In the UK, obesity now affects 25% of adults and approximately 50% of endometrial cancers are linked to obesity, says the paper produced by the RCOG’s Scientific Advisory Committee.
Standard treatment for endometrial cancer is surgery, however, there are problems with preoperative assessment of obese women and surgery itself poses its own challenges and risks, warns the paper.
An MRI scan is often used for assessment of endometrial cancer but many scanners have a weight limit which prohibits scanning morbidly obese patients, says the paper.
Laparoscopic surgery is the best approach in order to minimise postoperative wound complications and minimise the time spent in hospital. However any surgery is challenging and doctors should undergo further training in operative techniques to enhance their skills, the paper recommends. The paper calls for gynaecological cancer centres to offer expertise in surgery for morbidly obese women for their networks.
The paper also explores other methods of treatment apart from surgery including progestagens, which can be used for low grade endometrial cancer. However, there are no large case series reporting on the outcome of using progestagens as a primary treatment and the long-term outcome is unclear, say the authors.
In addition, the paper says that endometrial cancer is radiosensitive and radiotherapy may be used as a sole treatment.
Cancer prevention is also explored and the authors state that the growing evidence base suggests that obesity not only has a negative impact on cancer related outcomes but also on women’s global well being.
The RCOG’s recent report ‘High Quality Women’s Health Care: A proposal for change’ supports this view and calls for a life course approach to be adopted to improve women’s health.
Dr Pierre Martin-Hirsch, Consultant, Gynaecological Oncology Unit, Royal Preston Hospital, Lancashire, Dr Sadaf Ghaem-Maghami, Gynaecological Oncology Centre, Imperial College London, both co-authors of the SIP paper, say:
“Obesity is a serious public health issue. Weight management and the importance of leading a healthy lifestyle should be topics discussed with patients who are being treated for endometrial cancer.
“With the increasing number of morbidly obese patients, more thought needs to be given to investment in training of surgeons in appropriate technologies such as laparoscopic and plastic surgical techniques when treating endometrial cancer.”
The 10th RCOG International Scientific Congress takes place in Kuching, Malaysia between 5-8 June 2012. It is held in partnership with the Obstetrical and Gynaecological Society of Malaysia (OGSM).
For more information please visit: www.rcog2012.com
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About New RCOG Scientific Impact Papers
RCOG Scientific Impact Papers (formerly SAC Opinion papers) are produced by the Scientific Advisory Committee. They are up to date reviews of emerging or controversial scientific issues of relevance to obstetrics and gynaecology, together with the implications for future practice. These documents have been rebranded to raise awareness of the issues in obstetrics and gynaecology discussed in the documents and to more accurately reflect their content and remit of the Committee.
This new brand of RCOG documents have been launched on 6 June 2012 at the 10th RCOG International Scientific Congress in Malaysia.
The first two papers are:
Scientific Impact Paper No.8 IVF: Perinatal Risks and Early Childhood Outcomes
Scientific Impact Paper No.32 Management of Endometrial Cancer in Obese and Morbidly Obese Women