Cancer patients who work with dietitians that have oncology nutrition experience have improved overall outcomes, quality-of-life, and a better patient experience. *
CNC oncology dietitians have the specialized training and experience to address gynecologic cancer diet & nutrition questions, whether this be uterine, endometrial, ovarian, or cancer of the cervix. Having access to oncology nutrition expertise, and evidence-based cancer nutrition information, is important when building comprehensive care plans. Cancer Nutrition Care dietitians can competently provide for the unique needs of gynecologic cancer patients during treatment and into post-treatment survivorship.
Uterine/Endometrial Cancer Overview
The “endometrium” is the lining of the uterus where the majority of uterine cancers start. Most endometrial cancers are discovered at an early stage, are slow growing, and can be fully cured fortunately. The three most common types of uterine cancer include:
– Endometrioid Adenocarcinoma- This is an endometrial cancer that forms in the lining of the uterus and accounts for the largest number of gynecologic cancers.
– Uterine Carcinosarcoma- This is also characterized as an endometrial cancer, but the composition consists of both endometrioid and sarcoma cancer cells. “Sarcoma” refers to a less common group of cancers which tend to form in muscle, bones or other connective tissues in the body.
– Uterine Sarcomas- These are a much less common type of uterine cancer. Unlike the endometrial cancers described above, uterine sarcomas form in the muscle tissue of the uterus.
Endometrial Cancer and Lifestyle Factors
As per the American Institute for Cancer Research, there are currently four key risk factors that can impact a woman’s risk for endometrial cancer:
- Excess Body Fat: having a BMI greater than 24.9, along with the accumulation of excessive body fat increases endometrial cancer risk.
- High Glycemic Diets: regularly consuming foods high in refined carbohydrates, sugar sweetened beverages and other ultra processed foods increases endometrial cancer risk.
- Low Physical Activity: engaging in a sedentary lifestyle that lacks daily, moderate-intensity physical activity increases endometrial cancer risk too.
- Coffee: drinking coffee [both caffeinated & decaffeinated], which provides chlorogenic acid to the diet, decreases endometrial cancer risk.
Endometrial Cancer and Weight
Weight influences the risk of endometrial cancer greatly. It is estimated that clinically obese women account for at least 50% of all cases. The increased risk level is thought to be related to excess body fat which can influence insulin and blood hormone levels. It is well known that excess fat increases estrogen levels and creates an environment that makes it more conducive for cancer to grow.
Estrogens are a group of hormones that play a central role in the sexual and reproductive development of women. The majority of estrogens made in the body come from the ovaries but fat cells can also make estrogens. Excessive exposure to a specific type of estrogen (estradiol or “E2”), over time, increases the risk of getting endometrial cancer.
Estrogen dependent endometrial cancers comprise about 80% of all endometrial cancers. Hormone levels can be impacted by diet & weight changes. *
Endometrial Cancer and Diet
Although it can’t be stated with 100% certainty, it appears that the risk of getting endometrial cancer is lower among women who eat more fruits, vegetables, whole grains, and plant-based proteins. One reason for this may be related to the positive impact of plant-based antioxidants and anti-inflammatory compounds. Another reason might be that adhering to a plant-based diet assists in maintaining a healthy weight. What follows is a review of specific foods and their impact on endometrial cancer risk.
FRUITS & VEGETABLES
Although some studies have found no significant relationship between fruit & vegetable consumption and endometrial cancer, The American Cancer Society’s Cancer Prevention Study, which analyzed over 40,000 women, showed a 20-25% lower cancer risk among those study participants that consumed greater quantities of fruits and vegetables. Of note, this was among women that had never used hormone therapy. A variety of other research studies concluded that diets rich in plant-based foods may be associated with endometrial cancer risk reductions of 50-60%.
A statistical analysis of similar scientific studies (a “meta-analysis”) looked at the impact of soy-based foods and found that women who consumed higher quantities of whole soy foods had a 20% lower endometrial cancer risk. One theory for this result is related to the fact that certain compounds in soy foods interfere with the conversion of steroids to estrogen in the body. In doing so, soy-based foods appear to act like “aromatase inhibitors”, a class of drugs that can reduce the amount of estrogen in the blood.
RED MEAT & ANIMAL-BASED FOODS
Although some case-controlled research studies have shown an increased risk of endometrial cancer when consuming red meat, overall research findings are inconsistent. As a general rule, based on red meat research on other cancer types, red meat consumption should be minimized to reduce overall cancer risk. Processed meats should be eliminated completely, if possible.
The Nurses’ Health Study, one of the largest on-going investigations into the risk factors associated with major chronic diseases in women, found that dairy products contributed to a 40% risk increase for endometrial cancer in postmenopausal women who were not on any type of hormone replacement therapy. The higher risk group of nurses consumed 3 or more dairy servings per day compared to another group that consumed less than 1 each day. This finding could be related to the fact that many dairy foods (ice cream, yogurt, etc.) often contain high amounts of refined sugar, increasing their glycemic load. The American Institute of Cancer Research (AICR) has shown that high glycemic diets are a definite risk factor for endometrial cancer.
FAT & SATURATED FAT
Oncology nutrition research has shown that high fat intake increases the risk of endometrial cancer by 60%-80%. Specifically, it appears that the impact of saturated fat on endometrial cancer risk is significantly higher than other kinds of fat. Common sources of saturated fat include meat and other animal products but also plant-based sources like tropical fats (e.g. palm oil and coconut oil). Sources of healthy unsaturated fat include nuts, seeds, avocados, extra virgin olive oil, and fatty fish.
SUGAR & HIGH GLYCEMIC FOODS
The Iowa Women’s Health Study concluded that there was a 78% greater risk for endometrial cancer in women who consumed higher quantities of sugar sweetened beverages such as sodas, juices, flavored waters, and sweet coffee/tea drinks. A “meta-analysis”, a statistical analysis combining results of multiple, similar scientific studies, showed that women consuming more high glycemic foods were at a roughly 20% higher risk for endometrial cancer compared with a control group of women who consumed diets with a lower glycemic load.
COFFEE & TEA
Women who consume higher quantities of coffee were found to have a 20% lower risk for endometrial cancer, compared with women who drank less coffee. Women who have never been treated with hormone therapy and drank higher quantities of coffee experienced a 40% lower risk in endometrial cancer relative to those who drank less. This impact may be due to the ability of caffeine to increase insulin sensitivity in the body.
Studies that examined women who drank higher quantities of green tea had a roughly 20% lower risk for endometrial cancer (compared with women who drank less tea). This impact could be related to the increased activity of certain detoxification enzymes in the body that have the ability to combat carcinogens. Another theory is related to the anti-estrogen effects of green tea.
A combined statistical study, known as “cohort research”, showed some risk reduction when consuming small quantities of alcohol. This research found that women who drank 1 alcoholic beverage or less/day were shown to have a 4% to 7% less risk of endometrial cancer where women who consumed 2.5 or more alcoholic beverages/day were shown to have a 25% greater risk of endometrial cancer. One theory for this result is that women who drank less alcohol were also more mindful of their eating habits, body weight, and body fat level. This result should not be taken as a justification to start drinking alcohol, as ethanol is a known carcinogen and the current recommendation for cancer prevention and survivorship strongly recommends alcohol abstinence.
Hormone Therapy & Endometrial Cancer Risk
A woman’s hormone status plays a significant role in the risk and development of endometrial cancer. Menopausal women undergoing some forms of estrogen therapy, particularly those without progestin in the regimen, face a significantly higher endometrial cancer risk. In addition, the use of Tamoxifen, an estrogen reducing drug therapy for breast cancer patients, can also increase the risk of endometrial cancer by 2-3x in comparison to the general population. With that said, the risk of developing endometrial cancer from Tamoxifen is very low and should not deter patients from complying with their oncologist’s plan of care recommendations.
Uterine/Endometrial Cancer and Supplements
The American Institute for Cancer Research, and other well-regarded evidence-based cancer organizations, do not support the use of supplements for endometrial cancer prevention, treatment or survivorship. In place of dietary supplements, a focus on optimizing one’s diet to ensure adequate nutrient intake is advised. It’s important to know that supplements are “processed foods” and, like other highly processed traditional foods, should be avoided. With that said, there are times when dietary supplements play a valuable role in a patient’s care plan, when they’re targeting a specific medical condition like a nutrient deficiency.
One of the concerns with supplements is that they may interfere with chemotherapy regimens, radiation treatments, or other treatments. Supplements could also be outright unsafe! Always make sure your medical team is aware of any supplements you may be using, or plan to take. Cancer Nutrition Care (CNC) oncology dietitians are board certified specialists and have access to reliable information sources to help you learn more about supplement safety, benefit claims, and potential interactions with your prescribed treatment regimen(s). Take the first step today by going to www.cancernutritioncare.com and completing the CNC Supplement Review. Once completed, please read through the CNC Supplement ToolBox to learn more about the use and safety of supplements for cancer patients.
Nutrition Considerations for Endometrial Cancer (In-Treatment)
Endometrial Cancer treatment consists of both “local” and “systemic” therapies. Local treatments target tumors directly and consist of surgery and radiation therapy. Systemic treatments look to impact cancer cells anywhere in the body. The main categories of systemic endometrial cancer treatments are chemotherapy, hormone therapy, and immunotherapy.
Oncologists may recommend one or a multitude of therapies, over time, to treat and/or manage an endometrial cancer diagnosis. Treatment recommendations can be based on the size of the tumor, extent of the tumor, as well as the performance status of the patient which is why it is so important to focus on being as nourished as possible to tolerate whatever treatment is to come. Let’s take a deeper look into the variety of treatment regimens further.
Chemotherapy regimens are associated with a variety of nutrition related side effects. These include, but are not limited to: nausea, vomiting, diarrhea, mouth sores, taste changes, poor appetite, and early satiety. A CNC oncology dietitian can assist you in preparing for an upcoming course of chemotherapy and help you with recovery and healing from a prior cycle. CNC dietitians can also help manage current and potential nutrition related side effects and work with you to create an individualized nutrition plan of care to keep side effects at bay.
Immunotherapy and Hormone Therapy
Nutrition Considerations for Endometrial Cancer (Post-Treatment)
1. Healthy Weight Management
Maintaining a healthy weight is an important goal for endometrial cancer survivors as it may help lower one’s risk for cancer recurrence as well as the development of other types of cancer. Excess amounts of fatty tissue can cause an inflammatory state for the body which could promote cancer in otherwise healthy cells. Additionally, being overweight or obese can increase certain hormone levels and encourage the growth of various hormone related cancers. Emerging research suggests that metabolic changes associated with weight gain may also promote endometrial cancer progression.
2. Plant Based Diet
Nutrition research continues to evolve but findings to date strongly suggest that consuming a whole food, plant-based diet can be an effective approach to maintaining a healthy weight. Research also suggests consuming a whole food, plant-based diet can lower your cancer risk due to the regular intake of fiber, antioxidants and phytochemicals. Cancer Nutrition Care oncology dietitians can help you set specific dietary goals and develop an individualized nutrition plan of action to best meet your needs. Take the first step today by going to www.cancernutritioncare.com and completing the CNC Quality of Diet Screening to evaluate the current quality of your diet then schedule a free initial consultation with one of our oncology dietitians.
3. Routine Physical Activity
Cancer research in the area of physical activity indicates that routine, physical exercise may reduce endometrial cancer risk and that sedentary lifestyles increase risk. Studies have found that physically inactive women are more likely to develop endometrial cancer, compared with active women. Physical activity may decrease cancer recurrence, improve cancer‐specific and overall survival rates, quicken recovery from treatment side effects, and prevent long‐term side effects. Other exercise related intervention studies among cancer survivors show that exercise can improve fatigue, anxiety, depressive symptoms, self‐esteem, happiness, and overall quality of life.
Cancer Nutrition Care works with an oncology fitness specialist who can help you set goals and put together an action plan so you can feel confident moving forward.
This overview brought to you by:
CANCER NUTRITION CARE
The Oncology Nutrition Specialists
*Source: ASSOCIATION OF COMMUNITY CANCER CENTERS
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