Transcript Obesity & Gyn Oncology

OBesity Project
GYN ONCOLOGY
“Obesity is linked as
a cause of 20% of cancer
deaths in women.”
Obesity and Cancer
• Obesity is a risk factor for numerous cancers
• Esophageal
• Pancreatic
• Colorectal
• Postmenopausal breast
• Endometrial
• Ovarian
• Renal
Mechanisms of Increased Cancer Risk
• Increased female hormone exposure
• Excess Insulin
• Induction of inflammation
• Turning on of Onco-genes
Relationship Between Insulin Sensitivity and
Cytokines
Insulin Sensitivity
.25
.23
.2
.17
.15
.12
.1
r = -0.67, p < 0.0001
.08
.05
.03
0
0
1
2
3
4
5
6
TNF Alpha (pg/ml)
Kirwan, Diabetes; 2002
Incidence of Cancer Related to Obesity
• Breast Cancer (230,480 female US cases yearly)
• Increase circulating estradiol level is a risk factor for the
development of postmenopausal breast cancer
• Estrogen modulating hormones (SERMs) have been
shown to decrease the development of breast cancer
Obesity and Cancer
• Endometrial Adenocarcinoma (46,470 US
cases yearly)
• Increase in unopposed Estrogen
• Increase in Endometrial Hyperplasia
• Approx. 25% of Complex Atypical Hyperplasia (CAH)
becomes Invasive AdenoCA, the most prevalent form of
Endometrial CA
Obesity and Cancer
• Overweight and obese women have a 3.5x risk for
development of Endometrial Cancer relative to normal
weight controls
• Other risk factors for Endometrial Cancer are HTN and
DM, which are associated with obesity
Obesity and Cancer
• Ovarian Cancer (21,990 US cases yearly)
• Two-fold increase in risk in obese older women who have
never taken postmenopausal hormones
Obesity and Cancer
• Colon Cancer (52,400 female US cases yearly)
• Higher amounts of glucose have been associated with
subsequent risk of colon cancer
• Increased hyperinsulinemia and production of insulin-like
growth factor are possible agents leading to the increased
risk of colon cancer
Obesity and Cancer
• Esophageal Cancer (3,530 female US cases
yearly)
• Recent evidence suggests a shift to increased rates of
adenocarcinoma compared to squamous cancers
• Increased esophageal reflux with increased inflammation
as the possible pathway
Obesity and Cancer
• Weight loss can reduce the incidence of cancer
• Two large cohort studies from Sweden and the U.S.
suggest a lower cancer incidence as well as decreased
risk of death in women undergoing bariatric surgery
compared to BMI-matched controls
• Observational data also has demonstrated that weight loss
is associated with reduction of risk for certain cancers
including breast cancer
Obesity and Cancer
• Studies evaluating weight loss and weight gain
and survival following a diagnosis of cancer
• Survival after Endometrial CA reduced in Obese women
• Physical activity after diagnosis may reduce the risk of
breast cancer recurrence
• Trial for women diagnosed with breast cancer showed
longer disease-free survival times for those who lost more
weight through intervention with diet and physical activity
than the control group
Diagnosis and Treatment of Cancer
with Obesity
• Obesity affects the detection and treatment of
cancer
• Obese less likely to receive routine cancer
screening tests
• More likely to postpone preventive examinations
• Impacts treatment planning
• Surgery
• Radiation therapy
• Chemotherapy
Diagnosis and Treatment of Cancer
with Obesity
• Risks of surgery are increased by obesity
• Operative time
• Blood loss
• Thromboembolic complications
• Pneumonia
• Wound infection
• Operative site infection
Diagnosis and Treatment of Cancer
with Obesity
• Optimal delivery of radiation and chemotherapy
are affected by obesity
• Chemotherapy:
• Dosing of therapy may be affected by weight in heavier cancer
patients
• Concerns about high doses of chemotherapy leading to greater
toxicity
• Obese patients may not receive optimal dose intensities
compared to nonobese patients
• Radiation therapy:
• Target location may be altered and hamper receiving full doses
Diagnosis and Treatment of Cancer
with Obesity
• Many women are unaware of the link of obesity
and increased cancer risk
• Burden of obesity demands increased attention in
order to improve cancer prevention and treatment