VIDEO: Addressing obesity in endometrial cancer patients who want to have children

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Endometrial cancer is our most common GYN malignancy that we see and treat. The vast majority of patients that we treat for endometrial cancer are typically postmenopausal. We know that obesity is the biggest risk factor for the most common type of endometrial cancer, and that's typically seen for excess estrogen, for instance, in obesity, with the fat cells making extra estrogen, and post-menopausally no longer making enough progesterone to protect the lining of the uterus. But unfortunately, as we know, in the US we really have an obesity epidemic, and there are many younger patients, now that are much more obese than they were previously. So unfortunately, we are seeing younger and younger patients getting an endometrial cancer. This may be due to obesity, this may be due to other risks of extra estrogen, such as PCOS. And so unfortunately, we do have to address this diagnosis in women who are not yet done having children.

There is good data to support fertility sparing treatment of endometrial cancer, and that's typically with progesterone therapy. Historically, we used to get this through high dose megace, dosed 80 milligrams, b.i.d., but the side effect of megace, unfortunately, is pretty significant weight gain, which is often what we want to avoid in these patients, who are often already obese to begin with, which is why they developed their endometrial cancer. Many of us often now use progesterone IUDs to improve their histology with subsequent biopsies of the lining of the uterus. And then in that case, if there's been a response to the progesterone therapy, we're able to continue them on, for instance, an IUD, until they're ready to undergo childbearing.

We often work very closely with reproductive endocrinologists and infertility to really optimize patient's ability to get pregnant, particularly treat underlying diagnoses like PCOS. and then really have them off progesterone therapy for the short amount of time to try to get pregnant. Eventually, once someone's childbearing is complete, we do typically recommend a completion hysterectomy, unless, whatever the risk factor was for them to develop at their endometrial cancer, maybe no longer remains.