FAQ : Gynaecological cancer

Gynaecological cancers include all cancers of the female reproductive system: cervix, uterine body (endometrium), ovaries, vulva, vagina, and fallopian tubes.

Information on these cancers can be found in the following questions and answers. For more details, do not hesitate to go to the site Arcagy - InfoCancer.

Ovarian cancer is a disease where abnormal cells form in the ovaries, which are the female reproductive organs responsible for egg production. Ovarian cancer can develop in various parts of the ovary, including outer surface cells (epithelial cells), egg-producing cells (germ cells), or cells that produce hormones (stromal cells).

Cancer of the fallopian tubes (or uterine tubes) is cancer that is localized in the tubes, which are the thin muscular tubes that connect the ovaries to the uterus. These tubes play a key role in transporting eggs from the ovaries to the uterus for fertilization. Most often, it develops in glandular cells, which are found in the lining of the tubes.

There are several types of ovarian cancer, which are classified according to the types of cells they come from. The main types include:

Epithelial ovarian cancer : This is the most common type of ovarian cancer, which forms from cells on the outer surface of the ovary. Seven different histological subtypes are distinguished: serous (50 to 70%), endometrioid (10 to 70%), endometrioid (10 to 25%), mucinous (5 to 10%), clear cell (5%) and three much rarer subtypes (with transitional, undifferentiated and mixed cells).

Cancer ofgerm cells of the ovary: This type of cancer develops from the cells that produce eggs.

Stromal tumor : For this type of cancer, the tumor develops from cells that produce the female hormones estrogen and progesterone.

For more information on the different histologies of ovarian cancer, you can consult the site Arcagy - InfoCancer.

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

Three parameters must be taken into account:

• The T describes the size and extent of the primary tumor
• The N indicates whether the cancer faces a regional lymph node extension
• The M indicates whether the cancer has spread to other parts of the body, called metastases.

Note that this table is the same for ovarian and tubal cancer.

TNM classification chart for ovarian cancer

Primary tumor (T)

Lymph nodes (N)

Distant metastases (M)

Known to increase the risk of breast cancer, mutations in BRCA1 genesAndBRCA2are also associated with an increased risk of ovarian cancer.

If ovarian cancer recurs within 6 months following initial chemotherapy treatment with Taxol and Carboplatin, it is called a “platinum-resistant” recurrence. This means that treatment with platinum salts has not been effective, and a change in medication will be required to treat the relapse.

If the recurrence occurs after 6 months (or 12 months) after stopping standard treatment, there is a high probability that the treatment will require a combination of chemotherapy agents with platinum salts, as the recurrence is likely to be “platinum sensitive.”

Among the main chemotherapy drugs used to treat this type of cancer, there are mainly associations between a platinum salt And a Taxane. For example, Carboplatin with Paclitaxel (Taxol), which can be administered every three weeks or weekly according to the protocol in place.

This cancer forms in the tissue of the cervix, the lower, narrow part of the uterus. It is usually caused by a persistent infection by certain types of human papillomavirus (HPV), a sexually transmitted infection.

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

Three parameters must be taken into account:

• The T describes the size and extent of the primary tumor
• The N indicates whether the cancer faces a regional lymph node extension
• The M indicates whether the cancer has spread to other parts of the body, called metastases.

TNM classification chart for cervical cancer

Primary tumor (T)

Lymph nodes (N)

Distant metastases (M)

The FIGO (International Federation of Obstetrician Gynecologists) classification was established in 2002 by the WHO and is specific to gynecological cancers. This classification makes it possible to decide on the stage of evolution of the cancer according to the structures affected.

Treatment depends on the stage of the disease. If possible at the localized stage, surgery is proposed.

Another therapeutic option that is often proposed in the context of cervical cancer is chemoradiotherapy. It is a treatment that combines radiation therapy (often external radiation and brachytherapy) and chemotherapy (often cisplatin). Targeted immunotherapy is also used with a treatment such as Keytruda (Pembrolizumab), which is often combined with chemotherapy based on Avastin (Bevacizumab).

Uterine cancer is cancer that develops in the lining of the uterus, called the endometrium. Hormonal imbalances, such as excess estrogen without balancing progesterone, are often associated with its development.

Adenocarcinomas are the most common form of cancer in the uterine body. They develop from the endometrial glands. Sarcomas, on the other hand, are a much rarer form of this type of cancer.

Lynch syndrome : This hereditary cancer predisposition syndrome is caused by mutations in DNA repair genes, such as MLH1, MSH2, MSH6, and PMS2. Women with Lynch syndrome have an increased risk of developing endometrial cancer.

Mutation PIK3CA : This mutation is frequently observed in endometrial cancer. PIK3CA mutations activate the PI3K/Akt/mTOR signaling pathway, which promotes the growth and survival of cancer cells.

Amplification ofHER2 : It has been observed in certain subtypes of endometrial cancer. This genetic alteration can lead to excessive activation of the HER2 signaling pathway, promoting tumor growth.

Knowledge of these mutations can guide the choice of treatments followed and clinical trials in which to participate.

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

Three parameters must be taken into account:

• The T describes the size and extent of the primary tumor
• The N indicates whether the cancer faces a regional lymph node extension
• The M indicates whether the cancer has spread to other parts of the body, called metastases.

TNM classification chart for endometrial cancer

Primary tumor (T)

Lymph nodes (N)

Distant metastases (M)

Treatment depends on the stage of the disease. If possible at the localized stage, surgery (hysterectomy) is proposed. In addition, radiation therapy may be implemented. To treat endometrial cancer at more advanced stages or after initial local treatments have failed, chemotherapy is often proposed. And, now, there are also treatment options with immunotherapy, including two new treatments: Jemperli (dostarlimab) and Kysplyx (the combination of pembrolizumab and lenvatinib).

Vaginal cancer is a form of cancer that develops in the tissue of the vagina, the muscular canal connecting the uterus to the outside of the body in women. There are several types of vaginal cancer, which are classified according to the types of cells they come from.

The main types of vaginal cancer include:

Squamous cell carcinoma: It develops from squamous cells in the vaginal mucosa.

Adenocarcinoma: This type of vaginal cancer is formed from glandular cells in the vaginal mucosa.

Small cell carcinoma : It develops from neuroendocrine cells in the vaginal mucosa.

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

Three parameters must be taken into account:

• The T describes the size and extent of the primary tumor
• The N indicates whether the cancer faces a regional lymph node extension
• The M indicates whether the cancer has spread to other parts of the body, called metastases.

TNM classification chart for vaginal cancer

Primary tumor (T)

Lymph nodes (N)

Distant metastases (M)

This cancer forms in the tissue of the vulva, which is the outer part of the female genitals. The vulva includes the labia majora and minora, the Mount of Venus, the clitoris, and the vaginal vestibule.

The types of vulvar cancer primarily include:

Squamous cell carcinoma : It is the most common type of vulvar cancer, which is formed from skin cells in the vulva.

Basal cell carcinoma : This type of cancer is formed from basal cells in the skin of the vulva.

Melanoma: Vulvar melanoma develops from pigment-producing cells in the skin.

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

Three parameters must be taken into account:

• The T describes the size and extent of the primary tumor
• The N indicates whether the cancer faces a regional lymph node extension
• The M indicates whether the cancer has spread to other parts of the body, called metastases.

TNM classification chart for vulvar cancer

Primary tumor (T)

Lymph nodes (N)

Distant metastases (M)

If possible, the treatment is mostly surgical, but radiation therapy (external and brachytherapy) and chemotherapy (platinum + 5-FU) have been gradually integrated into the treatment protocols.