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Uterine cancer: respond to first bleeding

If bleeding occurs between two cycles or after menopause, don't wait to see a doctor.

With more than 8000 new cases a year, it is the most common gynecological cancer after breast cancer. Unlike cervical cancer that develops at the bottom of the uterus, endometrial cancer cells, also called cervical cancer, multiply in the inner lining of a woman's organs. . And, in 90% of cases, in the first layer of the endometrium. Another form, sarcoma that affects the uterine muscles, is a very rare tumor. Another big difference with cervical cancer is the age of onset of the disease: 68 years versus 51 years.

What risk?

Several risk factors have been identified and many of them are actually related to female hormones. Situations that support high estrogen levels associated with decreased levels of progesterone tend to be endometrial cancer. This is why women over 60 and those who do not have children are more at risk. Some research shows that obesity increases the risk.

Finally, in about 5% of cases, genetic predisposition is involved, especially Lynch syndrome, which also predisposes to colorectal cancer. Women whose careers must be followed for 30 years. According to a study conducted at the Curie Institute (Paris), those who carry the BRCA1 or 2 gene mutation are also more likely to develop rare endometrial cancer.

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What symptoms?

"It's a very symptomatic cancer, said the Dr Alexandra Leary, medical oncologist at Gustave-Roussy Institute (Villejuif). In postmenopausal women, vaginal bleeding must be inviting. Premenopausal periods, with irregular cycles, sometimes obscure traces. At the youngest, bleeding outside the rules must also be vigilant. Leucorrhoea and / or abdominal pain may also be a precursor of endometrial cancer. "

"Leucorrhoea and / or abdominal pain can also be an early warning sign of endometrial cancer."

Alexandra Leary, medical oncologist at the Gustave-Roussy Institute

Which diagnosis?

If Dr Leary insisted not to waste time when abnormal vaginal bleeding occurred, because they often intervened very early in the history of this cancer. As a result, the diagnosis may be earlier when there are no screening tests available. Smears are of no use because the cells analyzed are taken from the cervix, and not the body, from the uterus.

To make the diagnosis, pelvic ultrasound is first performed. If the endometrium is thickened, a biopsy will be performed as an outpatient. This will provide three pieces of information: confirmation or not of the diagnosis, tumor type and aggressiveness. Finally, MRI throughout the pelvic area will assess whether the disease has spread to other organs, including lymph nodes.

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What treatment?

"Because the diagnosis is relatively early, tumors are often limited to the uterus and there are excellent opportunities for healing with local treatment.", said the Dr Leary Removal of the uterus, ovaries and fallopian tubes can be performed under laparoscopy, allowing early recovery. Lymph node dissection, on the other hand, is not necessary for everyone. Research is underway to determine whether a simple sentinel lymph node is sufficient. "We are really in a therapeutic escalation"summarizes the oncologist.

In addition to surgery, some women will be treated with radiotherapy. "If the tumor is small, we can choose only brachytherapy, and therefore have a very targeted action. On the other hand, in dealing with tumors with greater volume, it will also be necessary to use conventional radiotherapy which will have more toxic effects at the intestinal level. ", added specialist Gustave-Roussy. In cases of recurrence, hormone therapy has a place in the therapeutic arsenal, because endometrial cells are clearly sensitive to female hormones.

What perspective?

Endometrial tumors often show molecular anomalies: microsatellite instability. "A quarter of women will carry this status called" MSI ". And this patient's profile is very sensitive to immunotherapy. It can really change management, with few side effects," said the Dr Leary At present, this treatment is not routinely available but a growing number of clinical trials are allowing most patients to access it.

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