Surgery

Du simple kyste au cancer de l’ovaire, en passant par la prise
en charge de l’endométriose, nos chirurgiens vous assurent
une prise en charge optimale.

Chirurgie Cancérologique

  • Uterine Cancer

 

Complications :

Cancer of the endometrium (the mucous membrane lining the uterus) or of the uterus is the most frequent type of pelvic gynaecological cancer. It mainly affects women after menopause, around the age of 60-70. This type of cancer normally has a good prognosis because it is often detected at an early stage.

 

The main risk factors for endometrial cancer are obesity, diabetes, treatment by Tamoxifen (hormonal treatment of breast cancer) and certain hereditary diseases.

 

 

Development :

Uterine cancer begins in the endometrium. The cancerous cells multiply, cause bleeding and create a swelling that slowly grows.

 

The cancer can then spread into the myometrium (the wall of the uterus) and then pass through the outer wall of the womb to attack the surrounding organs (the fallopian tubes, the ovaries, the bladder and the rectum). The affected cells can migrate towards the pelvic lymph nodes that surround the womb. Very rarely, and in advanced stages, the tumorous cells can migrate further away from the primary tumour and form secondary cancerous growths, usually in the abdomen or the lungs.

 

 

Classification of endometrial cancer:

  •  Stage I: the tumour is limited to the uterus.
  • Stage II: the tumour invades the cervix (the neck of the womb).
  • Stage III: the tumour invades the vagina, the fallopian tubes, the ovaries, or the pelvic lymph nodes.
  • Stage IV: the tumour invades the bladder or the intestine, or causes metastases further away (distant metastases).

 

Diagnosis:

Endometrial cancer can cause gynaecological bleeding after the menopause. Other vaginal discharge in a menopausal woman, which may relate to an infection, should also make us suspicious of this diagnosis. For women who have passed the menopause, bleeding is most often related to a non-cancerous condition.

 

Endometrial cancer is diagnosed through a biopsy of the endometrium, which is a simple procedure for a gynaecologist to carry out.

 

If the results are negative or it is too difficult to perform, a surgeon should perform a hysteroscopy (examination with a tiny camera which is introduced into the womb) for targeted sampling.

 

After the diagnosis, an MRI scan (Magnetic Resonance Imaging) is often conducted to identify the size of the tumour and the stage of the disease.

 

 

Treatment :

The most common treatment is an operation to remove the uterus and its neck, the fallopian tubes with the ovaries (total hysterectomy with bilateral annexectomy), as well as the lymph nodes around the uterus. The procedure is usually carried out by coelioscopy or laparoscopy (introducing an endoscope through an incision in the abdominal wall), but in the case of specific anatomical conditions, laparotomy (opening the belly) may still be necessary. The procedure requires patients to stay in hospital for 1-2 days and a recovery period of 3 weeks.

 

In some cases, it may be necessary to remove the lymph nodes situated along the aorta (the main artery). This is called lumbo-aortic lymphadenectomy. This operation is also conducted by laparoscopy.

 

Once specific information about the tumour has been obtained, your case will be discussed by a group of specialists from different medical fields (surgeons, oncologists and radiotherapists) in order to recommend the best complementary treatment if appropriate.

Most often, radiotherapy or even intravaginal brachytherapy (internal radiation therapy) is the only necessary treatment, but sometimes chemotherapy is required.

 

 

  • Ovarian Cancer

 

Ovarian cancer is the 7th most common cause of cancer in women. Most often, it affects women around the age of 65.

 

It is a rare type of cancer and genetic origin is the most significant risk factor.

 

Nowadays, it is possible to identify some of the genes responsible for ovarian cancer, and therefore recognise if a person is at high risk of developing a tumour.

 

It is therefore very important to tell your doctor if you have family history of ovarian cancer. In this case, it is sometimes recommended to see a geneticist to assess the risk or to have a blood test to check for genetic mutations.

 

This information is important for your whole family.

 

 

Development:

Ovarian cancer starts with some diseased cells, initially on the surface of the ovary and at the end of the fallopian tubes, but it spreads very quickly to other cells in the abdomen, forming secondary cancerous growths (metastases) at a very early stage. Ovarian cancer develops rapidly without symptoms until an advanced stage. In addition, the tumour cells can invade the pelvic lymph nodes or those near the aorta and the vena cava.

 

Classification of ovarian cancer:

  •  Stage I: the tumour is limited to the ovaries.
  • Stage II: the tumour spreads to the surrounding organs (uterus, fallopian tubes, bladder and rectum (the final section of the large intestine)).
  • Stage III: peritoneal metastases (metastases on the surface of the other abdominal organs).
  • Stage IV: distant metastases (mainly in the lungs).

 

Diagnosis:

Ovarian cancer has very few symptoms until an advanced stage. Symptoms suggestive of ovarian cancer include extreme fatigue, weight loss or weight gain and abdominal bloating or swelling.

 

It can be diagnosed at an early stage, but probably accidentally, during a surgical operation carried out for another reason. It can also be diagnosed through an imaging examination (ultrasound, CT or MRI) that shows one or more ovarian cysts and a certain amount of liquid in the abdomen. The diagnosis can only be confirmed after exploratory surgery.

 

 

Treatment:

The initial procedure both confirms the diagnosis (sometimes carried out by coelioscopy) and allows treatment to be administered (often by laparotomy). If there is a strong indication of ovarian cancer, the surgeon will inform the patient that they will carry out an initial procedure to examine the condition, quickly followed by a second procedure to provide full treatment. The surgeon will remove all affected abdominal areas but as a minimum the uterus, the cervix, the ovaries and fallopian tubes, the lymph nodes on both sides of the uterus and along the large vessels, as well as the appendix and the greater omentum (the fold of fat covering the intestines). This procedure can be lengthy and may require the assistance of other surgeons (such as a gastrointestinal, urological or vascular surgeon). It may lead to serious postoperative consequences (such as resuscitation or long-term hospitalisation). In case of a need for chemotherapy, an implantable port will also be placed during the operation.

 

With the results of the analyses, the case will be discussed by a group of specialists from different medical fields in order to recommend the best treatment, which generally consists of chemotherapy.

 

 

Check-ups:

Your health will be monitored by different physicians with check-ups and possibly blood tests every four months for two years, then every six months for three years, then once a year.

Unfortunately, ovarian cancer has a poor prognosis because it is often diagnosed at a late stage.

 

  • Cervical Cancer

 

Cervical cancer is the 11th most common cause of cancer in women. Most often, it affects women in their forties.

In the majority of cases, cervical cancer is caused by a slowly developing viral infection related to Human Papillomavirus (HPV). This is a sexually transmitted infection, certain factors of which favour the persistence of the virus.

 

 

Development:

Cervical cancer is usually caused by HPV, a virus which infects the cells of the cervix causing pre-cancerous lesions. If these are not treated in time, they can lead to cervical cancer several years later. Once formed, the cancer will grow, transferring cancerous cells to the lymph nodes around the uterus and along the large vessels (aorta and vena cava), as well as to the rest of the body, forming (distant) metastases.

 

Classification of cervical cancer:

  • Stage I: the tumour is limited to the cervix.
  • Stage II: the tumour extends beyond the womb.
  • Stage III: the tumour extends up to the pelvic wall or the lower part of the vagina.
  • Stage IV: the tumour invades the bladder or the rectum, or there are metastases further away (in the liver, in the lungs, etc.).

 

 

Diagnosis:

Suggestive symptoms of cervical cancer include bleeding after sexual intercourse, abnormal vaginal discharge, and pain during sexual intercourse.

 

It is often diagnosed before the cancer has developed by systematic screening carried out every two to three years with a smear test. Thanks to this screening, cervical cancer is becoming less and less common. However, if there is reason to suspect the development of a cancerous lesion, a biopsy is performed by a gynaecologist. After this, radiological examinations (abdomino-pelvic MRI) will be conducted in order to obtain more information about the size and the stage of the tumour.

 

Treatment:

Treatment combines surgery, chemotherapy and radiotherapy with brachytherapy (emission of X-rays by an intra-vaginal device) as required, according to the stage of the tumour. At an early stage, for example, an initial operation combined with radiotherapy might be recommended. Under more serious circumstances, chemotherapy and radiotherapy will be carried out at the same time before surgery is considered.

 

Check-ups:

Your health will be monitored by different physicians. Check-ups and possibly blood tests will follow every four months for two years, then every six months for three years, then once a year. Cervical cancer develops slowly, and if detected at an early stage, it has a very good prognosis.

L'Institut de Gynécologie et d'Obstétrique

121 A route d'Arlon / L-1150 LUXEMBOURG