Photo Credit: Mohammed Haneefa Nizamudeen
Despite the rising number of diagnoses, mortality rates have decreased thanks to advancements in early diagnosis and treatment.
Endometrial cancer is a significant concern globally, being the fourth most common cancer among women in high socioeconomic index nations and the sixth most common worldwide. Over the past three decades, its incidence has risen by 132%, driven by aging populations and increasing rates of obesity and diabetes, a report in Cancers noted. Despite the rising number of diagnoses, mortality rates have been decreasing thanks to advancements in early diagnosis and treatment. Understanding the molecular mechanisms driving endometrial cancer has led to personalized care, improving patient outcomes.
In 2020, there were over 417,000 new cases and 97,370 deaths related to endometrial cancer. The rising incidence is attributed to global aging and lifestyle-related factors such as obesity and diabetes. Researchers have identified potential strategies for primary prevention, but their clinical efficacy remains to be fully evaluated. Early diagnosis, typically involving invasive endometrial sampling, significantly improves survival rates. New minimally invasive diagnostic tests using protein and DNA biomarkers and cytology promise to revolutionize diagnostic pathways and enable the surveillance of high-risk populations.
Classification and Risk Factors
Molecular classification of endometrial cancers helps in prognosis and guides adjuvant treatment decisions. Advanced and recurrent disease management has improved with debulking surgery and targeted treatments, particularly immunotherapy. The landscape of endometrial cancer is rapidly changing with these advancements, but disparities in survival among different ethnic groups persist, highlighting the need for equitable access to healthcare and further understanding of genetic factors.
Prevention strategies focus on modifiable risk factors. Obesity is strongly linked to endometrial cancer, with weight loss significantly reducing risk. New anti-obesity medications, such as GLP-1 agonists like semaglutide and liraglutide, show promise in achieving substantial and sustained weight loss, potentially reducing cancer risk. Bariatric surgery is another effective intervention, reducing the risk of endometrial cancer by 62%, though it is not currently recommended solely for cancer prevention due to potential complications.
Hormonal chemoprevention with oral contraceptives and the levonorgestrel-releasing intra-uterine system has shown significant risk reduction. Aspirin and metformin have been investigated for their potential preventive effects, but the results are mixed. Identifying high-risk individuals, such as those with Lynch syndrome, is crucial for targeted prevention efforts.
Diagnosis Timeline and Care Management
Early diagnosis remains key, with most cases presenting in postmenopausal women with bleeding. Innovations in diagnostic tests are ongoing, exploring peripheral blood, uterine, cervicovaginal fluid, and urine as sources for biomarkers and cytological assessment. Human epididymis protein 4 is a promising serum biomarker, though its performance as a diagnostic tool is limited. Plasma cell-free DNA, circulating tumor DNA, and circulating microRNA are under investigation, showing potential for detecting endometrial cancer, particularly in advanced stages.
Cervicovaginal fluid collected via non-invasive methods like Pap tests and vaginal tampons is being studied for its diagnostic accuracy. Tests like PapSEEK and WID-qEC show high sensitivity and specificity, potentially reducing the need for invasive endometrial biopsies. Urine and vaginal cytology offer another non-invasive diagnostic approach with promising results for detecting gynecological malignancies.
Medical management options are expanding, particularly for women seeking fertility preservation or those with high peri-operative risks. Intrauterine progestin therapy shows similar efficacy to oral progesterone, with better compliance. Weight loss through dieting or bariatric surgery enhances the effectiveness of progestin therapy and reduces surgical risks.
What’s Next?
Future research in endometrial cancer is directed towards further personalizing treatment based on molecular profiles, improving prevention strategies, and refining diagnostic techniques to minimize invasive procedures. According to the report, the goal is to offer bespoke treatments that maximize benefits and minimize adverse effects, addressing the increasing incidence and complexity of endometrial cancer in the modern demographic landscape.
