Obesity is now affecting 25% of adults in the UK and predisposes women to endometrial as well as other cancers. In 2007, the UK government-commissioned Foresight report predicted that if no action were taken, 60% of men, 50% of women and 25% of children would be obese by 2050.
Excess body weight is known to be associated with an increased risk of many malignancies and the risk of endometrial cancer is strongly associated with obesity. Obesity is predominantly associated with type 1 (endometroid) endometrial cancers rather than type 2 (non-endometroid type such as serous or carcinosarcoma) endometrial cancer; however, both sub-types are increased with obesity. In the UK, approximately 50% of endometrial cancers are attributable to obesity.
Endometrial cancer is the fourth most common cancer in women in the UK with 7536 cases diagnosed in 2007, accounting for around 5% of all female cancers. The incidence of endometrial cancer is rising in postmenopausal women, but 5-year survival rates have improved to more than 77%, although women from deprived backgrounds have up to a 4% lower 5-year survival. In the UK, the incidence of uterine cancer remained stable between 1975 and 1993, but increased by more than 40% between 1993 and 2007. The incidence rates peak between the ages of 60 and 79, the age range within which the largest increases have occurred, with rates doubling since 1975, rising from 40 to over 75 in every 100 000 women in 2007.
Standard treatment for endometrial cancer is surgery (historically total abdominal hysterectomy and bilateral salpingo-oophorectomy, removal of uterus, cervix, tubes and ovaries, with or without lymph node dissection) with adjuvant treatment in the form of radiotherapy and/or chemotherapy as indicated. Preoperative assessment of endometrial cancer may be problematic in obese women. A magnetic resonance imaging (MRI) scan is often used for assessment of endometrial cancer, but many scanners have a weight limit which prohibits scanning morbidly obese patients.
A BMI >30 kg/m2 indicates obesity and is associated with an increased risk of perioperative complications, while a BMI >40 kg/m2 is described as morbid obesity and is associated with higher rates of complications. Obesity is associated with numerous disorders, notably diabetes, hypertension and cardiovascular disease. In morbidly obese women, perioperative complications such as obstructive sleep apnoea, arrhythmias, acute cardiac events and venous thrombotic events are more common. Obese and morbidly obese women are therefore likely to require more detailed preoperative assessment to reduce the sequelae of co-existing morbidity and more intensive postoperative care.
The challenges of perioperative care for such patients are likely to impact on medical, nursing and psychosocial resources. Thus, treatment for endometrial cancer needs to be reassessed in the complex and increasingly common situation of the obese older woman with this disease.