Active Metabolic Visceral Fat Linked to More Aggressive Endometrial Cancer

A groundbreaking study presented at the 38th Annual Congress of the European Association of Nuclear Medicine (EANM'25) in Barcelona reveals a significant connection between metabolically active visceral fat and more aggressive forms of endometrial cancer. This study draws attention to the role of metabolic activity of visceral fat, which has been traditionally overshadowed by the risk associated with mere accumulation of this fat type.

Research conducted by scientists from Haukeland University Hospital and the University of Bergen analyzed PET/CT scans from 274 women diagnosed with endometrial cancer. They specifically measured glucose uptake in visceral fat tissue, a key indicator of its metabolic activity. The findings indicate that women exhibiting higher glucose uptake showed a greater likelihood of having advanced stages of the disease and lymph node metastases.

Jostein Sæterstøl, a PhD candidate and the lead author, emphasized the implications of this discovery: "Our findings suggest that it is not only the quantity of visceral fat that matters but its biological activity as well". The study noted that there was no strong correlation between the volume of visceral fat and its metabolic activity, indicating that the aggressiveness of the disease may hinge on the physiological functions of the fat rather than its mere presence.

The researchers hypothesized that chronic inflammation caused by visceral fat could potentially unleash cytokines and fatty acids that facilitate tumor growth and immune evasion. Insulin resistance, linked to inflammation, is another significant risk factor for cancer progression. Furthermore, it’s suggested that interaction between adipokines - signaling molecules released by fat tissue - and cancer cells might foster cancer spread, especially to lymph nodes.

Despite these promising findings, the measurement of visceral fat metabolism via PET/CT is not yet streamlined enough for routine clinical application, primarily due to technical challenges and significant variability. The scans typically reveal low uptake signals in adipose tissue, complicating assessment.

Looking forward, the study proposes that advancements in imaging techniques, including standardized imaging procedures and quantitative PET approaches alongside AI technologies, could pave the way for identifying high-risk patients. Improved understanding of visceral fat's role could also help tailor therapeutic strategies and monitor disease progression effectively.

Future research efforts will aim to refine the methods of measuring fatty tissue metabolism while enhancing accuracy through AI segmentation techniques. Additionally, exploring relationships between visceral fat metabolism and circulating biomarkers such as cytokines and hormones will be pivotal in expanding this field of study.

In conclusion, the emergence of evidence linking active metabolic visceral fat to aggressive endometrial cancer advances our understanding of cancer biology. With ongoing investigations, scientists hope to clarify the complexity of these mechanisms and their potential implications for patient care. As we continue to unravel these connections, new pathways for diagnosis and treatment could emerge, reshaping our approach to endometrial cancer management.