Nearly 16,000 malignant tumors of the female reproductive system are detected each year in France. These develop mainly in the cervix, endometrium (the lining of the uterus) and the ovaries. The vagina and fallopian tubes are less often affected, according to the National Cancer Institute (Inca).

If we add the 54,000 new cases of breast cancer diagnosed per year, we come to a terrifying finding: 100% female cancers are legion. Most of them are happily better and better cared for today.

Stay alert to any body changes

The earlier a cancer is spotted, the higher its chances of recovery. It is therefore important to pay attention to the warning signs that should lead to consultation. Not all of them correspond to the presence of a tumor because many gynecological conditions generate similar symptoms. But we must be vigilant to the extent that they can testify to the development of cancer.

Bleeding between periods, a change in the appearance of the vulva, lower abdominal pain previously unknown and a desire to urinate almost permanently can evoke a gynecological cancer.

The appearance of a dimple on a breast, the sudden retraction of a nipple, a hardening of the skin on the breast , a flow or a change of shape of the breast must also lead to consultation. On the other hand, "breast pain is rarely a predictor of a tumor, especially when it is cyclical and occurs on both sides," explains Carole Mathelin, a gynecologist oncologist at Strasbourg University Hospital. A hormonal disturbance is often involved.

Breast cancer is much talked about: it is the number one cancer in women, in front of the colon (19500 new female cases / year) and lung (nearly 15000). Gynecological cancers are more unknown.

Cervical cancer: the most preventable

With 2800 new cases per year according to the Inca, cervical cancer strikes mostly between 40 and 50 years, but it can occur in women much younger. Its most common cause is sexually transmitted papillomavirus (HPV) infection . "When they persist for a long time, they cause a change in the cells of the cervical surface (a dysplasia) that can progress to cancer," says Dr. Alain Tamborini, gynecologist author of "GynécoGuide" (Marabout ed.). The transformation of precancerous lesions into cancer takes several years (sometimes more than 10 years). Hence the importance of performing regular smears to identify dysplasias and treat (laser or surgery) before they metamorphose into aggressive cancer.

But unfortunately, many cervical tumors are discovered too late for lack of sufficient gynecological monitoring. 40% of women do not perform regular smears , according to the Public Health Agency France. To remedy this, an organized screening program will soon be introduced in France.

In addition, there is a vaccine to protect the youngest against HPV. Reimbursed by the Social Security, it is aimed at girls from 11 to 14, before the age of the first intimate relationships. A catch-up is possible for women under 23, provided they have just started their sex life. But this vaccine remains underutilized in France. Only 19% of adolescent girls were given the two doses needed for its effectiveness, unlike other countries such as England or Australia.

A new vaccine protecting against more HPV strains is about to be marketed (Gardasil 9), which could broaden the target. Be careful though: this vaccine is extra protection. It does not replace regular smear screening.

Endometrial cancer: the most common gynecological cancer

More than 8000 new cases of cancer of the lining of the uterus are detected every year in the Hexagon, especially after menopause. Eight times out of ten, this cancer is hormone-dependent.

At each menstrual cycle , the endometrium is restored after menstruation. Its cells divide at full speed to rebuild a uterine wall likely to accommodate a possible embryo. "However, cell multiplication carries an increased risk of unrepaired genetic mutation, which causes cancer," says Dr. Philippe Vignal, gynecologist author of "L'enfer au féminin" (La Martinière edition). In women who have gone through pregnancies or whose contraception has eradicated menstruation, the endometrium has remained dormant for a long time: it has been renewed like the skin, in a slow and continuous manner, and not abruptly. Their risk of uterine cancer is reduced unless there is a family predisposition. But in other women, endometrial cancer threatens. Obesity is also a contributing factor, as adipose tissue secretes estrogen.

Vaginal bleeding after menopause , or between periods, should alert, especially in women who have had polyps. To establish the diagnosis, an ultrasound and a hysteroscopy (visualization of the inside of the uterus using a mini-camera) are carried out. If there is suspicion of cancer, a pelvic MRI is proposed to better visualize the tumor. If it is localized, removal of the uterus , ovaries and tubes is performed. Then, treatment by ray is often proposed to avoid recurrences. But in the presence of metastases , chemotherapy and hormone therapy become unavoidable.

Ovarian cancer: the most formidable

Although underestimated, it is the most aggressive gynecological cancer . It often occurs after age 60, but it appears earlier in women with a family predisposition (15% of cases). Of the 4500 new ovarian cancers identified each year in France, three-quarters are discovered at a very advanced stage, when the tumor presses on neighboring organs (bladder or intestine). She has often already scattered around. The symptoms are not specific: abdominal discomfort, bloating, sudden constipation, frequent urge to urinate ... They evoke a digestive disorder, hence the delay in diagnosis.

US researchers in Baltimore and Boston may end this terrible injustice with the development of an early screening test (by simple blood test or vaginal fluid analysis). The first results obtained seem promising.

Current treatment always involves duo surgery and chemotherapy. Ablation is usually complete *: ovaries, tubes, uterus and pelvic ganglia are removed, sometimes with a part of the intestine or peritoneum. But as the protocols are more and more personalized, targeted therapies are also sometimes proposed to reduce the risk of recurrence. They target cancer cells by sparing healthy cells as much as possible. Advances in immunotherapy, an additional weapon against cancer, are also particularly encouraging for ovarian tumors. Several clinical trials are in progress.

A useful handbook for ovarian cancer patients is available free of charge from cancer services or upon request from [email protected]

* except in cases of non-epithelial tumors