What is Cancer of the uterus?

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It is one of the most frequent of the woman's cancers after the breast cancer.there are 1/23 new cases every year for 100 000 women.It occurs the most often at the woman before the menopause.

Cancer of the uterus Anatomy

The anatomopathologie permits to distinguish to the microscope two very different cases.

The superficial part of the collar of the uterus is an epithelium. The Cancer of the uterus is a épithélioma.

Between the outside part of the collar (exocol) and the interior part (endocol), exist a zone of junction that is the fragile zone where starts the cancérisation in general.

The epithelium is composed of a superficial layer and a deep layer. These two layers separated by a formation histological named blade basale.

When the blade basale is not touched, only the cells épithéliales is modified in surface; it is about a épithélioma intra-épithélial or pre-invasif épithélioma or cancer to the stage 0 or cancer in situ.

When the cancerous cells punched the blade basale and overgrown the underlying connective tissue, it is about a cancer invasif.

Cancer of the uterus Encouraging factors

* The vaginal and cervical infections (herpes genital HSV of type 2, condylomes or infections to papillomavirus of the group HPV herpes);

* The overhauls of the hormonal origin mucous membrane: the states dysplasiques and inflammatory of the collar are considered like precancerous states;

* The number of pregnancies superior to 1;

* The forwardness of the sexual intercourse;

* The frequent change of partners;

* The tobacco addiction;

* The exhibition in utero to the OF THEM (diéthylstilbestrol).

Cancer of the uterus is possible during a pregnancy.Vaccines against the Cancer of the uterus.

Recently, two vaccines warn the infections by papillomavirus, responsible of the cancer of the collar of the uterus,: Gardasil® and Cervarix®.

March 9, 2007, the Council Supérieur of Public hygiene of France (CSHPF) and the technical Committee of the vaccinations (CTV) recommend the vaccination generalized of the girls of 14 years against the Papillomavirus Human. This same opinion recommends to propose the vaccination also to the girls and young women of 15 to 23 years that would not have had any sexual intercourse or at the latest, in the year according to the beginning of their sexual life.

The social Security repays to 65% every dose of the Gardasil® whose price rises to 135,59. INCLUSIVE OF TAX. The diagram of vaccination requires three doses. The demand of repayment of the Cervarix® is studied currently.

Cancer of the uterus The signs of the illness

The épithélioma non invasif in situ is completely mute: there is not any symptom. It is a discovery of systematic exam of the collar makes in the setting of the yearly gynecological balance or during the medical surveillance of an inflammatory state or a cervical dysplasie (polyp, ulceration etc...)

When the cancer makes speak of it, the patient consults in general for losses of blood (métrorragies) provoked often (sexual intercourse, intimate toilet etc.). Of the leucorrhées (white losses) painless are associated sometimes.

Anyway some smears cervicovaginaux is practiced, as well as a colposcopie, that is going to permit the biopsy.

The exam to the spéculum can also reveal the budding or ulcerated lesion.

Cancer of the uterus The smear cervicovaginal

The cervical smear is a simple exam. it consists in appropriating cells of the collar of the uterus by a simple painless scratching, and to spread this withdrawal on a blade. After fixing, the blades are examined to the microscope by a physician specialized in this reading, the anatomo-pathologist.

This one describes in its report the cells that it saw and can classify the smear in I classes in V, but it is not anymore absolutely necessary, the description of the cells being sufficient to overrule what is normal of what is suspected or honestly pathological.

He is recommended to practice two smears to one year of interval to all women having some sexual intercourse, and this from the age of 25 years. He seems then sufficient to control a normal smear every three years, until age of about 65 years. This frequency can be increased if the physician the necessary judge.

In case of dysplasie, this one is classified (classification of Bethesda) according to his/her/its importance in CIN (néoplasie cervical intra-épithéliale) I, II, or III. The presence of koïlocytes signs an infection to papillomavirus and is an equivalent of CIN I. If a narrow surveillance, every two or three months can be sufficient before a CIN I, the cervical biopsy under control colposcopique imposes itself before a CIN II or III.

The account returned of the smear cervicovaginal goes to describe the observed cells épithéliales, the hormonal state, the possible presence of an inflammation, of lesions dystrophiques or métaplasiques, of viral infection signs to papillomavirus (HPV) or of néoplasies.

The cervical smear is therefore an important exam, because it is simple, painless, and permits to track down the lesions to their all beginning, to a stage where the treatment is extremely efficient.

The colposcopie after application of a solution of Lugol (test of Schiller) permits to guide the fundamental biopsy for the diagnosis.

It is sometimes necessary to do an extended biopsy (conisation of the collar).

The balance of the extension of the cancer

The extension is especially loco-regional and lymphatic.

The extension of the tumor makes itself locally toward the vagina, the bladder, the rectum, the ureters.

The lymphatic extension makes itself toward the pelvic partition.

The metastases are always belated (liver, lungs)

This balance is very important since the treatment and the prognosis depend on some.

The pelvic touches (vaginal touch and rectal touch) are completed by the complementary exams:

* Cystoscopie (state of the bladder);

* Rectoscopie and enema baryté (state of the rectum);

* Hysterography (state of the uterus and horns);

* intravenous Urographie (state of the ureters and kidneys);

* Lymphographie (extension lymphatic ganglionnaire);

* Scanner and imagery by magnetic resonance so necessary.

To the continuation of this balance, he becomes possible to classify the stage of the tumor, what is going to guide the treatment.

Cancer of the uterus Prognosis

When the diagnosis is made to quite the beginning, the recovery is nearly complete in the totality of the cases.

Cancer of the uterus Treatment

It uses the radiotherapy (curiethérapie utérovaginale and cobaltothérapie) and the surgery. The chemotherapy is used in some cases.

The curiethérapie utérovaginale consists in putting a radioactive source in the uterine cavity and the vagina to the direct contact of the tumor. The principle of an elevated homogeneous dose, in a small volume, is to the basis of the efficiency and the good tolerance of the curiethérapie. The applicator is put in place under general anesthesia. Once in place, he is charged in a second time thanks to a spotlight of sources. The dosimétrie is practiced by computer.

To the stage of cancer in situ, intervention can limit itself at the young woman wanting more children to a simple conisation or amputation of the collar under table setting of an attentive surveillance. At the more aged woman, the ablation of the uterus (simple total hysterectomy) is achieved.

In more advanced shapes, a larger surgery is practiced, and can be associated to an external radiotherapy of the small basin.