What is endometrial cancer?
The endometrium is the innermost lining of the uterus.
Endometrial cancer develops when an initially healthy endometrial cell changes (e.g. due to a mutation) and then multiplies uncontrollably, forming a cluster of cancerous cells known as a tumour.
Endometrial cancer is the 4th most common cancer diagnosed in French women with an estimated 8,224 new cases in 2018. The condition mostly affects post-menopausal women with an average age of 68 at diagnosis. Nevertheless, endometrial cancer remains the most curable of all the gynaecological cancers.
The cardinal symptom indicative of endometrial tumour and requiring prompt medical attention is the onset of post-menopausal vaginal bleeding. Before the menopause, unusual bleeding (outside of menstruation or heavier than usual) should also be investigated.
Diagnosis of endometrial cancer
Gustave Roussy is involved in the diagnosis and treatment of endometrial cancer, but also manages patients whose diagnosis has already been confirmed.
During the initial consultation, patients are asked about their personal and family medical history. The doctor will document any other family cases of cancer in particular. This will prompt an investigation into Lynch syndrome - a rare hereditary disease that increases the risk of developing certain cancers including endometrial cancer. The doctor also assesses risk factors and potential tumour-related symptoms.
An ultrasound scan (transvaginal, if possible) is performed to highlight any thickening of the endometrium (hypertrophy), which may be indicative of cancer. A pelvic MRI scan may also be recommended.
An endometrial biopsy will also be carried out as a matter of routine.
Examination of this sample not only confirms the cancer diagnosis but also defines the histological tumour type as well as the level of aggressiveness.
Additional imaging tests (MRI) are then prescribed to assess the extent of the disease and to decide on an optimum treatment plan.
Decisions on cancer treatment pathways are taken during multidisciplinary meetings. These meetings involve several doctors from different disciplines including medical oncologists, surgeons, radiotherapy oncologists, radiologists and anatomo-pathologists who work in conjunction with community doctors. A multidisciplinary meeting report is compiled for each patient.
Endometrial cancer treatments
Various treatments are available to treat endometrial cancer:
In the case of localised cancer
Surgery is the primary treatment for endometrial cancer. It is performed if the patient is well enough to undergo the procedure and provided that the tumour has not metastasised. This type of surgery requires the expertise of specialised surgeons and anaesthesiologists to decide on the best treatment options. Gustave Roussy's specialist surgeons use robotic surgery, minimally invasive surgery, laparotomy and lymph node harvesting in particular.
In very rare situations and in women of childbearing age, fertility preservation through medical treatment, combined with limited surgical intervention, may be considered based on the outcome of the multidisciplinary meeting.
Post-surgical radiotherapy sessions in the pelvic region may be prescribed by doctors depending on various prognostic factors (stage, lymph node infiltration) in order to limit the risks of loco-regional recurrence.
Brachytherapy (or internal radiation therapy)
Vaginal brachytherapy is an internal radiotherapy technique delivering high-dose radiation to the specific area to be treated. It is sometimes recommended after surgery and/or external radiotherapy to limit the risk of vaginal recurrence. Between 2 and 4 brachytherapy sessions, each of 10 to 15 minutes’ duration, are performed on an outpatient basis (without the patient being admitted to hospital).
In the case of metastatic endometrial cancer
Chemotherapy is the main treatment for advanced endometrial cancer, particularly when the tumour cells have spread throughout the body, forming metastases. This treatment is based on the administration of anti-cancer drugs that act systemically (throughout the body).
Endometrial cells sometimes express receptors for female sex hormones (oestrogen and progesterone). Hormone therapy is often used to treat endometrial cancers that have spread to distant organs. The treatment is based on a progestin-only medicinal product that prevents progesterone from binding to endometrial cells and stimulating their growth.
Endometrial cancer treatment makes women infertile – hence the Gustave Roussy teams focus closely on patient fertility. Indeed, the Institute has been involved in improving practices over the last two decades.
Fertility preservation is seldom feasible but is discussed when it is can be offered safely alongside treatment. It may combine procedures to preserve the uterus with medical treatment.
Clinical trials and advanced therapy medicinal products
Depending on the characteristics and stage of the cancer, Gustave Roussy doctors may invite patients to participate in clinical trials. If a patient is eligible, clinical trial participation will be discussed during treatment by the referring oncologist. The patient will then be given access to advanced therapy medicinal products.
▶ View ongoing clinical trials for gynaecological cancers.