Renamed Cinderella of gynecological cancers because for twenty years it was forgotten by the medical profession and researchers, uterine cancer has, since 2023, been entitled to its awareness month.
Responsible for half of cancers of the gynecological system, uterine cancer has little or nothing to do with cervical cancer of the same name: “if they are part of the same organ, they do not have the same histology or the same risk factors. Cervical cancer, which keeps the uterus closed and protected from the outside, is most often linked to the papillomavirus while body cancer is linked to the endometra, the tissue that lines the uterus and changes with menstruation“, specifies Dr Stéphanie Henry, medical oncologist at UCL Namur University Hospital, Ste Elisabeth site.
Four genetic groups
Uterine cancer has come out of obscurity thanks to the complete analysis of the genome, carried out in 2014, which allowed us to better understand the disease by distinguishing four distinct genetic groups involved in tumorigenesis. A major breakthrough! Endometrial cancer is the 6th most common cancer in industrialized countries. In Belgium, 1,400 new cases are recorded each year.
“It is important to raise awareness among doctors and women because with the aging of the population and changes in behavior, cases of endometrial cancer are increasing, leading to an increase in mortality of 2% each year. An evolution which goes against that of most other cancers”, regrets the oncologist from the Namur University Hospital where we follow around fifty cases per year. Most patients are aged 70 to 90 years old.
At the gynecologist and at the notary
It is not because you are done with pregnancies or that you no longer have sexual relations that you should no longer consult your gynecologist, reminds Dr. Henry. “I always tell my patients that the gynecologist is like the notary: it is better to consult him to anticipate problems! A visit every 2 or 3 years is good. If the ultrasound, the gynecologist realizes that the uterus has thickened, we can intervene before the appearance of more serious symptoms. It is especially necessary to consult when you have colored vaginal discharge after menopause or discharge between periods.
Spontaneous weight loss associated with swelling of the abdomen caused by the tumor, changes in the bladder and intestine or even pain in the pelvis reflect a more advanced stage of the cancer.
Risk factors
Most cases of endometrial cancer occur in women over the age of 50, after menopause. Other risk factors include sedentary lifestyle and obesity, excess body fat modifying hormonal balance. People with type 2 diabetes are also slightly more predisposed.
Having fewer children and later age at first pregnancy are also risk factors. “In terms of hormonal therapy, we should avoid taking estrogens alone both for contraception and replacement therapy after menopause. A pill combining estrogen and progesterone or even hormonal IUDs is also recommended as a contraceptive.“,.
The risk is higher if family members have had this cancer or that of the colon or ovaries, suggestive of Lynch syndrome.
“Tamoxifen, a hormone therapy drug administered to prevent or treat breast cancer, doubles the risk but patients are closely monitored“, reassures the oncologist.
Personalized treatment
Previously, uterine cancer was treated with radiation after a hysterectomy (removal of the uterus). Basically, the same treatment for all patients. “Today, we can make tailor-made products depending on the progress of the disease, the patient’s state of health and of what she wants. Therapeutic advances are such that for certain subtypes of cancer, immunotherapy makes it possible to cure cancers even at the metastatic stage. And in the near future, we should be able to prescribe treatment adapted to each genetic group.” rejoices Dr. Henry.
