What is gynaecological cancer?
The most frequent type is cancer of the endometrium, the body of the uterus (as opposed to the cervix). There were 8,200 new cases in 2018 in France (Institut national du cancer). It mainly affects women aged between 60 and 70, peaking at age 68. The odds are increased by obesity, diabetes and a higher than average oestrogen level (relative hyperoestrogenia). There is a familial form in 6% of cases, called Lynch syndrome, which also associates a risk of colon and ovarian cancer and cancer of the biliary and urinary tracts. This cancer has a good prognosis at a localised stage and the mortality rate has tended to diminish over the last few years. The treatment consists of surgery, with or without radiotherapy depending on the stage, and chemotherapy for advanced forms.
Ovarian cancer affected 5,200 women in 2018 in France, at a median age of 65 years. There is a genetic risk: 5-10% of patients with ovarian cancer carry mutations of the BRCA1 or 2 genes. In this case, the disease may appear earlier, at around 50 years. These genetically predisposed women may be monitored so that a lesion can be detected as early as possible. They may also be offered preventive ablation of the ovaries and fallopian tubes.
This disease is often diagnosed quite late, at an advanced stage, since it is “silent” or manifested by non-specific symptoms: pain, bleeding, intestinal transit disorders and heaviness in the lower abdomen. It may be revealed by an imaging test and dosage of a marker called CA 125 in the blood, which makes it possible to monitor the evolution of the disease. If the disease is not extensive, the treatment consists of surgery to remove ovaries, uterus, various chains of ganglia and any other visible lesions in order to eliminate the macroscopic disease. This surgery is followed in the vast majority of cases by chemotherapy. If the cancer has spread, chemotherapy is applied first in order to reduce the size and number of lesions, and then followed by surgery to remove all the lesions.
2,900 women are diagnosed with cervical cancer every year. But its frequency has been decreasing steadily for 20 years, thanks to regular pap-smear screening, which makes it possible to detect precancerous lesions. In 95% of cases, cervical cancer resulting from these precancerous lesions is caused by an infection by a papilloma virus (HPV) transmitted sexually 15-20 years earlier. This is why young girls and boys are now offered a vaccination against this virus between ages 11 and 14. A follow-up is possible up to the age of 19.
But cervical cancer is still associated with high mortality: 1,100 deaths in 2015. Yet precancerous lesions can be treated before they become cancerous. A conical biopsy can be carried out, with the inner cone of the cervix affected by lesions removed. When cancer is confirmed but is not very advanced, the treatment consists of surgery to remove the uterus and the pelvic lymph nodes. In young women who wish to become pregnant and whose cancer is not very advanced, fertility-preserving treatment can be given. In advanced forms, the treatment consists instead of a combination of radiotherapy and chemotherapy followed in some cases by surgery.
Lastly, cancer of the vulva and the vagina represent less than 5% of female cancers. They occur mainly in post-menopausal women, at around age 70 on average. It is generally preceded by a precancerous phase. These precancerous lesions arise on a pre-existing skin condition, lichen sclerosus, or are caused by the HPV virus. If detected early, they can be treated by excision, or drugs in the case of HPV infection. At a cancerous stage, the treatment is surgical, sometimes followed by radiotherapy. Survival for this cancer is excellent if the disease has not reached the lymph nodes.
Treatment of gynaecological cancers at Institut Curie
Institut Curie treats around 400 gynaecological cancers per year, making it one of the biggest centres in the Île de France region.
Since 2012, patients with gynaecological cancers have benefited from a dedicated reception area. Three doctors at the Saint-Cloud site and three in Paris receive the women concerned and direct their healthcare. A surgeon systematically receives each patient and complements the information in his possession with new imaging tests, if necessary, before the treatment is discussed at a multidisciplinary consultation meeting.
In many cases, surgical operations are carried out by laparoscopy, i.e. only a small incision is made in the abdomen to introduce the surgical instruments. This so-called mini-invasive surgery is safer. Such operations pose fewer post-operative problems; the patients recover faster and heal better than with traditional surgery.
When laparoscopy is not possible, the surgeons and anaesthetists of the Institut are also skilled in handling major operations, which may last up to eight hours and require an epidural in addition to general anaesthetic, as well as constant cardiac and vascular monitoring during the operation. Institut Curie is charged with carrying out repeat surgery in cases of recurrent cancer.
For vulvar cancer, the Institut works in partnership with specialist dermatologists in order to avoid mutilating interventions.
Institut Curie also enables wide-scale access to therapeutic innovation regarding gynaecological cancers. Clinical trial protocols are available for ovarian cancer, as well as for endometrial and cervical cancer.
The teams of Fatima Mechta-Grigoriou and Marc-Henri Stern are interested in ovarian cancer. They study their mechanisms and the team of Fatima Mechta-Grigoriou has discovered several molecular signatures predictive of the aggressiveness and response to treatment of this cancer.