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Understanding the Disease
Endometrial cancer develops when a cell in the endometrium that was initially healthy undergoes a change—for example, due to a mutation—and then multiplies uncontrollably until it forms a cluster of cancer cells called a tumor.
Endometrial cancer is the fourth leading cause of cancer in women in France. An estimated 8,224 new cases were diagnosed in 2018. This disease most often affects women after menopause, with the average age at diagnosis being 68. Nevertheless, endometrial cancer remains the most curable of all gynecological cancers.
What is the endometrium?
The endometrium is the inner lining of the uterine wall.
Diagnosis and Treatment
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 any other cases of cancer in the patient’s family. This helps screen for Lynch syndrome, a rare hereditary condition that increases the risk of developing certain cancers, including endometrial cancer. The doctor also assesses risk factors and symptoms that may be associated with a tumor.
An ultrasound (preferably transvaginal) is performed to check for any thickening of the endometrium (hypertrophy), which may be a sign of cancer development. A pelvic MRI may also be recommended.
The doctor also routinely performs an endometrial biopsy.
Examination of this sample confirms the cancer diagnosis and helps determine the tumor’s histological type and its aggressiveness.
Additional imaging tests (MRI) are then ordered to assess the extent of the disease and determine the best course of treatment.
Decisions regarding treatment plans are made during 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. A MDT meeting report is prepared for each patient.
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 can be used to treat endometrial cancer.
Surgery
Surgery is the primary treatment for endometrial cancer. It is performed when the patient’s health permits and when the tumor has not spread as metastases. This surgery requires the expertise of specialized surgeons and anesthesiologists to determine the best treatment approach.
The specialist surgeons at Gustave Roussy use robotic surgery, minimally invasive surgery, and laparotomy, and perform lymph node biopsies.
In very rare cases and for women of childbearing age, fertility preservation through medical treatment, combined with limited surgical intervention, may be considered following consultation with the multidisciplinary team (MDT).
Learn more about gynecologic surgery [notes: link to be added]
External Beam Radiation Therapy
Doctors may prescribe radiation therapy sessions to the pelvic region after surgery, based on various prognostic factors (stage, lymph node involvement), to reduce the risk of locoregional recurrence.
Learn more about external radiation therapy [notes: link to be added]
Brachytherapy (or internal radiation therapy)
Vaginal brachytherapy is a form of internal radiation therapy that delivers a high dose of radiation directly to the area to be treated. It is sometimes recommended after surgery and/or external radiation therapy to reduce the risk of vaginal recurrence. Between 2 and 4 brachytherapy sessions, each lasting 10 to 15 minutes, are performed on an outpatient basis (without hospitalization).
Learn more about brachytherapy [notes: link to be added]
Chemotherapy
Chemotherapy is the primary treatment for advanced endometrial cancer, particularly when tumor cells have spread throughout the body, forming metastases. This treatment involves the administration of anticancer drugs that act throughout the body (systemic therapy).
Learn more about chemotherapy [link notes to be added]
Hormone Therapy
Endometrial cells sometimes express receptors for female sex hormones (estrogens and progesterone). Hormone therapy is therefore sometimes used to treat endometrial cancers that have spread to organs distant from the uterus. The treatment involves a progestin medication that prevents progesterone from binding to endometrial cells and stimulating their growth.
Learn more about hormone therapy [notes: link to be added]
Fertility Preservation
Treatment for endometrial cancer causes infertility. That is why the teams at Gustave Roussy pay special attention to preserving patients’ fertility and have been working to improve practices for the past two decades.
While fertility preservation is rarely feasible, it is discussed when it can be safely offered in conjunction with treatment. It may involve a combination of procedures to preserve the uterus and medical treatment.
Appointments and Second Opinions
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Les cancers féminins
Chaque année en France, près de 190 000 femmes découvrent qu’elles sont touchées par un cancer
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L’immunothérapie : un nouvel espoir pour les femmes atteintes de cancers gynécologiques
L’immunothérapie, stratégie thérapeutique déjà efficace dans le traitement des mélanomes, certains cancers du poumon, ORL, digestifs ou les lymphomes de Hodgkin s’avère prometteuse dans les cancers gynécologiques. Tour d’horizon des récentes avancées.
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5 questions with Prof Alexandra Leary on pragmatic trials
Pragmatic trials are simple, affordable trials aiming to inform or change practice broadly. Prof Alexandra Leary, MD, Ph.D., a medical oncologist at Gustave Roussy and deputy head of the Medical Oncology Department, explains these trials in five questions.
