Welcome to the new Gustave Roussy website
A new website designed to offer you a simpler, clearer, and more intuitive experience. Patients, caregivers, healthcare professionals, and donors: find information, news, and services more easily.
Understanding the Disease
Cervical cancer develops in the lining of the cervix. In the vast majority of cases, the cancer originates in the epithelial cells of the cervical lining; this is referred to as a carcinoma. There are two types of cervical carcinoma:
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Squamous cell carcinomas (85% of cases), which develop in the exocervix.
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Adenocarcinomas (15% of cases), which develop in the endocervix.
Cervical cancer is the 11th leading cause of cancer in women, with 2,900 new cases in 2018. It is the second most common cancer among young women.
What is the cervix?
The cervix is the lower, narrow part of the uterus that leads to the vagina. It consists of two parts: the endocervix (toward the uterus) and the exocervix (toward the vagina).
Prevention and Risk Factors
In nearly 100 percent of cases, cervical cancer is linked to a viral infection caused by the human papillomavirus (HPV).
HPV is a sexually transmitted virus that, in most cases, clears up on its own. There are many strains of HPV, some of which are considered oncogenic, meaning that when they infect the lining of the cervix and are not cleared, they can cause changes in the epithelial cells, resulting in dysplastic lesions. If these lesions are not resolved spontaneously or through local treatment, they become precancerous. In rare cases, these lesions may slowly progress to cancer.
There are two effective methods for preventing cervical cancer: regular Pap smears, testing for the presence of oncogenic HPV in the gynecological tract, and vaccination against the most common oncogenic HPV types.
Screening and Vaccination
There is a safe and effective vaccine to protect against HPV infections. In France, the vaccine used protects against nine different types of HPV, including those most commonly associated with cancer. Getting vaccinated can therefore prevent up to 90% of HPV infections that can lead to cancer.
To be most effective, this vaccine should be administered before young girls and boys become sexually active—that is, before any potential exposure to the human papillomavirus. However, catch-up vaccination is possible up to age 26.
In France, the HPV vaccine is recommended:
For all girls and boys aged 11 to 14, with two doses administered 5 months apart. The vaccine is offered free of charge in middle schools to 5th- and 4th-year students, subject to parental consent.
As a catch-up vaccination, for all girls and boys aged 15 to 26, with three doses required in this case.
To get vaccinated, you can contact your doctor, pharmacist, midwife, nurse, or a municipal or departmental vaccination service.
Screening helps identify chronic infection with a high-risk (oncogenic) HPV strain and detect and treat precancerous lesions before they develop into cervical cancer. However, this disease remains the 11th leading cause of cancer-related deaths among women in France, with more than 1,000 deaths per year. Hence the importance of the national screening program launched in 2018, for women whether vaccinated or not. This screening program is based on:
Ages 25 to 29: two Pap smears (cytological exams) one year apart to check for abnormal cells. If both results are normal, another screening is performed three years later.
Ages 30 to 65: A PCR test is used to directly detect the presence of a so-called high-risk oncogenic HPV virus (HPV-HR test) in the Pap smear. If the test is positive, the Pap smear is then examined for abnormal cells. This PCR test should be performed every five years, beginning either three years after the last normal Pap test or at age 30 if no screening has yet been performed. It is the chronic presence of the virus (multiple consecutive positive test results) that is a potential risk factor for cellular transformation.
In France, gynecological checkups are not mandatory (except during pregnancy), but are recommended starting when a woman becomes sexually active, with a primary care physician, a midwife, or a gynecologist. Apart from regular checkups (which only 60% of women undergo), certain symptoms should prompt an immediate visit to a healthcare provider:
Abnormal vaginal bleeding;
Pain during intercourse;
Unusual discharge;
Pelvic or lower back pain.
Diagnosis and Treatment
Gustave Roussy provides diagnosis and treatment of precancerous lesions, diagnosis of cervical cancer in cases of suspicious findings during screening, and care for patients who have already received a diagnosis.
During the initial consultation, the patient is interviewed to learn more about her personal and family medical history. In particular, the doctor will inquire about other cases of cancer in the patient’s family. This helps identify any possible hereditary predispositions to developing cancer.
A clinical examination is then performed, consisting of a gynecological exam and an examination of the abdomen and lymph node areas.
To confirm the diagnosis of cancer and determine its type, size, and extent, a cervical biopsy is performed directly on the suspicious lesions.
Additional imaging tests (pelvic MRI, PET scan) are often ordered in cases of cancer to assess the extent of the disease.
Decisions regarding cancer treatment plans are made during weekly multidisciplinary team meetings (MDTs). These meetings involve several physicians from different specialties—medical oncologists, surgeons, radiation oncologists, radiologists, and pathologists—in collaboration with primary care physicians. For each major decision, a recommendation is issued.
InstaDiag
Spotlight on InstaDiag Gynecology
Gustave Roussy offers an InstaDiag Gynecology program designed to diagnose and provide prompt, appropriate care to patients with suspicious results from an examination performed at a local clinic.
Treatments
Various treatments are available at Gustave Roussy for cervical cancer.
Surgery
Surgery is the primary treatment for localized forms of cervical cancer. It is sometimes preceded by utero-vaginal brachytherapy.
In most cases, surgery and brachytherapy are sufficient to effectively treat early-stage cancers.
For very limited-stage cancers, Gustave Roussy offers fertility-sparing treatment, following discussion in a multidisciplinary team meeting tailored to each individual case.
→ Learn more about gynecologic surgery [notes: link to be added]
External Beam Radiation Therapy
Radiation therapy is a highly effective treatment for cervical cancer.
Radiation therapy treatments are prescribed by physicians after surgery, based on various prognostic factors (stage, lymph node involvement) identified during the surgical procedure. Radiation is delivered by a precision machine outside the body, using radiation beams that converge on the pelvis.
→ Learn more about external radiation therapy [notes: link to be added]
Brachytherapy (or internal radiation therapy)
Uterovaginal brachytherapy is a form of internal radiation therapy that delivers a high dose of radiation directly to the area to be treated. For example, it can be used to reduce the size of a tumor before surgical removal or to complete the destruction of the tumor during treatment with concurrent chemoradiation therapy.
→ Learn more about brachytherapy [notes: link to be added]
Concomitant chemoradiation
Concomitant chemoradiation therapy combines external beam radiation therapy, chemotherapy, and brachytherapy. This treatment is the standard of care for tumors larger than 4 centimeters and for tumors that have spread beyond the uterus into the pelvis.
In the metastatic stage, treatment relies primarily on drug therapies.
Chemotherapy, targeted therapies, and immunotherapy
Treatment most often combines chemotherapy with targeted therapies and, in some cases, with immunotherapy. These approaches help slow the progression of the disease and improve survival.
Radiation therapy
It can be used in a targeted manner to relieve certain symptoms or treat specific sites.
Personalized Care
The choice of treatment is determined on a case-by-case basis during a multidisciplinary team meeting.
Goal: to control the disease and preserve quality of life.
Fertility Preservation
Treatment for cervical cancer can, in most cases, cause infertility.
That is why, whenever possible, the teams at Gustave Roussy pay special attention to preserving fertility for patients who wish to do so and have been working to improve these practices for two decades.
We discuss this issue during the very first consultation and support patients throughout the fertility preservation process until it is completed.
Clinical Trials and Therapeutic Innovation
Depending on the characteristics and stage of the cancer, doctors at Gustave Roussy may offer patients the opportunity to participate in clinical research trials. If appropriate, the possibility of participating in a clinical trial will be discussed with patients during their initial consultation with their referring oncologist, giving them access to innovative treatments.
Join a clinical trial
Many clinical trials are open to patients with cancer. Participating in a clinical trial provides access to innovative treatments while contributing to the development of new therapies.
Appointments and Second Opinions
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Cancer du col de l’utérus : se vacciner, se faire dépister et agir vite
Le cancer du col de l’utérus touche chaque année environ 3 000 femmes en France, alors qu’il pourrait être évité dans plus de neuf cas sur 10 grâce à la vaccination et à un dépistage régulier. À Gustave Roussy, le parcours InstaDiag Gynéco permet aujourd’hui un diagnostic rapide en cas de suspicion.
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Cancer du col de l'utérus : dépistage et vaccination, la meilleure prévention !
Le cancer du col de l’utérus est responsable de 1 100 décès par an. Pourtant, un dépistage régulier permet d’éviter la survenue de 90 % de ces cancers.
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Septembre Turquoise : Gustave Roussy mobilisé pour prévenir les cancers gynécologiques
Septembre marque aussi le mois de sensibilisation et de lutte contre les cancers gynécologiques.
