uterine cancer respond to first bleeding
uterine cancer respond to first bleeding
The endometrium is the lining of the uterus: it lines the inner wall of the cavity where the pregnancy takes place. It consists of a first layer of cells that form the epithelium (where endometrial cancer is most often born) and a connective tissue that contains glands.
If bleeding occurs between two cycles or after menopause, do not wait to see a doctor.
With more than 8000 new cases a year, it is the most common gynecological cancer after breast cancer. Unlike cancer of the cervix that develops in the lower part of the uterus, endometrial cancer cells, also called cancer of the body of the uterus, proliferate on the inner lining 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 disease: 68 years against 51 years.
What risks?
Several risk factors have been identified and many of them are actually related to female hormones. Situations favoring high levels of estrogen associated with reduced levels of progesterone predispose to endometrial cancer. This is why women over 60 and those who have not had children are more at risk. Several studies suggest that obesity increases risks.
Finally, in about 5% of cases, a genetic predisposition is involved, especially Lynch syndrome, which also predisposes to colorectal cancer. Women who are carriers must be followed by 30 years. According to a study conducted at the Institut Curie (Paris), those carrying a BRCA1 or 2 gene mutation are also more likely to develop a rare form of endometrial cancer.
What symptoms?
"It's a fairly symptomatic cancer," says Dr. Alexandra Leary, a medical oncologist at the Gustave-Roussy Institute (Villejuif). In a postmenopausal woman, vaginal bleeding must be inviting. The premenopausal period, with irregular cycles, sometimes blurs the tracks. In the youngest, bleeding outside the rules should also alert. White discharge and / or stomach pain may also be precursors to endometrial cancer. "
Which diagnosis?
If Dr. Leary insists on not wasting time when abnormal vaginal bleeding occurs, it is because they often intervene very early in the history of this cancer. As a result, the diagnosis may be earlier when no screening test is available. The smear is indeed of no use since the cells analyzed are taken from the cervix, and not the body, from the uterus.
To establish the diagnosis, a pelvic ultrasound is first performed. If the endometrium is thickened, a biopsy will be performed as an outpatient. It will provide three pieces of information: the confirmation or not of the diagnosis, the type of tumor and its aggressiveness. Finally, an MRI of the entire pelvic area will assess whether the disease has spread to other organs, including lymph nodes.
What treatment?
"Because the diagnosis is relatively early, the tumor is often limited to the uterus and there is an excellent chance of healing with local treatment," says Dr. Leary. Removal of the uterus, ovaries and fallopian tubes can be performed under laparoscopy, allowing earlier recovery. Lymph node dissection, on the other hand, is not necessary for everyone. Studies are underway to determine if a simple sentinel lymph node would suffice. "We are really in therapeutic de-escalation," says 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, in the face of a tumor of greater volume, it will also be necessary to resort to the classic radiotherapy which will have more toxic effects on the intestinal level ", adds the specialist of Gustave-Roussy. In case of recurrence, hormone therapy has its place in the therapeutic arsenal, since the cells of the endometrium are obviously sensitive to female hormones.
What perspectives?
Endometrial tumors frequently exhibit a molecular anomaly: the instability of microsatellites. "A quarter of women would carry this status called" MSI ". And this patient profile is very sensitive to immunotherapy. This can really transform care with very few side effects, "said Dr. Leary. For the time being, this treatment is not routinely available but the growing number of clinical trials allows most of these patients to access it.