Description
This session explores the link between Polycystic Ovary Syndrome (PCOS) and the increased risk of endometrial cancer, focusing on early identification and preventive strategies. Through case-based discussion, we will examine the hormonal and metabolic factors contributing to endometrial hyperplasia and malignancy in women with PCOS. The session will highlight screening approaches, lifestyle interventions, and medical therapies that can reduce long-term risk. It aims to equip clinicians with practical tools to recognize high-risk patients and implement timely, evidence-based prevention.
Summary Listen
- PCOS increases the risk of endometrial cancer by approximately 2.74 times due to prolonged exposure of the endometrium to unopposed estrogen. This is primarily caused by the anovulation commonly associated with PCOS.
- Clinical risk factors for endometrial cancer include age (50-70), obesity, unopposed estrogen hormone therapy, tamoxifen use, early menstruation (before age 12), prolonged menstruation (beyond age 50), and complex atypical hyperplasia. Additional risk factors are diabetes, hypertension, and colon cancer before age 50.
- Studies have shown that while PCOS increases the risk of endometrial cancer, it does not significantly increase the risk of ovarian or breast cancer.
- Treating PCOS, achieving and maintaining a healthy weight through diet and exercise, avoiding dietary fats, and regular Pap smears and pelvic examinations can help reduce the risk of endometrial cancer.
- Genetic testing is not helpful in predicting endometrial cancer risk in PCOS patients. However, clinical triggers such as being overweight or obese, older age, PCOS diagnosis, and prior tamoxifen use are significant risk factors.
- Mitochondrial dysfunction plays a key role in triggering endometrial cancer associated with PCOS. PCOS creates mitochondrial dysfunction, leading to increased oxidative stress, which disrupts energy production and metabolic balance.
- The basic treatments for endometrial cancer include surgery to remove the uterus, fallopian tubes, and ovaries, radiation therapy, chemotherapy, and hormone therapy to block hormones that cancer cells rely on for survival.
- The five-year survival rate for people with uterine cancer in the United States is 81%. Black women are more likely to be diagnosed with more aggressive forms of endometrial cancer and have lower survival rates.
- Endometrial thickness is a key marker for endometrial cancer. In menstruating women, a thickness beyond 20 mm is highly suggestive of malignancy. In postmenopausal women, a thickness greater than 10 mm requires malignancy to be ruled out.
- Other causes of thickened endometrium, besides malignancy, include obesity, tamoxifen use, hormone replacement therapy, diabetes, endometrial hyperplasia, endometrial polyps, and chronic high blood pressure.
- Treatment choices for thickened endometrium without malignancy include progesterone, a combination of recipients, and intra-uterine progesterone devices. Hysterectomy is a last resort option.
- Lifestyle changes, such as reducing weight, BMI, and free androgen index, can significantly reduce the risk of endometrial cancer in women with PCOS.
- Progesterone, including low doses or intra-uterine systems, can achieve regression of atypical hyperplasia. Separately, it is an effective reversing impending malignancy changes in subjects with PCOS.
- Metformin increases insulin sensitivity and reverses impaired glycolysis, normalizing mitochondrial function in PCOS patients with endometrial hyperplasia. This makes insulin sensitizers, such as metformin, valuable for chemo prevention in PCOS.
- Bariatric surgery has shown efficacy in some obese PCOS patients but more large-scale randomized control clinical trials are needed.
- Consuming a diet rich in fiber, fruits, vegetables, legumes, whole grains, dark leafy vegetables, broccoli, beans, fortified grains, nuts, seeds, and essential fatty acids can reduce endometrial lining thickness.
- In young women with endometrial cancer who desire fertility preservation, a fertility-preserving approach can be considered in selected patients with early-stage, low-grade endometrial cancer under regular follow-up.
Sample Certificate
About the Speakers
Dr. Pankaj Desai
Consultant Gynecologist, Janani Maternity Hospital, Vadodara, Gujarat
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