Metabolically Active Visceral Fat May Drive Aggressive Endometrial Cancer, Study Finds

A study presented at the 38th Annual Congress of the European Association of Nuclear Medicine (EANM’25) indicates that the metabolic activity of visceral fat, rather than its sheer volume, may be associated with more aggressive forms of endometrial cancer. The findings could redefine risk assessment for obese patients diagnosed with the disease.

Obesity has long been identified as a major risk factor for endometrial cancer, the most common gynecologic malignancy in developed countries. However, researchers now suggest that fat tissue’s biological activity, especially in the abdominal cavity, may play a crucial role in tumor progression.

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Study Details and Findings

Researchers analyzed PET/CT scans from 274 women diagnosed with endometrial cancer, using glucose uptake as a measure of metabolic activity in visceral fat.

The results revealed that women with higher glucose uptake in visceral fat were more likely to present with advanced-stage cancer and lymph node metastases. Importantly, the study found no strong correlation between the volume of visceral fat and its metabolic activity, suggesting that the quantity of fat alone does not explain disease severity.

“Higher metabolic activity in visceral fat was significantly associated with advanced cancer stages and lymph node involvement,” said Jostein Sæterstøl, PhD candidate and MSc, lead author of the study. He added that chronic inflammation, insulin resistance, and adipokine signaling from visceral fat may create a microenvironment that supports tumor growth and spread.

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Implications for Cancer Care

Currently, routine PET/CT imaging of fat metabolism is not widely used in clinical practice. However, researchers believe that advances in AI-driven imaging and quantitative analysis could make this a practical tool for predicting disease aggressiveness in the future.

“This research highlights the need to look beyond BMI or fat quantity when evaluating cancer risk,” Sæterstøl noted. “Understanding the metabolic activity of visceral fat could help clinicians identify patients at higher risk of aggressive disease and tailor treatment accordingly.”

Experts suggest that this approach could eventually complement existing diagnostic protocols, particularly for obese women at risk of endometrial cancer, by providing a more nuanced picture of how fat tissue interacts with tumor biology.