Endometrial Cancer Wellness Protocol
About 2.7 percent of women will be diagnosed with endometrial cancer at some point during their lifetime, based on the SEER 2008-2010 data.
Endometrial cancer is the most common malignancy of women in developed countries, and its incidence is 10 times higher than in developing countries.
81.1% of women with endometrial cancer have a 5 year survival rate.[1]
Endometrial cancer is heavily influenced by estrogen exposure, therefore it is found in higher amounts in women with early start of menstrual cycle, no children and late menopause.
WATCH YOUR WEIGHT
Maintain a healthy weight as obesity is related to an increased risk of estrogen dependent cancers.
A number of risk factors are known to be associated with endometrial cancer occurrence, with different risk factors among different age groups. Endometrial cancer occurs much more frequently in post- menopausal women.[2]
Among the most well-established risk factors include:
- A history of cancer in the family, particularly a first degree relative.
- Tamoxifen use for breast cancer. Women with breast cancer who take the hormone therapy drug tamoxifen have an increased risk of developing endometrial cancer.
- Starting menses prior to age 12 and having no pregnancies significantly increases the risk.
- Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome that increases the risk of endometrial cancer. HNPCC occurs because of a gene mutation from parents to their offspring.
Risk factors for older women:
- Taking hormones after menopause that contain estrogen but not progesterone increases the risk of endometrial cancer. Unopposed estrogen is associated with increased risk of endometrial hyperplasia at all doses, and durations of therapy between one and three years.[3]
Other known risk factors include:
- Alcohol intake
- Higher amounts of dietary fat
- Elevated blood sugar – overweight women with an elevated blood glucose had over a 2.5 fold increase (260%) in risk for female reproductive cancers, while overweight women with a normal glucose had only a 70% increase in risk.[4]
- High percentage of body fat
REDUCE STRESS Practice mindfulness-based stress reduction, like breathing techniques, yoga, Pilates and meditation.
Physical symptoms
There is not one lab test to diagnose endometrial cancer, rather it is most often suspected from initial physical exam and history. It is estimated that 90% of women with endometrial cancer experience changes in their menses, vaginal bleeding, or experience post-menopausal vaginal bleeding and 10% of endometrial cancers present as a non-blood discharge. Later stages of the cancer may show up as pain in the pelvis, feeling a mass in the abdomen or pelvis, and losing weight without trying.
Non-invasive methods:
Ultrasound of the pelvic region and endometrial cytology (cell study).
Invasive methods:
Dilatation and curettage (D&C) endometrial biopsy and hysteroscopy with biopsy of the endometrium (uterine lining).
STAY ACTIVE Exercise often. It has been established that exercise reduces endometrial cancer risk.[5]
Emphasize:
- 4 or more daily servings of fruits and vegetables that are orange or yellow, which provide beta carotene (peppers, squashes and carrots for example). Tomatoes and watermelon are rich sources of lycopene.
- Whole foods (foods that are as close to their natural form as possible)
- Low sugar/low glycemic diet: (Glycemic index (GI) and glycemic load (GL) are measures of the effect on blood glucose level after a food containing carbohydrates is consumed)
- Omega-3 fatty acids, found in cold water fish such as sardines, wild-caught salmon, cod, mackerel, tuna
- High fiber, from whole grains, beans, vegetables and fruits
- Healthy fats, from avocados, nuts, seeds, olive oil, coconut oil, cold water fish
- For animal protein, choose lean poultry and fish over red meat, and aim to view meat as a condiment rather than a staple. Try to choose grass fed and organic meats and eggs whenever possible. Eat no fish larger than a salmon to minimize environmental contaminants, including mercury.[6]
- Having one to two servings of whole soy foods each day may prove beneficial (as long as the soy is GMO free). Try non GMO soymilk as a beverage as well as edamame, tempeh, tofu, roasted soy nuts and soy nut butter. Traditional fermented soy foods, such as miso, tempeh, and natto, are particularly beneficial.
Avoid:
- Processed and grilled meats. Also, try to limit intake of red meat to avoid excess estrogens.
- Insulin plays a role in a women’s estrogen balance so eliminate refined sugar, processed flours, artificial sweeteners and sugary beverages to keep blood sugar under control.
- Fast foods, fried foods, baked goods and packaged, processed foods
- Limit or avoid alcohol. In most studies that have looked at alcohol consumption and risk of most cancer, regular consumption is linked with increased cancer risk.
Multiple nutritional supplements have been associated with reduced cancer incidence and/or cancer progression. This list contains those with the greatest evidence-based benefit.
Lycopene
Lycopene has been used as an immune stimulant in a variety of cancers. Blood levels of lycopene were found to be inversely related to the risk of developing endometrial cancer in a group of females.[11] Additionally, cell studies show that lycopene can inhibit cancer progression in estrogen affected cancer cells, such as the endometrial cells.[12]
Suggested dose:
30mg per day.
Omega-3 Fatty Acids Omega-3 fatty acids, DHA and EPA, have been shown to exert numerous anti-cancer effects on breast cancer cells. Human studies are limited on endometrial cancer but one did recently establish that dietary PUFA and DHA inhibited endometrial cancer cell proliferation, colony formation, and migration, and promoted cell-programmed death (apoptosis) in animal and in-vitro models.[18] Additionally, GLA, another omega-3, helps to maintain balance in the fatty acids and enhances the anti-inflammatory effect.[19],[20]
Suggested dose:
2-3 grams combined EPA & DHA per day, with at least 1-2 grams of a GLA source.
Scutellaria Baicalensis
Used as an adjunctive to chemotherapy for lung cancer patients, cell-based studies have demonstrated that Scutellaria inhibited NFκB formation, which could be beneficial to slow endometrial cancer.[10]
Suggested dose:
Dried herb: 1 to 2 grams 3 times per day; Tea: 240 mL 3 times per day or as a tincture: 2 to 4 mL 3 times per day.
Vitamin D
Vitamin D levels are associated with the risk of most hormone cancers, including endometrial cancers. Studies on human cells demonstrate that vitamin D protects against endometrial cancer progression.[7],[8] Individuals with a history of lymphoma should also monitor 1,25 dihydroxy-vitamin D levels, as rapid conversion to this active form has been observed.
Suggested dose is that sufficient to raise vitamin D blood levels to >40 ng/mL, which may require 5000 IU per day or more.[9]
Beta Carotene
Beta carotene has been used as an immune stimulant in many disease states as well as cancer. Blood levels of beta carotene were found to be inversely related to the risk of developing endometrial cancer in several studies upon review of intake and cancer development.[13],[14] Furthermore endometrial cancer was inhibited in cells treated with beta carotene and other carotenoids.[15]
Suggested dose:
Experts recommend as high as starting at 10,000 IU per day up to 83,000 IU per day
Green Tea Extract Catechins, antioxidants found in green tea, particularly EGCG (epigallocatechin-3-gallate), are known to have numerous anti-metastatic and anti-proliferative properties in cancers that are affected by estrogens. Cell studies demonstrated that EGCG inhibits cellular proliferation via inhibiting ERK activation and induces apoptosis (cell death) in endometrial carcinoma cells.[16][17]
Suggested dose:
1g EGCG and mixed catechins.
[1] Matsuo K, Cahoon SS, Gualtieri M, Scannell CA, Jung CE, Takano T, Paulson RJ, Muderspach LI, Roman LD. Significance of Adenomyosis on Tumor Progression and Survival Outcome of Endometrial Cancer. Ann Surg Oncol. 2014 Jul 8.
[2] Ali AT. Reproductive factors and the risk of endometrial cancer. Int J Gynecol Cancer. 2014 Mar;24(3):384-93.
[3] Furness S, Roberts H, Marjoribanks J, Lethaby A. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev. 2012 Aug 15;8:CD000402.
[4] Moore LL1, Chadid S2, Singer MR2, et al. Metabolic Health Reduces Risk of Obesity-Related Cancer in Framingham Study Adults. Cancer Epidemiol Biomarkers Prev. 2014 Jul 10. pii: cebp.0240.2014. [Epub ahead of print]
[5] Keum N, Ju W, Lee DH, Ding EL, Hsieh CC, Goodman JE, Giovannucci EL. Leisure-time physical activity and endometrial cancer risk: dose-response meta-analysis of epidemiological studies. Int J Cancer. 2014 Aug 1;135(3):682-94.
[6] Arem H, Neuhouser ML, Irwin ML, Cartmel B, Lu L, Risch H, Mayne ST, Yu H. Omega-3 and omega-6 fatty acid intakes and endometrial cancer risk in a population-based case-control study. Eur J Nutr. 2013 Apr;52(3):1251-60.
[7] Bergadà L, Pallares J, Vittoria Arcidiacono M, Cardus A, Santacana M, Valls J, Cao G, Fernàndez E, Dolcet X, Dusso AS, Matias-Guiu X. Role of local bioactivation of vitamin D by CYP27A1 and CYP2R1 in the control of cell growth in normal endometrium and endometrial carcinoma. Lab Invest. 2014 Jun;94(6):608-22. doi: 10.1038/labinvest.2014.57. Epub 2014 Apr 14.
[8] Nguyen H, Ivanova VS, Kavandi L, Rodriguez GC, Maxwell GL, Syed V. Progesterone and 1,25-dihydroxyvitamin D₃ inhibit endometrial cancer cell growth by upregulating semaphorin 3B and semaphorin 3F. Mol Cancer Res. 2011 Nov;9(11):1479-92.
[9] Garland CF, French CB, Baggerly LL, et al. Vitamin D supplement doses and serum 25-hydroxyvitamin D in the range associated with cancer prevention. Anticancer Res. 2011 Feb;31(2):607-11.
[10] Kavandi L, Lee LR, Bokhari AA, Pirog JE, Jiang Y, Ahmad KA, Syed V. The Chinese herbs Scutellaria baicalensis and Fritillaria cirrhosa target NFκB to inhibit proliferation of ovarian and endometrial cancer cells. Mol Carcinog. 2013 Nov 19.
[11] Jeong NH, Song ES, Lee JM, Lee KB, Kim MK, Yun YM, Lee JK, Son SK, Lee JP, Kim JH, Hur SY, Kwon YI. Preoperative levels of plasma micronutrients are related to endometrial cancer risk. Acta Obstet Gynecol Scand. 2009;88(4):434-9.
[12] Hirsch K, Atzmon A, Danilenko M, Levy J, Sharoni Y. Lycopene and other carotenoids inhibit estrogenic activity of 17beta-estradiol and genistein in cancer cells. Breast Cancer Res Treat. 2007 Aug;104(2):221-30.
[13] Jeong NH, Song ES, Lee JM, Lee KB, Kim MK, Yun YM, Lee JK, Son SK, Lee JP, Kim JH, Hur SY, Kwon YI. Preoperative levels of plasma micronutrients are related to endometrial cancer risk. Acta Obstet Gynecol Scand. 2009;88(4):434-9.
[14] Pelucchi C, Dal Maso L, Montella M, Parpinel M, Negri E, Talamini R, Giudice A, Franceschi S, La Vecchia C. Dietary intake of carotenoids and retinol and endometrial cancer risk in an Italian case-control study. Cancer Causes Control. 2008 Dec;19(10):1209-15.
[15] Hirsch K, Atzmon A, Danilenko M, Levy J, Sharoni Y. Lycopene and other carotenoids inhibit estrogenic activity of 17beta-estradiol and genistein in cancer cells. Breast Cancer Res Treat. 2007 Aug;104(2):221-30.
[16] Manohar M, Fatima I, Saxena R, Chandra V, Sankhwar PL, Dwivedi A. (-)-Epigallocatechin-3-gallate induces apoptosis in human endometrial adenocarcinoma cells via ROS generation and p38 MAP kinase activation. J Nutr Biochem. 2013 Jun;24(6):940-7.
[17] Park SB, Bae JW, Kim JM, Lee SG, Han M. Antiproliferative and apoptotic effect of epigallocatechin-3-gallate on Ishikawa cells is accompanied by sex steroid receptor downregulation. Int J Mol Med. 2012 Nov;30(5):1211-8.
[18] Zheng H, Tang H, Liu M, He M, Lai P, Dong H, Lin J, Jia C, Zhong M, Dai Y, Bai X, Wang L. Inhibition of Endometrial Cancer by n-3 Polyunsaturated Fatty Acids in Preclinical Models. Cancer Prev Res (Phila). 2014 May 27.
[19] Xu Y, Qian SY1. Anti-cancer activities of ω-6 polyunsaturated fatty acids. Biomed J. 2014 May-Jun;37(3):112-9.
[20] Biomed J. 2014 May-Jun;37(3):112-9. Gamma linolenic acid with tamoxifen as primary therapy in breast cancer. Int J Cancer. 2000 Mar 1;85(5):643-8.
Lycopene
Omega-3 Fatty Acids
Scutellaria Barbata
Vitamin D
Multiple nutritional supplements have been associated with reduced cancer incidence and/or cancer progression. This list contains those with the greatest evidence-based benefit.