Gynecological cancers

Endometrial cancer – or uterine cancer

Uterine cancer most often develops in the endometrium, which is the mucous membrane that lines the inside of the uterus. This is why doctors often use the term “endometrial cancer” to describe it. With 8,220 cases estimated in 2018 in France, it is the most common gynaecological cancer and the fourth-most common cause of cancer in women after breast, colon and lung cancer. It usually affects women after menopause; the average age of diagnosis is 69 years. It is diagnosed in 75% of cases at an early stage. This cancer is often responsible for abnormal bleeding, which is an early indicator allowing treatment to begin quickly. Obesity, diabetes and oestrogen-based hormonal treatments are the classic risk factors. This cancer has a good prognosis with a net survival of 75% at five years and 68% at 10 years. The prognosis is excellent for stage 1 (limited to the uterus) with 90% survival after five years. Treatment most often consists of surgery including a total hysterectomy with removal of the ovaries and fallopian tubes. This surgery is usually performed by laparoscopy, a minimally invasive surgical procedure. Depending on the type of cancer and the preoperative imaging tests, surgery may also include the removal of the lymph nodes. Depending on the results, radiotherapy or chemotherapy follows.

➥ At the Antoine Lacassagne Center:
A diagnostic hysteroscopy consultation is dedicated to patients suspected to have endometrial cancer (either post-menopausal patients who experience bleeding or patients with thickening of the endometrium discovered during an ultrasound). During a consultation, the interior of the uterine cavity is viewed using a flexible hysteroscope. Biopsies may also be taken. Hysteroscopy consultations take place every Thursday.

Cervical cancer

This cancer is very different from that affecting the uterus. It is a squamous cell cancer caused by Human Papillomavirus (HPV) infection in nearly all cases. It affects the lower part of the uterus that connects to the vagina. Screening is very easy by a Pap smear, which has halved the number of new cases as well as the number of deaths in 20 years. Treatment of the disease at the “cancer in situ” stage almost always leads to a cure. This disease can be prevented by vaccinating young girls against papillomavirus. It is the 12th most common cause of cancer in women with 2,920 new cases in 2018 in France. It can occur at any age, but affects younger women than uterine cancer: the median age of diagnosis is 53 years. Treatment depends on the stage of the disease, which is determined by clinical examination and pelvic MRI. This may be surgical or consist of radiotherapy combined with chemotherapy, sometimes followed by brachytherapy.

➥ At the Antoine Lacassagne Center:
Colposcopy consultations allow rapid exploration of any anomaly of the cervix detected by a Pap smear. The radiology department is an expert in female imaging and allows optimal evaluation of the disease through pelvic MRI.

Ovarian cancer

Ovarian cancer is a relatively uncommon disease. Its precise causes are still, at present, poorly understood. Most ovarian cancers result from a malignant transformation of surface tissue cells of the ovary or the fallopian tube, which adjoins the peritoneum (the covering that lines the inside of the abdominal cavity). With nearly 5,200 new cases estimated in 2018, ovarian cancer ranks fifth among female cancers. The median age of discovery is 68 years. There is no reliable and sensitive screening test. This cancer remains asymptomatic for a very long time. This is why it is often diagnosed at an advanced stage and the prognosis is poor. Nevertheless, research is progressing and new therapies are being developed. Net survival in 2018 was 40% at five years and 32% at 10 years, and is therefore improving. Because it is a rare and serious disease, ovarian cancer requires treatment in a specialised center by expert teams. This guarantees treatments as quickly as possible and access to therapeutic trials. Treatment usually combines surgery and chemotherapy. Some ovarian cancers are of genetic origin, most often linked to a mutation in the BRCA 1 or 2 genes. Seeking this information is essential in order to best define treatments.

➥ At the Antoine Lacassagne Center:
The Antoine Lacassagne Center brings together all the specialists needed for multidisciplinary care in the best conditions: medical oncologists, surgeons, radiologists specialising in female imaging, geneticists and clinical research assistants.

Vulvar cancer

It is a rare disease: less than 1,000 cases per year in France in 2018, i.e. less than 5% of female cancers. The median age at diagnosis is 77 years. It can affect the labia minora or labia majora, but also the clitoris and the entrance to the vagina (vestibule). Pre-cancerous states are the main risk factors: never neglect them and consult your doctor in the slightest suspicion:
– Papillomavirus infection, as with cervical cancer, causes vulvar cancer. Infection and therefore cancer could be prevented by vaccination.
– Leucoplastic lichen sclerosis (LSA) is a disease developing in particular in 50-year-old post-menopausal women. It causes pearly white lesions. Rapid improvement with treatment with topical corticosteroids is a pathognomonic sign of lichen sclerosus.
– Paget’s disease causes severe itching and oozing or crusty plaques, which may look like eczema.
– Leukoplakia manifests as thick, dry and rough white patches.
– Bowen’s disease
These diseases are rare and poorly understood. If in doubt, a biopsy should be performed. The treatment of choice is early and complete surgical excision. Other methods such as local antimitotics, radiotherapy, cryotherapy, laser and photodynamic therapy may constitute alternatives.

Vaginal cancer

This is the rarest gynaecological cancer: it represents 1 to 2% of cancer cases affecting less than 1,000 women per year and mainly elderly women. Symptoms include abnormal bleeding post-menopause, pain during sexual intercourse (dyspareunia), pain in the lower abdomen and urinary signs later on due to ureteral compression during extension of the tumour.
Its management is complex, involving several specialities (surgery, radiotherapy and medical oncology) and requires specialist advice