The cancer of the endometrium (the slimy layer of cells lining the womb) or the body of the womb is the most frequent type of pelvic gynaecological cancer. It mainly affects women after the 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 risk factors for endometrial cancer are mainly obesity (being overweight), diabetes, treatment by Tamoxifen (this is a hormone therapy used in the case of breast cancer) and certain hereditary diseases.
The cancer of the body of the womb begins at the level of the endometrium. The cancerous cells multiply, they cause bleeding and create a swelling that will slowly grow.
The cancer will then advance in the myometrium (the wall of the womb) and then pass through the outer wall of the womb to invade the surrounding organs (the fallopian tubes, the ovaries, the bladder and the rectum (the final section of the large intestine)). The cells affected by the disease can migrate towards the pelvic lymph nodes that surround the womb. Very rarely, and in advanced stages, the tumorous cells can migrate far away from the primary tumour and form secondary cancerous locations called metastases, mainly in the abdomen or the lungs.
Classification of endometrial cancer:
- Stage I: the tumour is limited to the body of the womb.
- Stage II: the tumour is invading the cervix (the neck of the womb).
- Stage III: the tumour is invading the vagina, the fallopian tubes or the ovaries, or the pelvic lymph nodes.
- Stage IV: the tumour is invading the bladder or the intestine, or there are metastases further away (distant metastases).
Endometrial cancer is the first reason to think of when we are faced with gynaecological bleeding after the menopause. Other vaginal discharge that may relate to an infection by a menopausal woman should also make us suspicious of this diagnosis. At the women who have not yet had their menopause, bleeding is most often related to a non-cancerous condition.
Endometrial cancer is diagnosed by a biopsy of the endometrium, which can be carried out simply in the practice of the gynaecologist.
If this is negative or it is too difficult to perform it, a surgeon should perform a hysteroscopy (examination by a tiny camera introduced to the womb) for targeted sampling.
After the diagnosis, we also often conduct an MRI (Magnetic Resonance Imaging) examination to identify the size of the tumour and the stage of the disease.
The main treatment is a surgery that removes the womb together with its neck, the fallopian tubes with the ovaries (this is called total hysterectomy with bilateral annexectomy), as well as the lymph nodes around the womb. The intervention is most often 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 surgery requires 1-2 days to be spent in the hospital, and the convalescence may last for 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.
With specific information about the tumour at hand, your case will be discussed by a group of specialists in different medical fields (surgeons, oncologists and radiotherapists) in order to recommend you the best complementary therapy if needed.
Most often, radiotherapy or even brachytherapy (radiotherapy by intra-vaginal track) is the only treatment, but sometimes chemotherapy is needed.
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, the most important risk factor of which is of genetic origin.
Nowadays, it is possible to find some of the genes responsible for ovarian cancer, and thus to know if a person is at a high risk of developing such a tumour.
It is therefore very important that you tell your doctor if there has been any such case in your family. If so, sometimes it is recommended to see a geneticist in order to assess the risk or to do a blood test to the search for a certain genetic mutation.
This information are important for your whole family.
Ovarian cancer starts by the appearance of a few 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 entire abdomen, forming secondary cancerous locations (metastases) very early. Ovarian cancer develops rapidly, progressing without symptoms until an advanced stage. In addition, the tumorous cells can invade the pelvic lymph nodes or those near the artery and the vein.
Classification of ovarian cancer:
- Stage I: the tumour is limited to the ovaries.
- Stage II: the tumour has extended to the surrounding organs (the womb, the fallopian tubes, the bladder and the 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).
Ovarian cancer has very few symptoms until an advanced stage. Suggestive symptoms may be significant fatigue, weight loss or weight gain, or the increase of the abdominal perimeter.
It might be diagnosed at an early stage, but probably accidentally, during a surgical intervention carried out for another reason. It might also be detected during an imaging examination (ultrasound, CT or MRI) that shows one or more ovarian cysts together with a certain amount of liquid in the abdomen. The diagnosis can be confirmed only by an exploratory surgery.
The initial surgery will allow for confirming the diagnosis (sometimes done by coelioscopy) and for administering the treatment (often by laparotomy) at the same time. If there is a strong suspicion of ovarian cancer, the surgeon will warn the patient that they will carry out an intervention with the purpose of examination, and then a second operation will take place to quickly provide full treatment. The surgeon will remove all the diseased and invaded abdominal areas but at least the womb, the womb neck, the ovaries and the fallopian tubes, the lymph nodes on both sides of the womb and along the large vessels, as well as the appendix and the greater omentum (the greasy mass covering the intestines). This intervention can last for a long time, it may require the assistance of other surgeons (such as a gastrointestinal, a urological or a vascular surgeon), and it may lead to serious postoperative consequences (such as resuscitation or long-term hospitalisation). In case of the future need for chemotherapy, an implantable port will also be placed during the operation.
With the results of the analyses at hand, the case will be discussed will be discussed by a group of specialists in different medical fields in order to propose you the best possible treatment, that is generally chemotherapy.
Your health will be monitored by the different physicians involved in your treatment. Control examinations will follow every 4 months for 2 years, then every 6 months for 3 years, then annually, possibly together with a blood test.
Unfortunately, ovarian cancer has a poor prognosis, because most often, it is diagnosed at a late stage.
Cervical cancer (cancer of the neck of the womb) is the 11th most common cause of cancer in women. Most often, it affects women towards their forties.
In the majority of cases, cervical cancer is due to 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.
Cervical cancer is related to HPV that infects the cells of the cervix (the neck of the womb) and converts them into pre-cancerous lesions (injuries). If these are not treated in time, this can lead to cervical cancer several years later. Once existing, the cancer will grow, disseminating diseased cells to the lymph nodes around the womb and along the large vessels (the arteries and veins), as well as to the rest of the body forming (distant) metastases.
Classification of cervical cancer:
- Stage I: the tumour is limited to the neck of the womb.
- Stage II: the tumour extends beyond the womb.
- Stage III: the tumour has extended up to the pelvic wall or the lower part of the vagina.
- Stage IV: the tumour has invaded the bladder or the rectum, or there are metastases further away (in the liver, in the lungs, etc.).
The symptoms that can hint at cervical cancer are bleeding after sexual intercourse, dirty vaginal discharge, pain during sexual intercourse.
The diagnosis is most often set up before the start of the cancer, by the systematic screening carried out every 2 or 3 years by a cervical-vaginal smear test. Thanks to this screening, cervical cancer is less and less frequent. However, if there is suspicion of a cancerous lesion, a biopsy is performed in the practice of the gynaecologist. After this, radiological examinations (abdomino-pelvic MRI) will take place in order to obtain more information about the size and the stage of the tumour.
The treatment combines surgery, chemotherapy and radiotherapy with brachytherapy (emission of X-rays by an intra-vaginal device) as needed corresponding to the stage of the tumour. For example, at an early stage, an initial surgery combined with radiotherapy might be proposed. If the attack is more serious, a chemotherapy and a radiotherapy will be carried out at the same time before considering a secondary surgery.
Your health will be monitored by the different physicians involved in your treatment. Control examinations will follow every 4 months for 2 years, then every 6 months for 3 years, then annually, possibly together with a blood test. Cervical cancer develops slowly, and if detected at an early stage, it has a very good prognosis.