikh MA, Althouse AD, Freese KE, et al. USA endometrial cancer projections to 2030: Should we be concerned? Future Oncol. 2014;10(16):2561-8. doi: 10.2217/fon.14.192