1 – Endometrial cancer is the most common gynecological cancer
On the occasion of Turquoise September, specialists from the French National College of Gynecologists and Obstetricians shed light on endometrial cancer, also called cancer of the body of the uterus. With more than 8,800 cases per year and a constantly increasing incidence, it is the most common gynecological cancer and the fourth most common cancer in women. The median age of onset of this cancer is 69 years, with a peak incidence between 70 and 74 years.
2 – It remains a cancer that is still little known among women
Specialists regret a lack of public knowledge. For Coralie Marjollet, president of the IMAGYN association (Initiative of Patients Suffering from GYNecological Cancers), it is necessary “lifting the veil on these cancers that are still taboo because they affect the intimate, sexual sphere. In 2014, there were 70 associations for breast cancer but none for gynecological cancers. Whatever their socio-economic and cultural level, women, in great distress, did not dare to talk about it and had difficulty going through this ordeal.” Launched in 2017 in France, Septembre Turquoise aims to break taboos and stigmas in order to enable early detection.
3 – Detected at an early stage, it is one of the most curable cancers
The endometrium is the mucous membrane that lines the inside of the uterus, also called the body of the uterus. It thickens under the influence of hormones during the first phase of the cycle. Part of the endometrium is then evacuated in the absence of fertilization, this is the period. “In case of cancer, the cells of the endometrium multiply in an anarchic way, forming a tumor. If the disease is not detected and treated in time, the tumor can spread to the uterine muscle or to neighboring organs.” Endometrial cancer kills 2,500 women each year. However, “This cancer is one of those that is most curable,” “We read in the press release of the collective organizing the campaign. Detected at an early stage of the disease, the cure rate is 90% at 5 years. Caught at stage 2, the figure drops to 80%.
4 – Abnormal bleeding is the first warning symptom
Overweight, obesity, diabetes and Lynch syndrome are among the main risk factors. With or without risk factors, the first symptom, the one that should prompt you to consult, is abnormal bleeding, after menopause and between periods for women who are not menopausal, “even minimal”, “This symptom is only characteristic during the early phase of the disease,” emphasizes Professor Vincent Lavoué, head of the gynecology department at the Rennes University Hospital.
In addition to these bleedings, women should also be vigilant for heavier bleeding during menstruation, with clots. White discharge, associated with a pinkish color. Finally, in more advanced cancers, women may experience symptoms of an endometrial infection (stomach pain, fever, urinary tract infections).
5 – Surgery is sufficient in the majority of cases
Cancer is diagnosed during an initial gynecological consultation and a clinical and gynecological examination. In the event of an abnormality, an ultrasound scan of the pelvis is performed to look for thickening of the endometrium. If the result is positive, a biopsy is performed to determine the histology of the tumor and its aggressiveness. Finally, an MRI will be used to determine the extent of the tumor.
In 60 to 70% of cases, when the cancer is localized, surgery is enough to cure patients. It consists of removing the uterus, ovaries and fallopian tubes. In 95% of cases, the surgeon uses the coelioscopic route, with an optical system. Radiotherapy and/or chemotherapy may be offered to the patient, alone or combined. Sometimes, hormone therapy is used.
6 – Research is progressing and treatments are chosen on a case-by-case basis
Targeted therapies and immunotherapy (mobilization of the patient’s immune system against cancer cells) have made significant progress in recent years. The choice of treatment is now based on the biology of the tumor, its anatomopathological (cancer type) and molecular (genetic abnormalities) characteristics. “Thanks to the molecular characterization of tumors – particularly in the presence of the P53 protein (20% of patients) or the POLE anomaly, as well as genetic anomalies and the extent of the disease (depending on whether the cancer is localized or metastatic), treatments are targeted more precisely. These anomalies determine the prognosis and chances of recovery,” explains Professor Aljandra Martinnez. And several studies confirm the place that immunotherapy will take in the coming years. The objective is therapeutic de-escalation, eliminating chemotherapy to only offer immunotherapy to patients.
7 – Techniques exist to maintain fertility
In 5 to 10% of cases, endometrial cancer affects women of childbearing age. If the cancer is at an early stage, fertility-sparing treatment may be offered. “This treatment consists of removing all or part of the tumor (hysteroscopic resection), then prescribing anti-estrogen treatment (progestin for 3 months) and monitoring, to check for the absence of recurrence. In 80% of cases, the tumor will disappear,” explains Professor Martin Koskas, surgeon at Bichat Hospital (Paris). The uterus will only be removed once the pregnancy plan has been completed, by medically assisted procreation.
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