1
|
Ducote M, Schauer T, Ross R, Boyer LM, Stagg MP, Domangue E, Graham B, Garcia J, Stillwell C, Drews KL, Schauer PR, Cook MW, Jernigan A, Albaugh VL. High prevalence of dysfunctional uterine bleeding in candidates for metabolic/bariatric surgery: increased endometrial cancer risk? Surg Obes Relat Dis 2024:S1550-7289(24)00688-9. [PMID: 39129110 DOI: 10.1016/j.soard.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/22/2024] [Accepted: 07/07/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Endometrial cancer (EC) is the strongest obesity-associated malignancy and the fastest-growing cancer in young women. Early identification of EC and other endometrial pathology (malignant and nonmalignant) in women with severe obesity may improve treatment options and uterine preservation. Screening for endometrial pathology using abnormal or postmenopausal uterine bleeding (APUB) as a surrogate in women pursuing metabolic/bariatric surgery may be clinically beneficial, but data supporting this effort are limited. OBJECTIVE To develop and institute a screening program for APUB as a surrogate for endometrial pathology in bariatric surgery candidates. SETTING Two, academic metabolic/bariatric surgery programs in Louisiana, United States. METHODS The Modified SAMANTA is a 10-item questionnaire that was implemented to identify patients with APUB, specifically combining tools designed to identify anovulatory/postmenopausal and heavy menstrual bleeding. Demographic (age, race), body mass index, and questionnaire data were analyzed with respect to positive screening using data from March 2021 through May 2023. RESULTS Of 1371 eligible women presenting for surgical evaluation, 664 (48.4%) positive screens were identified and referred for gynecologic evaluation to rule out endometrial hyperplasia/cancer or other endometrial pathology. The likelihood of positive screening for APUB was associated with increasing BMI (P = .001) and Black/African American race (P = .003), as well as increasing SAMANTA score (P < .001). In contrast, risk of positive screening was negatively associated with increasing age (P < .001). CONCLUSIONS Women presenting for metabolic/bariatric surgery have a high prevalence of APUB and, given this dysfunctional bleeding and concurrent obesity, are at greater risk for underlying EC. Potential risk factors for APUB, given their associations with screening positive, include increased body mass index, younger age, and Black/African American race. Standardized screening with appropriate gynecologic referral should be a routine part of the overall evaluation for women with severe obesity.
Collapse
Affiliation(s)
- Maggie Ducote
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - Teresa Schauer
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - Robert Ross
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Laura M Boyer
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - M Patrick Stagg
- Our Lady of the Lake Regional Medical Center, Franciscan Missionaries of Our Lady Healthcare System, Baton Rouge, Louisiana
| | - Emma Domangue
- Department of Obstetrics & Gynecology, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Breyanah Graham
- Department of Obstetrics & Gynecology, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Jesus Garcia
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Clinton Stillwell
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana
| | - Kimberly L Drews
- Department of Biostatistics, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - Philip R Schauer
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana; Our Lady of the Lake Regional Medical Center, Franciscan Missionaries of Our Lady Healthcare System, Baton Rouge, Louisiana
| | - Michael W Cook
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana; University Medical Center, New Orleans, Louisiana
| | - Amelia Jernigan
- Department of Obstetrics & Gynecology, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana; University Medical Center, New Orleans, Louisiana
| | - Vance L Albaugh
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana; Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, New Orleans, Louisiana; Our Lady of the Lake Regional Medical Center, Franciscan Missionaries of Our Lady Healthcare System, Baton Rouge, Louisiana.
| |
Collapse
|
2
|
Marin AG, Filipescu A, Vladareanu R, Petca A. Metabolic Syndrome and Survival Outcomes in Endometrial Cancer. Cureus 2024; 16:e60324. [PMID: 38883006 PMCID: PMC11177328 DOI: 10.7759/cureus.60324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Menopause, through attributable estrogen level decline and the corresponding increase in circulating androgens, significantly elevates a woman's risk for cardiometabolic diseases, including metabolic syndrome (MetS), type 2 diabetes, and cardiovascular disease. Metabolic syndrome itself is a cluster of interconnected risk factors, and among them, central obesity is a well-established factor for the development of endometrial cancer (EC), the most common gynecologic malignancy. This research investigates the impact of metabolic syndrome on survival rates among patients with endometrial cancer. The goal is to assess whether having metabolic syndrome or its individual components influences disease-free survival (DFS), overall survival (OS), cancer-specific survival, and recurrence rates. Understanding this link is crucial for determining risk levels and could help tailor treatment approaches for better long-term outcomes in endometrial cancer care.
Collapse
Affiliation(s)
| | - Alexandru Filipescu
- Obstetrics and Gynaecology, Elias Emergency University Hospital, Bucharest, ROU
| | - Radu Vladareanu
- Obstetrics and Gynaecology, Elias Emergency University Hospital, Bucharest, ROU
| | - Aida Petca
- Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Obstetrics and Gynaecology, Elias Emergency University Hospital, Bucharest, ROU
| |
Collapse
|
3
|
Gallo A, D'alisa R, Di Spiezio Sardo A, Guerra S, Berardi G, Vitale SG, Palumbo M, Cretella P, Angioni S, Bifulco G, Musella M. Hysteroscopy and weight loss in treatment of endometrial cancer: case report and literature review. MINIM INVASIV THER 2024; 33:109-119. [PMID: 38108527 DOI: 10.1080/13645706.2023.2294993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
Fertility-sparing treatments have become important for young women with atypical endometrial hyperplasia (AEH) or endometrial carcinoma (EC) who wish to preserve their reproductive potential. Evidence indicates a strong relationship between weight and EC and the effect of weight loss on reducing the risk of EC. We report the case of a young obese woman with a body mass index (BMI) of 46.6 kg/m2, diagnosed with grade 2 endometrial endometrioid adenocarcinoma, who underwent a combined fertility-sparing treatment with hysteroscopic resection followed by insertion of a levonorgestrel intrauterine system. After twelve months of failure to achieve a complete response, bariatric surgery was proposed to lose weight and improve the response to treatment. Histologic regression was achieved three months after surgery, with a weight loss of 30 kg and fifteen months after combined treatment of endometrial cancer. We reviewed the literature to summarize the evidence on the role of bariatric surgery and weight loss in modifying the oncologic and reproductive outcomes of women undergoing fertility-sparing treatment for atypical endometrial lesions.
Collapse
Affiliation(s)
- Alessandra Gallo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Rossella D'alisa
- Department of Maternal and Child Health and Urology, "Sapienza" University of Rome, Rome, Italy
| | | | - Serena Guerra
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giovanna Berardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Mario Palumbo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Cretella
- Department of Advanced Biomedical Sciences, Pathology Unit, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giuseppe Bifulco
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Mario Musella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| |
Collapse
|
4
|
Lin J, Ho WY, Lim QX, Chin HXF. Effect of bariatric surgery on endometrial cancer regression as part of fertility sparing treatment. Cancer Rep (Hoboken) 2023; 6:e1857. [PMID: 37404200 PMCID: PMC10480406 DOI: 10.1002/cnr2.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/12/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Obesity is a major risk factor in the development of endometrial cancer (EC) in young patients of reproductive age. Fertility sparing treatment is a viable option for a select group of patients with early EC, and involves systemic and intra-uterine hormonal therapy. Weight loss has been associated with improved outcomes in this group. Bariatric surgery (BS) has been shown to be the most efficient and durable method of weight loss in obese patients. However, there is a paucity of data studying the benefit of BS as part of fertility sparing treatment. METHODS We present a retrospective case series of five patients who are undergoing fertility sparing treatment for early EC, who also underwent BS for treatment of obesity and related comorbidities. We aim to show early regression of EC for all the patients and also report on the other health benefits of BS. RESULTS All five patients in the series achieved regression of EC within 6 months of undergoing BS. They also achieved significant weight loss consistent with previous studies, and three patients who had comorbidities related to obesity had remission of these conditions. One of the patients with EC regression also managed to conceive with IVF (In-vitro Fertilisation). CONCLUSION Patients on fertility sparing treatment for early EC who underwent BS was associated with early regression within 6 months, significant weight loss and resolution of comorbidities. BS could be a promising component of fertility sparing treatment. Long term, prospective studies are required to confirm the benefits reported in this case series.
Collapse
Affiliation(s)
- Jinlin Lin
- Consultant, Department of SurgeryChangi General HospitalSingaporeSingapore
| | - Weng Yan Ho
- Consultant, Department of Gynaecological Oncology, Division of O&GKK Women's and Children HospitalSingaporeSingapore
| | - Qi Xuan Lim
- Medical Officer, Department of SurgeryChangi General HospitalSingaporeSingapore
| | - Hui Xian Felicia Chin
- Consultant, Department of Gynaecological Oncology, Division of O&GKK Women's and Children HospitalSingaporeSingapore
| |
Collapse
|
5
|
Cook E, Fajardo O, Walden RL, Harvey L. Gynecologic counseling for patients undergoing bariatric surgery: a scoping review. Curr Opin Obstet Gynecol 2023; 35:321-327. [PMID: 37144578 DOI: 10.1097/gco.0000000000000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Obesity is associated with several gynecologic conditions. While bariatric surgery is regarded as the most effective treatment option for obesity, gynecologic counseling for patients planning bariatric surgery is limited and often focused on fertility. The goal of this scoping review is to investigate the current recommendations for gynecologic counseling prior to bariatric surgery. RECENT FINDINGS A comprehensive search was conducted to find peer reviewed studies written in English discussing a gynecologic issue of patients who were planning or previously had bariatric surgery. All the included studies identified a gap in preoperative gynecologic counseling. The majority of the articles made specific recommendations for a multidisciplinary approach to preoperative gynecologic counseling with a call to involve gynecologists or primary care providers. SUMMARY Patients deserve to receive appropriate counseling about how obesity and bariatric surgery impact their overall gynecologic health. We advocate that the scope of gynecologic counseling includes more than pregnancy and contraception counseling. We propose a gynecologic counseling checklist for female patients undergoing bariatric surgery. Offering patients a referral to a gynecologist from the patient's first entry to a bariatric clinic is imperative to facilitate appropriate counseling.
Collapse
Affiliation(s)
- Elizabeth Cook
- Minimally Invasive Gynecologic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive
| | - Olga Fajardo
- Minimally Invasive Gynecologic Surgery, Vanderbilt University Medical Center
| | - Rachel Lane Walden
- Vanderbilt University Eskind Biomedical Library, Nashville, TN 37232, USA
| | - Lara Harvey
- Minimally Invasive Gynecologic Surgery, Vanderbilt University Medical Center
| |
Collapse
|
6
|
Cable J, Rathmell JC, Pearce EL, Ho PC, Haigis MC, Mamedov MR, Wu MJ, Kaech SM, Lynch L, Febbraio MA, Bapat SP, Hong HS, Zou W, Belkaid Y, Sullivan ZA, Keller A, Wculek SK, Green DR, Postic C, Amit I, Benitah SA, Jones RG, Reina-Campos M, Torres SV, Beyaz S, Brennan D, O'Neill LAJ, Perry RJ, Brenner D. Immunometabolism at the crossroads of obesity and cancer-a Keystone Symposia report. Ann N Y Acad Sci 2023; 1523:38-50. [PMID: 36960914 PMCID: PMC10367315 DOI: 10.1111/nyas.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Immunometabolism considers the relationship between metabolism and immunity. Typically, researchers focus on either the metabolic pathways within immune cells that affect their function or the impact of immune cells on systemic metabolism. A more holistic approach that considers both these viewpoints is needed. On September 5-8, 2022, experts in the field of immunometabolism met for the Keystone symposium "Immunometabolism at the Crossroads of Obesity and Cancer" to present recent research across the field of immunometabolism, with the setting of obesity and cancer as an ideal example of the complex interplay between metabolism, immunity, and cancer. Speakers highlighted new insights on the metabolic links between tumor cells and immune cells, with a focus on leveraging unique metabolic vulnerabilities of different cell types in the tumor microenvironment as therapeutic targets and demonstrated the effects of diet, the microbiome, and obesity on immune system function and cancer pathogenesis and therapy. Finally, speakers presented new technologies to interrogate the immune system and uncover novel metabolic pathways important for immunity.
Collapse
Affiliation(s)
| | - Jeffrey C Rathmell
- Vanderbilt-Ingram Cancer Center; Vanderbilt Center for Immunobiology; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Erika L Pearce
- Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, Maryland, USA
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Ping-Chih Ho
- Department of Fundamental Oncology and Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Marcia C Haigis
- Department of Cell Biology, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Murad R Mamedov
- Gladstone-UCSF Institute of Genomic Immunology and Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Meng-Ju Wu
- Cancer Center, Massachusetts General Hospital; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Susan M Kaech
- NOMIS Center for Immunobiology and Microbial Pathogenesis, Salk Institute for Biological Studies, La Jolla, California, USA
| | - Lydia Lynch
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Febbraio
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Sagar P Bapat
- Diabetes Center and Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Hanna S Hong
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Weiping Zou
- Department of Surgery; Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center; Department of Pathology; Graduate Program in Immunology; Graduate Program in Cancer Biology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Yasmine Belkaid
- Metaorganism Immunity Section, Laboratory of Immune System Biology, and NIAID Microbiome Program National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Zuri A Sullivan
- Department of Immunobiology, Molecular and Cellular Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Andrea Keller
- Department of Biological Chemistry and Pharmacology, College of Medicine; and Comprehensive Cancer Center, Wexner Medical Center, Arthur G. James Cancer Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Stefanie K Wculek
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Douglas R Green
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Catherine Postic
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | - Ido Amit
- Department of Systems Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Salvador Aznar Benitah
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology (BIST) and Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Russell G Jones
- Department of Metabolism and Nutritional Programming, Van Andel Research Institute, Grand Rapids, Michigan, USA
| | | | - Santiago Valle Torres
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Semir Beyaz
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, USA
| | - Donal Brennan
- UCD Gynecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Ireland
| | - Luke A J O'Neill
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Rachel J Perry
- Department of Cellular and Molecular Physiology and Department of Internal Medicine (Endocrinology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dirk Brenner
- Experimental and Molecular Immunology, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Immunology and Genetics, Luxembourg Centre for System Biomedicine (LCSB), University of Luxembourg, Belval, Luxembourg
- Odense Research Center for Anaphylaxis, Department of Dermatology and Allergy Center, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Mutlu L, Manavella DD, Gullo G, McNamara B, Santin AD, Patrizio P. Endometrial Cancer in Reproductive Age: Fertility-Sparing Approach and Reproductive Outcomes. Cancers (Basel) 2022; 14:cancers14215187. [PMID: 36358604 PMCID: PMC9656291 DOI: 10.3390/cancers14215187] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Endometrial cancer is the most common gynecologic malignancy in developed countries and approximately 7% of the women with endometrial cancer are below the age of 45. Management of endometrial cancer in young women who desire to maintain fertility presents a unique set of challenges since the standard surgical treatment based on hysterectomy and salpingo-oophorectomy is often not compatible with the patient's goals. A fertility-preserving approach can be considered in selected patients with early stage and low-grade endometrial cancer. An increasing amount of data suggest that oncologic outcomes are not compromised if a conservative approach is utilized with close monitoring until childbearing is completed. If a fertility-preserving approach is not possible, assisted reproductive technologies can assist patients in achieving their fertility goals.
Collapse
Affiliation(s)
- Levent Mutlu
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Diego D. Manavella
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Giuseppe Gullo
- IVF Unit AOOR Villa Sofia Cervello, 90146 Palermo, Italy
| | - Blair McNamara
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Alessandro D. Santin
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Pasquale Patrizio
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Correspondence: ; Tel.: +1-305-689-8003
| |
Collapse
|