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Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 2/2016

01-02-2016 | Review

Diabetes mellitus and gynecologic cancer: molecular mechanisms, epidemiological, clinical and prognostic perspectives

Authors: Nikolaos Vrachnis, Christos Iavazzo, Zoe Iliodromiti, Stavros Sifakis, Andreas Alexandrou, Charalambos Siristatidis, Charalambos Grigoriadis, Dimitrios Botsis, George Creatsas

Published in: Archives of Gynecology and Obstetrics | Issue 2/2016

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Abstract

Introduction

Diabetes mellitus, the prevalence of which has increased dramatically worldwide, may put patients at a higher risk of cancer. The aim of our study is the clarification of the possible mechanisms linking diabetes mellitus and gynecological cancer and their epidemiological relationship.

Materials and Methods

This is a narrative review of the current literature, following a search on MEDLINE and the Cochrane Library, from their inception until January 2012. Articles investigating gynecologic cancer (endometrial, ovarian, and breast) incidence in diabetic patients were extracted.

Results

The strong evidence for a positive association between diabetes mellitus and the risk for cancer indicates that energy intake in excess to energy expenditure, or the sequelae thereof, is involved in gynecological carcinogenesis. This risk may be further heightened by glucose which can directly promote the production of tumor cells by functioning as a source of energy. Insulin resistance accompanied by secondary hyperinsulinemia is hypothezised to have a mitogenic effect. Steroid hormones are in addition potent regulators of the balance between cellular differentiation, proliferation, and apoptosis. Inflammatory pathways may also be implicated, as a correlation seems to exist between diabetes mellitus and breast or endometrial carcinoma pathogenesis, although an analogous correlation with ovarian carcinoma is still under investigation. Antidiabetic agents have been correlated with elevated cancer risk, while metformin seems to lower the risk.

Conclusion

Diabetes mellitus is associated with an elevation in gynecologic cancer risk. Moreover, there are many studies exploring the prognosis of patients with diabetes and gynecological cancer, the outcome and the overall survival in well-regulated patients.
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Metadata
Title
Diabetes mellitus and gynecologic cancer: molecular mechanisms, epidemiological, clinical and prognostic perspectives
Authors
Nikolaos Vrachnis
Christos Iavazzo
Zoe Iliodromiti
Stavros Sifakis
Andreas Alexandrou
Charalambos Siristatidis
Charalambos Grigoriadis
Dimitrios Botsis
George Creatsas
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 2/2016
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-015-3858-z

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