The rise of obesity in the United States and around the world is shockingly on a continuous rise and with that said, the diseases that are related to obesity also increased in parallel thus, making such a disease one of the most important public health problems in the United States and around the world.
The body mass index (BMI) is used to measure overweight and obesity and basically equals to the body weight (in kilograms) divided by the height (in meters) squared.
BMI categories are as follows: BMI of 25 and 30 kg/m2 are considered overweight. Those with a BMI ≥30 kg/m2 are considered to be obese. Obesity in adults is subcategorized as class I (BMI ≥30 to 35), class II (BMI ≥35 to 40), and class III (BMI ≥40).
In addition to the increased risk of developing heart diseases, diabetes and other illnesses in people with obesity, women who are obese are at a significantly increased risk of developing endometrial cancer. This cancer develops from the inner lining of the uterus (the womb) and it is most commonly identified in women who are beyond the age of menopause. With the rise in obesity, however, women who are young are at an increased risk too.
Obesity increases the risk of this malignancy secondary to the hormonal changes that occur in the excess fatty tissue causing an increase in the concentration of estrogen in such women which in turn stimulates the inner lining of the uterus and causes overproduction of it cells and eventual progression into cancer.
What are the odds of developing endometrial cancer in obese women?
The odds are increased as the BMI increases:
• 1.5 times for overweight women (BMI 25.0 to <30.0 kg/m2).
• 2.5 times for class 1 obesity (BM 30.0 to <35.0 kg/m2).
• 4.5 times for class 2 obesity (BMI 35.0 to 39.9 kg/m2).
• 7.1 times for class 3 obesity (≥40.0 kg/m2). This means that such a woman has a 710% chance increase in developing endometrial cancer.
In postmenopausal women who are mostly beyond the age of 50-51 years old, any form of bleeding must be evaluated by the doctor. Bleeding, spotting or even a bloody discharge or stain are all concerning and should not be ignored even if such occurred once.
Women who are in their late forties, any abnormalities in their periods must be evaluated such as frequent, or heavy periods or any bleeding in between periods.
On the other end of the spectrum, women younger than 45 years old, any bleeding in women who are at an increased risk of developing this cancer (obese or have genetic predisposition such as Lynch syndrome) that is heavy or persistent despite medication, must be evaluated.
Lynch syndrome is a genetic carrier disorder which is characterized by the presence of colon cancer in two generations or more within the same family and women who carry the genetic mutation are at increased risk for endometrial and ovarian cancer.
What would your doctor do?
Once a female complains of the above and seeks an evaluation by her doctor, the doctor will evaluate the bleeding with a physical examination of the cervix and uterus and perform an ultrasound evaluation too. Eventually, a tissue sampling of the lining of the endometrium will be obtained with either an office-based biopsy called an endometrial biopsy or a dilation and curettage (D&C).
D&C is a procedure in which the patient is put under anesthesia and the surgeon scrapes the lining of the uterus “endometrium” with a special instrument and sometimes puts in a camera into the uterus to view how the lining appears.
Once a diagnosis of endometrial cancer is confirmed, the female will be referred to a specialist who manages such a malignancy called the gynecologic oncologist. The gynecologic oncologist will then evaluate the patient and plan on surgical removal of the uterus, both tubes and ovaries and possibly lymph node evaluation.
Such surgeries can be performed either by an open surgery called a laparotomy or by minimal invasive surgery which could be via conventional laparoscopy or robotic surgery. The difference in these two modalities is that the former, laparotomy, is associated with a higher risk of complications such as those related to intraoperative complications, wound healing, prolonged hospital stay all of which are increased due to obesity.
Minimal invasive surgery allows for a faster recovery, discharge from the hospital within a day in most occasions and a faster return to normal functions.
What is the prognosis of endometrial cancer that occurs in obese women?
Most of the endometrial cancers identified in obese women are curable by surgery alone but has been identified that being obese by itself increases the risk of recurrence thus such women are advised on weight loss as it would also minimize the risk of dying from obesity related illness such as high blood pressure and diabetes.
Losing weight can be a challenging endeavor but when done for the sake of health and improving a person’s well-being, it can be a joyful experience and an addictive one too.
Losing weight relies on the perseverance of continuous regular exercises with increasing difficulty and monitoring one’s diet avoiding unhealthy food.
Dr. Hanna is clinical assistant professor in obstetrics and gynecology at Wayne State University in Detroit, Michigan, and holds a senior staff position in the Division of Gynecologic Oncology, Department of Women’s Health, at Henry Ford Health System in Detroit.