Endometrial cancer

Clinical / Scientific

Endometrial carcinomas include endometrioid (PTEN/, ER) and serous-like (TP53 copy-number high) groups, plus MSI-high immune-visible disease. Metabolic syndrome is a strong epidemiologic partner of endometrioid disease; that does not make metformin an endometrial cancer drug.

Core Biological Drivers

PTEN / PI3K

Endometrioid map.

Estrogen signalling

Unopposed estrogen risk biology.

TP53

Serous-like tumours.

MSI

Immune-visible subset.

Key Pathways

PI3K/AKT

Scientific explanation

phosphorylates PIP2 to PIP3, recruiting . supports growth, survival, glucose uptake and mTORC1 input. Pathway activation is common via PIK3CA mutation, PTEN loss or -tyrosine- signalling.

mTOR

Scientific explanation

mTORC1 integrates growth-factor and nutrient signals to drive protein synthesis, lipid synthesis and suppression. It sits downstream of PI3K/AKT and amino-acid sensing.

Estrogen receptor

Scientific explanation

ERα (ESR1) drives a large fraction of breast cancers via genomic and non-genomic signalling. ESR1 mutations and growth-factor crosstalk contribute to endocrine resistance.

p53

Scientific explanation

TP53 encodes a stress-responsive factor controlling cell-cycle arrest, and metabolic adaptation. Loss or mutation is among the most common cancer events.

PD-1 / PD-L1

Scientific explanation

PD-1 on T cells engaging PD-L1/PD-L2 restrains cytotoxic function. Tumour or myeloid PD-L1 is a canonical adaptive immune-evasion axis.

Glycolysis

Scientific explanation

Aerobic (Warburg metabolism) supports ATP, biomass and redox buffering even when oxygen is available. Hexokinase, PKM2 and lactate export are frequent nodes.

Wnt/β-catenin

Scientific explanation

Canonical Wnt signalling stabilizes β-catenin, driving TCF/LEF . APC loss is a classic colorectal initiating event; the pathway also contributes to stemness in several tissues.

Pathway Convergence

Target → pathway → downstream effect → biological consequence. Shared intersections are mechanistic maps, not protocols.

Growth-factor signalling

Ligand or mutation-driven RTK input feeds PI3K/AKT and mTORC1, supporting anabolic growth. This is a map of signalling, not a treatment protocol.

Receptor tyrosine kinase
↓
PI3K/AKT
↓
mTOR
↓
Protein synthesis / growth

Energy stress

Energetic stress activates AMPK, which can restrain mTORC1. Biguanides and related tools map onto this axis in models.

Complex I / ATP stress
↓
AMPK
↓
mTOR restraint
↓
Reduced anabolism

Inflammatory survival

Chronic cytokine tone activates NF-κB and STAT3 transcriptional programmes that favour survival, invasion and sometimes immune evasion.

Cytokines
↓
NF-κB / STAT3
↓
Survival and invasion genes
↓
Therapy-tolerant phenotype

Metabolic Vulnerabilities

Aerobic supports ATP, biomass and acidification even when oxygen is available. Extent varies by tumour and remains a vulnerability hypothesis rather than a uniform target.

/IGF and obesity-associated signalling reinforce .

Tumor Microenvironment

Disordered vasculature creates , HIF-1α stabilization, induction and immune-suppressive adenosine/lactate milieus.

Metastasis Module

, protease-mediated invasion, , circulating tumour-cell survival and organ-specific colonization form the metastatic cascade. Pre-metastatic niches and vascular permeability influence tropism.

Resistance Biology

persistence and endocrine-independent clones.

Cancer Stemness

Wnt, Notch, Hedgehog, ALDH and CD44-associated programmes can mark stem-like fractions with quiescence and therapy tolerance. These markers are not interchangeable across tumour types.

Mechanism-Based Adjunctive Strategies

Compounds appear only where a mechanistic overlap exists for this cancer. Evidence tiers are not equivalent. Nothing here is a treatment recommendation.

Metformin

Clinical / Human EvidenceIn VivoIn VitroMechanistically Plausible

Target / Mechanism

Modest complex I inhibition raises AMP:ATP, activating and restraining hepatic and -linked anabolism. Direct antineoplastic efficacy is not established from that pharmacology alone.

Cancer relevance

activation and restraint provide a metabolic rationale in - and -linked tumours. Human data are mixed and do not establish metformin as cancer therapy.

Metabolic adjunctive research context. Convergence: AMPK, mTOR, Glycolysis.

Berberine

In VitroIn VivoMechanistically Plausible

Target / Mechanism

Isoquinoline alkaloid that can inhibit complex I and activate in metabolic models, with additional -independent reports. Not an approved antineoplastic.

Cancer relevance

Complex I / pharmacology overlaps metformin-like energy stress in models. Bioavailability and lack of oncology indication keep this mechanistic.

Metabolic energy-stress hypothesis. Convergence: AMPK, mTOR, Mitochondrial oxidative phosphorylation.

Celecoxib

Clinical / Human EvidenceIn VivoIn Vitro

Target / Mechanism

Selective -2 reducing PGE2. Relevant to -associated epithelial neoplasia; cardiovascular risk and lack of broad anticancer approval constrain interpretation.

Cancer relevance

-2/PGE2 biology is relevant in some epithelial neoplasias. Cardiovascular risk and lack of broad anticancer approval apply. Do not equate polyp or biomarker studies with tumour cure.

Inflammation-associated epithelial neoplasia research. Convergence: COX / inflammatory signalling, Angiogenesis.

Statins (HMG-CoA reductase inhibitors)

Clinical / Human EvidenceIn VitroMechanistically Plausible

Target / Mechanism

Inhibit HMG-CoA reductase, depleting mevalonate-pathway isoprenoids needed for RAS/RHO prenylation and some sterol-dependent growth programmes. Observational oncology signals are mixed and not a licence to treat cancer with statins.

Cancer relevance

Mevalonate-pathway blockade can affect prenylation of RAS-family GTPases. Observational human signals are mixed and confounding is substantial.

Mevalonate / prenylation mechanistic overlap. Convergence: RAS/RAF, Fatty-acid metabolism.

Curcumin

In VitroMechanistically Plausible

Target / Mechanism

Polyphenol with promiscuous in-vitro NF-κB, and ROS effects. Bioavailability is poor; dish activity does not establish clinical anticancer efficacy.

Cancer relevance

In-vitro NF-κB/ effects are frequent. Poor bioavailability and absence of robust clinical anticancer efficacy keep this pathway-level.

Inflammatory-signalling dish models. Convergence: NF-κB, JAK/STAT.

Research Context

  1. Hallmarks. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646-674. https://doi.org/10.1016/j.cell.2011.02.013
  2. Metformin oncology. Pollak MN. Investigating metformin for cancer prevention and treatment: the end of the beginning. Cancer Discov. 2012;2(9):778-790. https://doi.org/10.1158/2159-8290.CD-12-0263
  3. Checkpoints. Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nat Rev Cancer. 2012;12(4):252-264. https://doi.org/10.1038/nrc3239

This oncology atlas is educational. Pathway maps, adjunctive strategies, and compound listings describe mechanistic relevance. They do not establish clinical efficacy, do not recommend treatment, and are not a substitute for oncology care. Evidence tiers are not equivalent.