Endometrial cancer or cancer of the “body” of the uterus is the fourth most common cancer in women in France. It is more common than cervical cancer but is much less talked about.
Endometrial cancer or cancer of the “body” of the uterus (different from cancer of the “cervix” of the uterus) is here fourth cause of cancer among women in France. He touches nearly 8,000 women every year, against 3000 for cervical cancer and yet we know him less. Endometrial cancer is a cancer that mainly affects older women, after menopausearound 70 years. “This cancer affects the menopausal woman, often obese, because after menopause, the endometrium remains stimulated by estrogen contained in the fatty mass without being counterbalanced by progesterone which the ovaries no longer produce“, explains gynecologist Odile Bagot. On October 31, 2023, theMedicines Agency announced the provision of a new medicine to treat women who have an advanced form of this cancer: the Jemperli (dostarlimab), manufactured by the laboratory GlaxoSmithKline (GSK). Specifically, Jemperli is indicated in combination with chemotherapy, in patients over 18 years of age, with endometrial cancer And candidates for systemic treatment (which has an action on the entire body). It is administered as an infusion.
What is endometrial cancer?
In women, the uterus can be affected by cancerous tumors, of which there are two distinct types:
- cervical cancer which we hear about more often (around 3000 cases per year)
- THE endometrial cancer or cancer of the body of the uterus (about 8,000 cases per year)
The endometrium is the name for the uterine lining, a layer of cells lining the inside of this cavity. In more than 90% of cases, Endometrial cancers start in the first layer of the endometrium, l‘epithelium. We are talking of adenocarcinomas. The rest is mainly represented by sarcomas developing in the myometrium or in the cytogenic chorion of the endometrium.
What are the symptoms of endometrial cancer?
In the vast majority of cases, endometrial cancer is discovered before vaginal bleeding outside of menstruation in premenopausal women or after menopause. A postmenopausal woman who is bleeding should see a doctor to discuss it. Endometrial cancer can also be associated with:
- unusual white discharge
- recurrent infections (urinary or gynecological)
- sometimes also pain in the lower abdomen, fever.
Back pain ? “Endometrial cancer is not associated with back pain”observes Dr. Odile Bagot.
Prognosis: is endometrial cancer fatal?
According to the latest figures published by Public Health FranceTHE number of deaths linked to endometrial cancer was 2,415 in 2018, out of 67,800 deaths by cancers recorded in women that year, i.e. 3.6% of deaths. The prognosis of the disease varies depending on its grade and stage at the time of diagnosis but “endometrial cancer is good prognosis (relative survival at 5 years = 95%) since it causes warning signs quite early. Therefore, the diagnosis is made early and the chances of survival are high.”, indicates Dr Odile Bagot. Endometrial cancers “have the best prognosis for gynecological cancers, after breast cancer” confirms the National Cancer Institute on its site.
In front of evocative signs:
- a endovaginal ultrasound will be carried out
- a endometrial biopsy in the office and/or a hysteroscopy
If lesions are found, samples or biopsies will be taken. for more precise analysis.
“Facing a postmenopausal and overweight woman, we recommend systematic screening for endometrial cancer through regular endovaginal ultrasounds”
In the case of cancer, an extension assessment will be necessary, that is to say the search through various examinations for other locations of the cancer by cell migration. “Facing a postmenopausal and overweight woman, we recommend systematic screening for endometrial cancer through regular endovaginal ultrasounds”comments the gynecologist. Imaging will help determine the stage and grade of the cancer before the surgical procedure. They are defined from the size of the tumor, its location and possible spread.
What are the different stages of endometrial cancer?
Endometrial cancer evolves in four stages :
- Stage 1: the tumor is in the uterus.
- Stage 2: the tumor has spread to the cervix.
- Stage 3: the tumor has spread beyond the uterus and cervix (female genitals: vagina, ovary, fallopian tube).
- Stage 4: the tumor has spread to other organs like the bladder, intestines.
“The stages are all the more serious as the cancer cells penetrate deep into the uterine muscle“, adds the gynecologist.
What treatment to treat endometrial cancer?
The treatment of endometrial cancer will depend on the nature of the tumor and the results of the biopsies but also those of the extension assessment. Classically in early stages, a surgical removal of the entire uterus as well as surrounding structures, tubes and ovarieswill be carried out: we are talking abouttotal hysterectomy enlarged with adnexectomy. Lymph nodes located nearby will also be sampled. Sometimes part of the vagina will also be removed. Radiotherapy, chemotherapy or brachytherapythat is to say localized treatment after implantation of a radioactive source, will be considered according to the tumor classification criteria.
“We know that taking the pill significantly reduces the risk (as is the risk of ovarian cancer). The most important thing is to fight against obesity which represents the main risk factor endometrial cancer“, adds the gynecologist. Among the other risk factors for this cancer: diabetes and treatment with tamoxifen. Finally, early puberty and late menopause are factors likely to increase the risk.
Thanks to Dr Odile Bagot, gynecologist and author of “Vagin & Co., we tell you everything!” published by Mango.