If bleeding occurs between two cycles or after menopause, you should not delay in seeing a doctor.
With more than 8,000 new cases per year, it is the most common gynecological cancer after breast cancer . Unlike cervical cancer which develops in the lower part of the uterus, endometrial cancer cells, also called cancer of the body of the uterus, proliferate on the inner wall of the female organ. . And, in 90% of cases, on the first layer of the endometrium. The other forms, sarcomas that affect the uterine muscle, are very rare tumors. Another big difference with cervical cancer is the age of onset of the pathology: 68 years against 51 years.
What risks?
Several risk factors have been identified and many of them are in fact related to female hormones. Conditions favoring high estrogen levels associated with reduced progesterone levels predispose to endometrial cancer. This is why women over 60 and those who have not had children are more at risk. Several studies seem to indicate that obesity increases the risks.
Finally, in about 5% of cases, a genetic predisposition is involved, and in particular Lynch syndrome, which also predisposes to colorectal cancer. Women who are carriers must be followed up from the age of 30. According to a study conducted at the Institut Curie (Paris), those who carry a mutation in the BRCA1 or 2 genes are also at greater risk of developing a rare form of endometrial cancer.
What symptoms?
"It's a fairly symptomatic cancer," says Dr. Alexandra Leary, medical oncologist at the Gustave-Roussy Institute (Villejuif). In a postmenopausal woman, vaginal bleeding should absolutely encourage consultation. The period of premenopause, with irregular cycles, sometimes blurs the lines. In the youngest, bleeding outside the rules should also alert. White discharge and / or pain in the stomach can also be warning signs of endometrial cancer. ”
"White discharge and / or pain in the stomach can also be warning signs of endometrial cancer."
What diagnosis?
If Dr. Leary insists on not wasting time when abnormal vaginal bleeding occurs, it is because it often occurs very early in the history of this cancer. Result: the diagnosis can be earlier when there is no screening test. The smear is indeed of no use since the cells analyzed are taken from the cervix, and not the body, of the uterus.
To establish the diagnosis, a pelvic ultrasound is first performed. If the endometrium is thickened, then a biopsy will be done on an outpatient basis. It will provide three pieces of information: confirmation or not of the diagnosis, the type of tumor and its aggressiveness. Finally, an MRI of the entire pelvic area will help assess whether the disease has spread to other organs, including the lymph nodes.
What treatment?
“Because the diagnosis is relatively early, the tumor is often confined to the uterus and there is an excellent chance of recovery with local treatment,” says Dr. Leary. Removal of the uterus, ovaries and tubes can be done laparoscopically , which allows for earlier recovery. Lymph node dissection, on the other hand, is not necessary for everyone. Studies are underway to determine if a simple sentinel node would suffice. "We are really in the therapeutic de-escalation" , summarizes the oncologist.
In addition to surgery, some women will be treated with radiotherapy . “If the tumor is small, we can opt for brachytherapy alone, and therefore have a very targeted action. On the other hand, faced with a tumor of larger volume, it will also be necessary to resort to conventional radiotherapy which will have more toxic effects on the intestinal level , ” adds the specialist from Gustave-Roussy. In the event of recurrence, hormone therapy has its place in the therapeutic arsenal, since the cells of the endometrium are obviously sensitive to female hormones.
What prospects?
Endometrial tumors frequently present a molecular anomaly: the instability of microsatellites. “A quarter of women are said to be carriers of this so-called“ MSI ”status. And this patient profile is very sensitive to immunotherapy. It can really transform management, with very few side effects, ” says Dr. Leary. For the moment, this treatment is not accessible on a routine basis, but the growing number of clinical trials allows most of these patients to have access to it.
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