Endocrine and metabolic disorders involved in the pathogenesis of endometrial carcinoma

Abstract

Introduction. Endometrial cancer is the most common gynecological malignancy in industrialized countries, the incidence is constantly increasing globally. Globally, endometrial cancer ranks third among female genital malignancies, after the cervix and ovary, accounting for six percent of new cases of cancer in women and accounting for three percent of all cancer deaths in women. About 69,950 new cases of endometrial cancer were estimated in 2022, with 12,550 deaths from the disease, according to the American Cancer Society. The most common histological type is endometrioid adenocarcinoma, accounting for 75- 80%. Aim of study. The purpose of this study was to review data about characteristics of endocrine and metabolic disorders involved in the pathogenesis of endometrial carcinoma. Methods and materials. The source of information was represented by articles published in the online databases: PubMed, HINARI, SCOPUS, EMBASE. Results. Current evidence revealed the hypothesis that the complex of endocrine and metabolic disorders that occur long before the development of endometrial carcinoma determines the biological characteristics of the tumor, both its clinical evolution and the prognosis of the disease. Based on prospective studies in patients with endometrial carcinoma, the authors postulate the existence of two different pathogenetic types of endometrial carcinoma. The first pathogenetic type of the disease with a frequency of 65% occurs in women with obesity, hyperlipidemia and signs of hyperestrogenism: anovulatory uterine bleeding, infertility, late onset of menopause and hyperplasia of the ovarian and endometrial stroma, developing high and moderate superficial invasion tumors. myometrium, high progestin sensitivity and favorable prognosis (survival rate greater than 5 years) While the second pathogenetic type (35%) of the disease occurs in women who have no signs mentioned above or these signs are not clearly defined and endocrine. Conclusion. Endocrine and metabolic disorders are divided into two clinical / epidemiological entities: type 1 cancers, which occur in young and obese patients, are associated with excess estrogen, a favorable prognosis and endometrioid histology, and are often accompanied by and / or endometrial hyperplasia ( EH); compared to type 2 cancers, which are tumors that appear in older and non-obese patients, are associated with an unfavorable prognosis and nonendometrioid histotypes and are usually serous histology with no associated hyperplastic lesions.