Endometrial Cancer and the Fattening of America

I see a lot of endometrial cancer patients- which means I see a lot of overweight patients. Why you ask? What does body size have to do with cancer?

The female body is a very fine tuned machine. Each month during the menstrual life, the pituitary gland sends out signals that tell the ovary to start producing an egg and making estrogen. This estrogen causes the lining of the uterus to thicken in anticipation of a fertilized egg making a landing. After the egg is released (around day 14 if your counting) the ovary converts over to making progesterone. This "matures" the lining of the uterus, turning the "proliferative endometrium" into a "secretory endometrium". The corpus luteum (the old cells in the ovary that helped kick start the egg and that have now switched over to progesterone production) only has a life of 14 days. Once this corpus luteum "dies" the progesterone levels drop, and this withdrawal of progesterone causes the lining of the uterus to shed... yep Aunt Flo. And the cycle starts over.

So what happens if you don't ovulate (produce an egg)? No progesterone conversion, no maturation of the lining of the uterus, and the continued estrogen stimulation continues to cause growth of the lining of the uterus. Now, this may become unstable, and an unstable endometrium likes to slough off. This usually happens when you least expect it- like when you wore those white pants to the office. This is what most women refer to as irregular periods. Sometimes this sloughing is on a semi-regular basis, and can fool some women into thinking that they are ovulating. Sometimes its heavy, sometimes nothing for months at a time.

So what does this have to do with the size of your waist? Fatty tissue in our bodies has an enzyme called aromatase. This converts male hormones such as androstenedione, produced by the adrenal glands, into estrone.  Estrone acts as a weak estrogen, stimulating the lining of the uterus to continually grow.  However, this estrone also fools the brain. Instead of sending out signals such as FSH that would stimulate the ovary to produce another egg, the estrone causes a release of LH which tells the ovary to produce more androstenedione.  This androstenedione is then converted into more estrone thus starting the cycle over again.  Although estrone is a weak estrogen, a long enough period of stimulation will eventually thicken the lining of the uterus significantly. Over time, this continued stimulation of growth, without the maturing effects of progesterone lead to occasional genetic abnormalities. These genetic abnormalities accumulate in the form of pre-cancers and eventually cancer. One example of one of these pre-cancers is a condition called endometrial hyperplasia.  I will discuss this condition, especially complex atypical endometrial  hyperplasia, in another blog post as it gets quite complex. So, the more fat you have, the less likely you are to ovulate regularly. And the less likely that you ovulate the less likely you are to produce progesterone.  So you see, it's actually the regular progesterone induced maturation and sloughing of the lining of the uterus that prevents endometrial cancer.

 It's obviously more complex than that however. Not all obese patients develop uterine cancer, and not all patients with uterine cancer are obese.  However this appears to be the major risk factor, and the reason why America's endometrial cancer rates continue to rise.  So what can you, as a patient, due to prevent individual cancer? It's simple–exercise, eat right, and lose weight. If you're still in menstruating  years, make sure that you are actually ovulating if you're not on some form of progesterone containing birth control. If you don't ovulate, and you suspect that your estrogen levels are too high, talk to your doctor about some form of semi-regular progesterone supplementation. Lastly, if you notice any abnormal bleeding, particularly if you're overweight or menopausal please see your doctor as soon as possible.

Until next time…

What is this all about?

This blog is about empowerment. As a practicing Gynecologic Oncologist, I see patients every day that have no idea where to turn, who to believe. This thing called cancer has shown up at their door, invited itself in, and propped its feet up on the coffee table without so much as a hello, thank you for dinner. They are thrown into this new world called oncology and have to make rapid, life changing choices at a moment's notice. How can you possibly provide 15 years worth of training to someone in a 30 minute consultation? I may not be able to comment on every topic in the Gynecologic Cancer world, but over time, I hope to be able to cover most topics enough to allow an adequate discussion with your doctor, or friend, or relative. Maybe, someone will stumble across this blog in their internet research on ovarian, uterine, vulvar, cervical, breast cancer and will prompt a simple question that will save their life.

Why do this? Sure, I have better things to do with my time. However, I have always been an advocate of teaching the patient. To this end, I am constantly giving lectures and workshops in my area teaching patients and the public what to ask, where to go. I love the interaction with patients when I am able to better their lives, and convey a small tidbit of the extensive education we have been through. I am a  former member of the Board of Directors of the Gynecologic Cancer Foundation, now the Foundation for Women's Cancer. This is our national effort to get the word out, teach women about gynecologic cancers.

What is a Gynecologic Oncologist? This is a great question. When I was in medical school, a friend of the family had an ovarian mass and someone approached me about who they should see. My natural response- their OBGYN or the local medical oncologist of course. Boy was I wrong... although these can sometimes be good places to start, neither of these specialties are trained to handle the workup, surgery, and subsequent comprehensive therapy that a Gynecologic Oncologist can prescribe. Gyn Oncs start their training as OBGYNs but then spend an additional 3-5 years training in basic science cancer research, extensive surgical training, and chemotherapy and radiation therapy administration. I like to say that we are a combination of gynecologist, medical oncologist, and general surgeon all mixed into one. This is one of the few areas where the same doctor can follow you from initial symptoms, through diagnosis, treatment, subsequent followup, and beyond. This gives us unique insight into how an individual patient is going to do through each phase of their therapy, and a special bond between doctor and patient. All other cancers are diagnosed by one specialty, operated on by another, get chemotherapy from another, radiation from yet still another, and perhaps followup from another. Do they all communicate well? Does one know what the other is doing? Who does she turn to when she has a problem or question?

I plan on touching on a number of topics as we go. Once I have covered the basics, I may start in on the current issues facing gynecologic cancer patients, such as new research, trials, insurance coverage, etc. Please feel free to post and ask questions- I hope this blog  is an interactive forum for everyone to learn from.

Until next time...