The pelvis is located in the lower part of the abdomen and contains several organs. In a woman, part of this anatomical region includes the uterus and the ovaries. The uterus is made up of two parts: the lower part, the cervix, and an upper part where pregnancy occurs, the body. The endometrium is the mucous membrane, or surface, situated in the cavity of the body of the uterus.

Cancer of the endometrium is more frequent than ovarian cancer, which is however more widespread than cancer of the cervix.

Symptoms, screening and diagnostics

Cancer of the cervix

There is an effective screening examination which means precancerous lesions can be detected: a cervical-vaginal smear test.

Smear tests consist of taking a sample of superficial cells from the cervix during a gynaecological examination. These cells are then examined under the microscope. Since cervical cancer develops slowly, regular gynaecological monitoring means that it can be detected at a very early stage.

Screening using smear tests begins at the age of 25. The test is repeated every three years.

Cervical cancer is caused by a virus called HPV or “human papillomavirus”, which is transmitted during sexual intercourse.

HPV is very widespread. It only causes cancer in a minority of cases. However the risk is not to be ignored and vaccination against HPV is therefore very important. This virus is transmitted during sexual intercourse, so it is important that young girls be vaccinated as early as possible, that is before they first start to have sexual intercourse.

At the moment this vaccine is funded for girls between the ages of 12 and 15 (public cost of 130 €, with contribution from INAMI: 10 € per injection). The vaccination requires three injections.

This vaccine can prevent 70 % of cases of cervical cancer. In the absence of 100 % protection, screening should be carried out or continued even after vaccination. For young female patients aged 16 and over, opinion with regard to vaccination is to be discussed with their doctor (family doctor, paediatrician, gynaecologist, …).

Cervical cancer does not reveal many symptoms, which is why regular monitoring is important. It is quite easy to diagnose by means of smear tests and a gynaecological examination.

Cancer of the endometrium

The occurrence of cancer of the endometrium is increased by obesity, arterial hypertension  and diabetes. Cancer of the endometrium is indicated by abnormal losses of blood. If examinations are carried out prior to the initial symptoms, early diagnosis can be made in most cases and prognosis is good.

Cancer of the endometrium generally occurs beyond the age of 50.

The recurrence of blood loss at the menopause, or the occurrence of blood loss between menstruation in a woman who has not reached the menopause is sometimes significant. Such indications justify a medical consultation which will enable a diagnosis to be made quickly.

Diagnosis of cancer of the endometrium is made using a biopsy examination: a sample is taken of a small part of the suspected area and examined under the microscope. The sample is taken during an “endoscopy”, or to be more precise, a “hysteroscopy” - an examination which consists of inserting a guide, equipped with a small camera on the end, into the vagina. 

Ovarian cancer

Strictly speaking, there is no such thing as a risk factor of ovarian cancer. Where genetic factors intervene, in the majority of cases it may occur in women who have no particular past history, at menopause or beyond.

Diagnosis of ovarian cancer at an early stage is not easy. The disease may manifest itself through abdominal pain. Confirmation of the diagnosis requires a biopsy taken during a “laparoscopy” or a “coelioscopy”. This minimally invasive technique allows the interior of the abdomen to be examined and samples or surgical treatments to be carried out, without opening the abdominal wall. This increases comfort for the patients and reduces the period of convalescence.

Treatment

Cancers of the endometrium can be diagnosed early in women who have regular gynaecological examinations, they do not generally require additional treatment. Radiotherapy focused on the lower pelvis is sometimes carried out when the tumour presents a risk of recurrence.

Cervical cancer is also treated by hysterectomy, which is generally more extensive since it is often accompanied by the removal of the neighbouring glands. Radiotherapy combined with chemotherapy supplements surgery in certain cases. Exact identification of the extent of the tumour, also enables better targeting of possible complementary radiotherapy.

Some women wish to protect their fertility. Partial removal of the uterus, when possible, aims to meet this requirement. Clarification, which rests to a large extent on the endoscopy, means the precise spread of the cancer can be determined and means there is a possibility of keeping a part of the uterus, without removing the entire organ.

Finally, treatment of ovarian cancer is generally based on a combination of surgery and chemotherapy.

New targeted therapies are used in the context of wide-ranging international studies, in which reference centres, like the Cancer Centre, play an active part.

Optimal treatment requires a pluridisciplinary approach

The frequent combination of different therapeutic weapons such as surgery, radiotherapy and chemotherapy, illustrates the need to correctly define the characteristics of cancer. This approach means a programme of care and the sequence of different treatments can be established. It requires the support of specialists in imaging or in microscopy who are capable of assessing the aggressiveness of the cancer and its spread.

Weekly multidisciplinary meetings organised at the Cancer Centre therefore include all specialists involved in the diagnosis and treatment of gynaecological tumours. They enable the therapeutic approach which is the most appropriate for each patient to be tailored , in accordance with current care standards.

Preserving fertility and anti-cancerous treatments

Anti-cancerous treatments, no matter where the tumour is located, at times prove to be deleterious to female fertility. Cryopreservation of ovarian tissue carried out at the Cancer Centre compensates for this disadvantage. It consists of taking a sample from a piece of the ovary and freezing it before anti-cancerous treatment, which is potentially deleterious to fertility. At the end of this treatment, the piece of the ovary is re-implanted by coelioscopy. Click here to learn more about this technique.