Adipositas in der gynäkologischen Onkologie

Abstract

Die Adipositas ist eine moderne Zivilisationskrankheit, deren Häufigkeit steigt und die mit zahlreichen Risiken für Folgeerkrankungen verbunden ist. In der gynäkologischen Onkologie ist sie vor allem mit einem erhöhten Risiko für ein Endometrium- und für eine postmenopausale Erkrankung an einem Mammakarzinom verbunden. Ursachen dafür können eine gesteigerte Östrogensekretion, eine Hyperinsulinämie und eine chronische Entzündung sein. Die Datenlage bezüglich einer Risikoerhöhung für andere gynäkologischer Entitäten wie dem Zervix-, Ovar- und Vulvakarzinom ist weiterhin unklar. Hinsichtlich des Einsatzes einer möglichen Chemotherapie gibt es immer wieder Unklarheiten bezüglich der korrekten Dosierung und möglicher Toxizitäten bei adipösen Patientinnen. Die internationale ASCO- (American Society of Clinical Oncology) Leitlinie empfiehlt, die volle, gewichtsabhängige Dosierung, im kurativen Setting einzusetzen. Eine operative Therapie sollte, wenn technisch möglich und onkologisch sicher, minimal-invasiv durchgeführt werden. Hierbei wird für adipöse Patientinnen vor allem das Risiko für frühe postoperative Komplikationen, im Gegensatz zu offenen Operationen, gesenkt.

Abstract

Obesity is a modern disease that is becoming increasingly common and is associated with numerous risks for secondary diseases. In gynecological oncology, obesity is primarily associated with an increased risk for endometrial cancer and postmenopausal breast cancer. This may be due to increased estrogen secretion, hyperinsulinemia and chronic inflammation. The data regarding an increased risk for other gynecological entities such as cervical, ovarian and vulvar cancer is still unclear. With regard to the use of chemotherapy, there are still uncertainties about the correct dosage and possible toxicities in obese patients. The ASCO (American Society of Clinical Oncology) guideline recommends using the full, weight-dependent dosage in the curative setting. If possible and oncological safe, surgical treatment should be done laparoscopically. Above all, this reduces the risk for early complications for obese patients, in contrast to open surgery.

Schlüsselwörter

Adipositas - Übergewicht - Gynäkologische Malignome

Keywords

obesity - overweight - Gynecological malignancies

Publication History

Article published online:
13 December 2024

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