A 55-year-old woman has been steadily gaining weight for the past 30 years. She underwent cholecystectomy for cholelithiasis 5 years ago. She does not smoke. She is now 164 cm (5 ft 4 in) tall and weighs 126 kg (BMI 47). On physical examination, she has a decreased range of motion with pain on movement of the knees. Laboratory studies show a serum glucose level of 176 mg/dL. This patient is at greatest risk of developing which of the following neoplasms?
A 55-year-old woman has been steadily gaining weight for the past 30 years. She underwent cholecystectomy for cholelithiasis 5 years ago. She does not smoke. She is now 164 cm (5 ft 4 in) tall and weighs 126 kg (BMI 47). On physical examination, she has a decreased range of motion with pain on movement of the knees. Laboratory studies show a serum glucose level of 176 mg/dL. This patient is at greatest risk of developing which of the following neoplasms?
💡 Explanation
## **Core Concept**
The patient's presentation suggests **obesity**, which is a significant risk factor for various health conditions, including **type 2 diabetes mellitus** (evidenced by a serum glucose level of 176 mg/dL) and **osteoarthritis** (suggested by decreased range of motion and pain on movement of the knees). Obesity is also associated with an increased risk of certain types of cancer.
## **Why the Correct Answer is Right**
The correct answer, **endometrial cancer**, is linked to obesity due to the conversion of **androgens** to **estrogens** by **aromatase** in adipose tissue. This leads to **unopposed estrogen** effects on the endometrium, increasing the risk of endometrial hyperplasia and cancer. The patient's profile, including obesity and likely hormonal imbalances, puts her at a higher risk for this type of cancer.
## **Why Each Wrong Option is Incorrect**
- **Option A:** While obesity and diabetes may increase the risk of **pancreatic cancer**, the direct and specific link between obesity and endometrial cancer makes it a more relevant choice here.
- **Option B:** **Breast cancer** risk is influenced by many factors, including genetics, hormonal exposure, and lifestyle. While obesity in postmenopausal women is associated with an increased risk of breast cancer, the link is not as direct or strong as with endometrial cancer.
- **Option C:** **Colorectal cancer** risk factors include genetics, diet, lifestyle, and certain medical conditions. Obesity may increase the risk, but again, the association is not as strong or direct as with endometrial cancer.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **obesity** significantly increases the risk of **endometrial cancer**, likely due to the peripheral conversion of androgens to estrogens in adipose tissue leading to unopposed estrogen stimulation of the endometrium. This association is critical for understanding the increased cancer risk in obese postmenopausal women.
## **Correct Answer Line**
**Correct Answer: D. Endometrial cancer.**
✓ Correct Answer: B. Endometrial carcinoma
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