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Description
It is estimated that there were 2,920 new cases of cervical cancer in women in France in 2018.
Almost all cervical cancers are carcinomas, that is, cancers that originate in the epithelium of the cervix. These carcinomas are divided into two groups: squamous cell carcinomas and adenocarcinomas.
The number of new cases of uterine cancer in women in mainland France in 2018 is estimated at 8,224. It is estimated that there were 2,920 new cases of cervical cancer in women in France in 2018.
The majority of cancers of the corpus uteri develop from the endometrium. For this reason, the terms corpus uteri cancer and endometrial cancer are often used synonymously.
Cancers of the corpus uteri are most often carcinomas, meaning they arise from the cells that make up the epithelium of the endometrium. Other, much rarer forms exist, such as sarcomas and leiomyosarcomas, which appear in the connective tissue of the endometrium and in the myometrium, respectively.
>It is estimated that there were 5,200 new cases of ovarian and uterine adnexal cancer in mainland France in 2018.
In nearly 9 out of 10 cases, ovarian cancer develops from epithelial cells in the form of adenocarcinoma. Other, rarer forms of ovarian cancer can develop from ovarian follicles or the supporting tissue that forms the body of the ovaries.
Ovarian cancer causes few symptoms. Thus, the vast majority of patients are diagnosed at an advanced stage with involvement of the peritoneum called “peritoneal carcinomatosis.”
The main recognized risk factors are: genetic predisposition, nulliparity, endometriosis.
Certain factors are considered protective: oral contraception, pregnancy, removal of the fallopian tubes.
Treatments
Endometrial cancer is most commonly treated with surgery. Other treatments that may be used include radiotherapy (brachytherapy, external beam radiotherapy) and, more rarely, chemotherapy and hormone therapy. These treatments can be used alone or in combination.
SURGERY
Surgery is the primary treatment for endometrial cancer. It is most often performed as long as the tumor has not spread to the bladder, bowel, or more distant organs in the form of metastases. Its goal is to remove the entire tumor and reduce the risk of recurrence.
RADIOTHERAPY (EXTERNAL AND BRACHYTHERAPY)
Radiation therapy for endometrial cancer is based on two techniques:
- External beam radiation therapy which uses an external source of radiation that is directed through the skin onto the area to be treated;
- Brachytherapy, which involves placing a radioactive element, most often iridium, directly in contact with the area to be treated.
External beam radiotherapy and brachytherapy can be used independently or in combination.
CHEMOTHERAPY
Chemotherapy is one of the main treatments for advanced endometrial cancers, that is, cancers that have spread to the bladder and/or bowel or that have spread to more distant organs in the form of metastases. Chemotherapy can slow or even stop the progression of the disease and relieve symptoms caused by the tumor and metastases.
Chemotherapy may also be offered for advanced stage cancers as adjuvant treatment, i.e. in addition to surgery and/or radiotherapy.
HORMONE THERAPY
Endometrial cells are naturally sensitive to female sex hormones. When an endometrial cell becomes cancerous, it may retain this sensitivity to hormones.
Hormone therapy is used to treat endometrial cancers that have metastasized to organs far from the uterus. Hormone therapy is offered when chemotherapy cannot be used or when the disease is progressing slowly. It helps slow the progression of the disease and relieve symptoms caused by the tumor and metastases.
Three types of treatments are used to treat invasive cervical cancer: surgery, radiotherapy (external beam radiotherapy and brachytherapy), and chemotherapy.
SURGERY
Surgery is primarily used to treat tumors confined to the cervix. The goal of surgery is to remove the entire tumor and eliminate the risk of recurrence. This most often involves removing the uterus and the network of lymph nodes located near the uterus.
RADIOTHERAPY
The most commonly used external beam radiotherapy technique for treating cervical cancer is three-dimensional (3D) conformal radiotherapy. This technique involves matching the volume onto which the rays are directed as precisely as possible to the volume of the tumor.
Brachytherapy is often used to treat cervical cancer. For example, it can reduce the size of the tumor before surgical removal or complete the destruction of the tumor during concomitant radiochemotherapy treatment. The advantage of this radiotherapy technique is that it directly irradiates the tumor at high doses. Because its action is highly targeted, it has few side effects.
CHEMOTHERAPY
Most often, chemotherapy is administered as part of concomitant chemoradiation therapy (treatment combining external beam radiotherapy, brachytherapy and chemotherapy).
The purpose of this combination is to enhance the respective action of each treatment. Chemotherapy has its own action of destroying cancer cells, but it also makes them more sensitive to radiation. The combined action of external radiotherapy and brachytherapy allows the tumor to be precisely targeted and the optimal dose of radiation to be delivered to both destroy the cancerous tissue and preserve the healthy tissues and organs located nearby as much as possible.
Chemotherapy may be offered to treat cancers with distant metastases (beyond the pelvic cavity). Chemotherapy is then used alone or in combination with radiotherapy, most often external. It can slow or even stop the progression of the disease.
Treatment for ovarian cancer is multidisciplinary with complementary medical and surgical care.
SURGERY
Its objective is to resect the entire visible tumor. It must be performed by an expert surgeon within a trained team.
CHEMOTHERAPY
Chemotherapy is often given in addition to surgery to eliminate any remaining cancer cells and reduce the risk of recurrence.
In some cases, chemotherapy may be given before surgery to reduce the size of the tumor and make the operation easier.
When cancer is discovered at a very advanced stage, chemotherapy may be the only treatment used.
It should be noted that a good initial response to the proposed treatments is observed in 80% of patients.
The recurrence rate is high. Access to therapeutic innovation (medical or surgical) is a major issue in this disease.
