gyn oncology
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
GYN ONCOLOGYOBesity Project
“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
0.03.05.08
.1.12.15.17
.2.23.25
Insu
lin S
ensi
tivity
0 1 2 3 4 5 6
TNF Alpha (pg/ml)
r = -0.67, p < 0.0001
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