Obesity as a Risk Factor for Endometrial Cancer – Pathophysiological Mechanisms
DOI:
https://doi.org/10.12775/QS.2026.54.70644Keywords
endometrial cancer, obesity, molecular classification, TCGA, physical activityAbstract
Background. Endometrial cancer is the most common gynecological malignancy in developed countries. Obesity is a major modifiable risk factor, promoting inflammation, hyperinsulinemia, increased estrogen production, and metabolic disturbances that contribute to carcinogenesis.
Aim. This narrative review summarizes current evidence on the pathophysiological mechanisms linking obesity with endometrial cancer and highlights the relevance of molecular classification and lifestyle-related prevention.
Material and methods. A narrative analysis of open-access publications (2008–2026) was conducted, focusing on epidemiology, metabolic and hormonal pathways related to obesity, and molecular subtypes of endometrial cancer described by The Cancer Genome Atlas (TCGA).
Results. Obesity contributes to endometrial cancer through estrogen excess, insulin resistance, IGF-1 signaling, chronic inflammation, and adipokine imbalance. Four molecular subtypes are recognized: POLE ultramutated, mismatch repair deficient, p53-abnormal, and non-specific profile. Physical activity may reduce cancer risk.
Conclusions. Understanding obesity-related molecular pathways in endometrial cancer may improve risk stratification and treatment decisions. Preventive strategies, including weight control and regular physical activity, may reduce disease burden.
Key words: endometrial cancer, obesity, molecular classification, TCGA, physical activity.
References
Baker-Rand, H., & Kitson, S. J. (2024). Recent Advances in Endometrial Cancer Prevention, Early Diagnosis and Treatment. Cancers, 16(5), 1028. https://doi.org/10.3390/cancers16051028
Siegel, R. L., Giaquinto, A. N., & Jemal, A. (2024). Cancer statistics, 2024. CA: A Cancer Journal for Clinicians, 74(1), 12–49. https://doi.org/10.3322/caac.21820
Ordeanu, I.-M., Busuioc, C. J., Văduva, C.-C., Pană, R.-C., Petrescu, A.-M., Văruț, R. M., Stanciu, M., & Popescu, M. (2025). Obesity as a Catalyst for Endometrial Hyperplasia and Cancer Progression: A Narrative Review of Epidemiology, Molecular Pathways, and Prevention. Biomedicines, 13(11), 2612. https://doi.org/10.3390/biomedicines13112612
Crosbie, E. J., Zwahlen, M., Kitchener, H. C., Egger, M., & Renehan, A. G. (2010). Body Mass Index, Hormone Replacement Therapy, and Endometrial Cancer Risk: A Meta-Analysis. Cancer Epidemiology, Biomarkers & Prevention, 19(12), 3119–3130. https://doi.org/10.1158/1055-9965.epi-10-0832
Onstad, M. A., Schmandt, R. E., & Lu, K. H. (2016). Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment. Journal of Clinical Oncology, 34(35), 4225–4230. https://doi.org/10.1200/jco.2016.69.4638
Setiawan, V. W., Yang, H. P., Pike, M. C., McCann, S. E., Yu, H., Xiang, Y.-B., Wolk, A., Wentzensen, N., Weiss, N. S., Webb, P. M., van den Brandt, P. A., van de Vijver, K., Thompson, P. J., Strom, B. L., Spurdle, A. B., Soslow, R. A., Shu, X., Schairer, C., … Horn-Ross, P. L. (2013). Type I and II Endometrial Cancers: Have They Different Risk Factors? Journal of Clinical Oncology, 31(20), 2607–2618. https://doi.org/10.1200/jco.2012.48.2596
Iyengar, N. M., Gucalp, A., Dannenberg, A. J., & Hudis, C. A. (2016). Obesity and Cancer Mechanisms: Tumor Microenvironment and Inflammation. Journal of Clinical Oncology, 34(35), 4270–4276. https://doi.org/10.1200/jco.2016.67.4283
Gallagher, E. J., & LeRoith, D. (2020). Hyperinsulinaemia in cancer. Nature Reviews Cancer, 20(11), 629–644. https://doi.org/10.1038/s41568-020-0295-5
Ray, I., Meira, L. B., Michael, A., & Ellis, P. E. (2021). Adipocytokines and disease progression in endometrial cancer: a systematic review. Cancer and Metastasis Reviews, 41(1), 211–242. https://doi.org/10.1007/s10555-021-10002-6
Pérez-Pérez, A., Sánchez-Jiménez, F., Vilariño-García, T., & Sánchez-Margalet, V. (2020). Role of Leptin in Inflammation and Vice Versa. International Journal of Molecular Sciences, 21(16), 5887. https://doi.org/10.3390/ijms21165887
Słabuszewska-Jóźwiak, A., Lukaszuk, A., Janicka-Kośnik, M., Wdowiak, A., & Jakiel, G. (2022). Role of Leptin and Adiponectin in Endometrial Cancer. International Journal of Molecular Sciences, 23(10), 5307. https://doi.org/10.3390/ijms23105307
Ellis, P. E., Barron, G. A., & Bermano, G. (2020). Adipocytokines and their relationship to endometrial cancer risk: A systematic review and meta-analysis. Gynecologic Oncology, 158(2), 507–516. https://doi.org/10.1016/j.ygyno.2020.05.033
Deng, T., Lyon, C. J., Bergin, S., Caligiuri, M. A., & Hsueh, W. A. (2016). Obesity, Inflammation, and Cancer. Annual Review of Pathology: Mechanisms of Disease, 11(1), 421–449. https://doi.org/10.1146/annurev-pathol-012615-044359
Levine, D. A. (2013). Integrated genomic characterization of endometrial carcinoma. Nature, 497(7447), 67–73. https://doi.org/10.1038/nature12113
Vrede, S. W., Kasius, J., Bulten, J., Teerenstra, S., Huvila, J., Colas, E., Gil-Moreno, A., Boll, D., Vos, M. C., van Altena, A. M., Asberger, J., Sweegers, S., van Weelden, W. J., van der Putten, L. J. M., Amant, F., Visser, N. C. M., Snijders, M. P. L. M., Küsters-Vandevelde, H. V. N., Kruitwagen, R., … Pijnenborg, J. M. A. (2022). Relevance of Molecular Profiling in Patients With Low-Grade Endometrial Cancer. JAMA Network Open, 5(12), e2247372. https://doi.org/10.1001/jamanetworkopen.2022.47372
Le, D. T., Durham, J. N., Smith, K. N., Wang, H., Bartlett, B. R., Aulakh, L. K., Lu, S., Kemberling, H., Wilt, C., Luber, B. S., Wong, F., Azad, N. S., Rucki, A. A., Laheru, D., Donehower, R., Zaheer, A., Fisher, G. A., Crocenzi, T. S., Lee, J. J., … Diaz, L. A., Jr. (2017). Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science, 357(6349), 409–413. https://doi.org/10.1126/science.aan6733
Talhouk, A., McConechy, M. K., Leung, S., Li-Chang, H. H., Kwon, J. S., Melnyk, N., Yang, W., Senz, J., Boyd, N., Karnezis, A. N., Huntsman, D. G., Gilks, C. B., & McAlpine, J. N. (2015). A clinically applicable molecular-based classification for endometrial cancers. British Journal of Cancer, 113(2), 299–310. https://doi.org/10.1038/bjc.2015.190
Friedenreich, C. M., Ryder‐Burbidge, C., & McNeil, J. (2020). Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms. Molecular Oncology, 15(3), 790–800. https://doi.org/10.1002/1878-0261.12772
McTiernan, A. (2008). Mechanisms linking physical activity with cancer. Nature Reviews Cancer, 8(3), 205–211. https://doi.org/10.1038/nrc2325
Coemans, E., van den Brandt, P. A., & Schouten, L. J. (2025). Healthy lifestyle and the risk of endometrial cancer. Cancer Epidemiology, 96, 102798. https://doi.org/10.1016/j.canep.2025.102798
Burkett, W. C., Clontz, A. D., Keku, T. O., & Bae-Jump, V. (2023). The interplay of obesity, microbiome dynamics, and innovative anti-obesity strategies in the context of endometrial cancer progression and therapeutic approaches. Biochimica et Biophysica Acta (BBA) – Reviews on Cancer, 1878(6), 189000. https://doi.org/10.1016/j.bbcan.2023.189000
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Patrycja Pietraszkiewicz, Paula Żak, Inez Michalska, Zuzanna Korbel, Katarzyna Pinkowska, Zuzanna Taciak, Filip Glista, Anna-Maria Grzeczka, Mikołaj Jaszowski, Agnieszka Dąbrowska, Weronika Klara Nawrocka

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 13
Number of citations: 0