The link between GH excess and cancer risk is still debated. GH and IGF-I promote cellular proliferation, angiogenesis and inhibit apoptosis. In general population, serum IGF1 levels were modestly associated with increased risk of cancer in both genders. A positive association has been described between IGF1 levels and breast, prostate, colorectal, thyroid, renal carcinomas and melanoma, but an inverse association with lung, ovaries, head and neck and liver carcinoma.

Incidence of benign tumors in acromegaly is increased more than two fold. In patients with acromegaly, some studies have also shown an increased cancer prevalence (4.8% to 21%) and a link between different types of cancer and acromegaly, whilst others do not confirm increased cancer prevalence or incidence. It seems that the effect of prolonged GH excess in carcinogenesis in acromegaly is just marginally increased and its clinical impact is modest.

Due to recent advances in understanding acromegaly, personalized treatment is applied, with decreased referral to pituitary radiotherapy, use of second generation somatostatin analogues (SSA) in patients resistant to first generation SSA and improvement of response rate and cure. Consequently, life expectancy has increased in patients with acromegaly and, in recent studies, cancer has been reported as one of the leading causes of death, with the most common associated cancers being thyroid, colorectal, anal, renal and ureteral, gastric, and testicular cancer, respectively. Age, duration of disease and family history of cancer were cited as independent risk factors for the development of cancer in acromegaly.

Another controversial issue is cancer screening in patients with acromegaly. Some studies recommend similar screening to that of the general population. Other studies, finding malignant/premalignant lesions in 21.5% of the patients submitted to a colonoscopy and in 20.8% submitted to superior endoscopy, recommend an earlier screening.

Lack of consensus between study authors has multiple causes: selection biases in some early studies, different modalities of cancer screening, improvement in acromegaly control in recent era, increased patients’ life expectancy and more intensive medical surveillance.

Data from analysis of neoplasm subgroups within the national registries of acromegaly patients and future prospective studies will solve this problem. A unitary cancer screening may become mandatory in the management of acromegaly, in order to increase the survival rates through earlier detection of cancers.

This Research Topic aims to collect studies, adding to our knowledge of cancer risk in acromegaly patients broadly, and more specifically, insights into effective screening practices.

Submit your idea

Impact

Frontiers in Endocrinology

Participating Journals

Impact