New Research Links Metabolically Active Visceral Fat to Aggressive Endometrial Cancer

A groundbreaking study showcased at the 38th Annual Congress of the European Association of Nuclear Medicine (EANM'25) reveals a significant correlation between metabolically active visceral fat and the aggressiveness of endometrial cancer. Traditionally, obesity has been acknowledged as a risk factor for various types of cancer, including endometrial cancer. However, this new research indicates that not only the quantity of visceral fat matters, but also its metabolic activity plays a crucial role in disease progression.

Visceral fat refers to the fat that surrounds internal organs, and it has been shown to influence metabolism and inflammation more significantly than subcutaneous fat. Researchers from Haukeland University Hospital and the University of Bergen analyzed PET/CT scans from 274 women diagnosed with endometrial cancer. They quantified glucose uptake in visceral fat as a measure of its metabolic activity.

Dr. Jostein Sæterstøl, the lead author and a doctoral candidate, explained, “We found that women exhibiting higher metabolic activity—reflected in the average glucose uptake in visceral fat—were more likely to present with advanced disease stages and lymph node metastases.” This finding underscores the importance of assessing not just the volume of fat but its biological activity in understanding cancer aggressiveness.

The study revealed that elevated metabolic rates in visceral fat are significantly associated with more advanced stages of cancer and increased occurrences of lymph node metastases. Notably, a strong correlation was not identified between the volume of visceral fat and its metabolic activity, suggesting that cancer severity is influenced not just by how much fat is present, but by how active and metabolically responsive it is.

“The link between increased metabolic activity in visceral fat and aggressive diseases is likely governed by several mechanisms,” Dr. Sæterstøl elaborated. He mentioned that chronic inflammation within visceral fat can release cytokines and fatty acids that may promote tumor growth and immune system evasion. Additionally, chronic inflammation is known to induce insulin resistance, which is another risk factor for cancer progression. Other factors, such as signaling molecules known as adipokines and interactions between fat tissue and tumor cells, may further facilitate cancer spread, particularly to lymph nodes.

Currently, the measurement of visceral fat metabolism using PET/CT faces technical challenges and variability that hinder its routine clinical application, particularly due to low uptake signals in fat tissue. However, future advancements, including standardized imaging analyses, improved quantitative PET techniques, and the implementation of artificial intelligence, could enhance the identification of high-risk patients, inform treatment decisions, and monitor disease progression more accurately.

The exploration of new methodologies to refine measurement techniques, improve accuracy through AI-based segmentation, and investigate relationships between visceral fat metabolism and circulating biomarkers such as cytokines and hormones will be the focus of future research.

This study not only contributes to our understanding of endometrial cancer but also highlights the evolving nature of obesity research. The implications of this research could lead to more tailored and effective treatment strategies for patients diagnosed with endometrial cancer, opening the door for further innovative approaches in cancer care.