Type V : exentération partielle (résection urétérale ou vésicale partielle)
B- fertilité et adénocarcinome de l’endomètre :
Le traitement médical conservateur des adénocarcinomes endométriaux débutants repose sur le postulat suivant : obtenir une grossesse.
L’inclusion d’une patiente dans un tel protocole doit donc répondre à des critères stricts garantissant la limitation du processus carcinologique et les chances réelles de voir survenir une grossesse. [226]
On retrouve dans la littérature dès 1968 quelques publications sporadiques faisant état de grossesses survenues chez des patientes porteuses d’un adénocarcinome endométrial et traitées sans recours à l’hystérectomie. Ainsi les publications de Kempson en 1968, celles de O’Neill, de Fechner et d’Eddy en 1970, 1974 et 1978 respectivement [226].
Et Si on regroupe les cas publiés dans la littérature, on arrive à 43 patientes traitées de la sorte pour 25 réponses partielles ou totales. Par la suite 7 femmes ont eu 13 enfants. [310-311]
143
144
L’adénocarcinome de l’endomètre est le 4ème plus fréquent des cancers de la femme après le cancer du sein, du col utérin, et de l’ovaire.
C’est un cancer essentiellement de la femme âgée.
Les métrorragies post ménopausique constituent la circonstance de découverte la plus fréquente.
Le diagnostic positif repose essentiellement sur l’échographie endovaginale et éventuellement l’hystérographie et/ou l’hystéroscopie et/ou le curetage biopsique de l’endomètre. Ce dernier examen permet la confirmation diagnostique en préopératoire.
Le traitement de base l’adénocarcinome de l’endomètre est l’association chirurgie-radiothérapie.
La prévention passe par le diagnostic précoce et surtout le dépistage orienté chez les patientes à haut risque du développement de l’adénocarcinome de l’endomètre, notamment celles qui présentent des hyperplasies endomètriales atypiques.
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Résumé
Titre : Adénocarcinome de l’endomètre: à propos de 14 cas de l’institut national d’oncologie de Rabat (série chirurgicale).
Auteur : ILHAM CHKARNAT
Mots clés: adénocarcinome endomètrial – hystérectomie totale – annexectomie bilatérale – radiothérapie.
L’adénocarcinome de l’endomètre est le plus fréquent des cancers gynécologiques dans les pays développés.
Notre travail a porté sur une série de 14 cas d’adénocarcinome de l’endomètre à l’institut national d’oncologie de rabat (2012 et 2013).
Il s’agit essentiellement du cancer de la femme âgée, l’âge moyen de nos patientes était de 55,5 ans. 64,2% des patientes étaient ménopausées. L’étude des antécédents à la recherche des facteurs de risque a montré : 06 cas d’obésité, 03 cas d’hypertension artérielle et 02 cas de cancer de sein. Le délai de consultation moyen a été de 10 mois avec des extrêmes allant de 04 mois et 22 mois. Les métrorragies post-ménopausiques ont été le signe révélateur, rencontré dans 78% des cas.
Le curetage biopsique de l’endomètre est l’élément capital de diagnostic, réalisé chez douze patientes, a permis de faire le diagnostic dans 100%. L’adénocarcinome endomètroïde est le type histologique le plus fréquent (78.6%).
Toutes les patientes ont bénéficié d’un bilan d’extension au terme duquel et selon la classification de la Fédération Internationale de Gynécologie et d’Obstétrique : 61.6% des cas avaient un stade I, 23% un stade II, et 15.4 % un stade III.
Sur le plan thérapeutique, le traitement chirurgical a représenté toujours la référence, toute les patientes ont bénéficié d’une hystérectomie ou colpohystérectomie avec annexectomie bilatérale et curage pelvien .La Radiothérapie externe, associée à une curiethérapie, a été pratiquée dans 10 cas en post-opératoire.
Enfin, le pronostic de l’adénocarcinome de l’endomètre reste meilleur si le diagnostic est fait à des stades précoces, d’où l’intérêt d’une sensibilisation des femmes sur les risques et les symptômes de l’adénocarcinome de l’endomètre, notamment les saignements post ménopausiques qui présentent un véritable signal d’alarme.
146
ABSTRACT
Title: Endometrial adenocarcinoma: about 14 cases of the National Institute of Oncology in Rabat (surgical series)
Author: ILHAM CHKARNAT
Keywords: endometrial adenocarcinoma - hysterectomy - bilateral oophorectomy - radiotherapy.
Adenocarcinoma of the endometrium is the most common gynecological cancer in developed countries.
Our work has focused on a series of 14 cases of adenocarcinoma of the endometrium at the National Institute of Oncology in Rabat (2012 and 2013). It is basically cancer of the elderly woman; the average age of our patients was 55.5 years. 64.2% of patients were postmenopausal. The study of history in search of risk factors showed: 06 cases of obesity, 03 cases of hypertension and 02 cases of breast cancer. The average consultation time was 10 months, with a range of 04 months and 22 months.
Postmenopausal bleeding were the telltale sign, found in 78% of cases.
The biopsy endometrial curettage is the capital element analysis conducted in twelve patients, helped to make the diagnosis in 100%.
The endometroïd adenocarcinoma is the most common histological type (78.6 %).
All patients underwent a staging after which and according to the classification of the International Federation of Gynecology and Obstetrics: 61.6 % of patients had stage I, 23% stage II, and 15.4 % stage III.
Therapeutically, surgical treatment has always been the reference; all patients underwent a hysterectomy with bilateral oophorectomy or colpohysterectomy and pelvic lymphadenectomy. External radiotherapy combined with brachytherapy was performed in 10 cases postoperative.
Finally, the prognosis of endometrial adenocarcinoma is still better if the diagnosis is made at earlier stages, hence the importance of awareness among women about the risks and symptoms of endometrial cancer including postmenopausal bleeding have a real alarm signal.
147
صخلملا
ناونعلا : محرلا ةناطب ةيدغ ناطرس . ةيحارج ةلسلس فرط نم : طنركش ماهلاء ةيساسلاا تاملكلا : ناطب ةيدغ مرو ةجلاعملا،ةيئانثلا ضيبملا،محرلا لاصأتسا، محرلا ة عاعشلإلاب ةمدقتملا لودلا يف ةيئاسنلا مارولأا نيب نم اعويش رثكلأا وه محرلا ةيناطب ةيدغ مرو . ليلحت ىلع انلمع زكر دق و 41 ىف مارلولأا ملعل ىنطولا دهعملا ىف محرلا ةناطب ةيدغ ماروأ نم ةلاح طابرلا . صوصخرملأا قلعتي وه انتاضيرم نس لدعم نأ ثيح،ةنسملا ةأرملا ناطرسب ا 5555 ، ةنس % 2152 سأيلا نس دعب نهنم . اندجو محرلا ةيناطب ةيدغ مروب ةباصلإا اهعم لمتحي يتلا لماوعلا ىفثحبلادنعو 62 ،ةنمس تلااح 60 طرس نم نيتلاح و مدلا طغض عافترإ تلااح يدثلا نا . وه رواشتلا ةرتف طسوتم 10 ارهش . ملاعلا امأ فيزنلا يهف ضرملا نع تفشك يتلا ة دنع دجو ، % 88 تلااحلا نم . تلااحلا بلغأ يف دجو يدلا يجسنلا عونلا وه يذغلا نرقلا ) % 8882 ) . و ، يلحرملا بيترتلل ةبسنلاب امأ ديلوتلا و ءاسنلا ضارملأ يلودلا داحتلاا فينصت بسح : ةبسنب ةدئاسلا يه ىلولأا ةلحرملا % 2482 ، رملا ةيناتلا ةلح % 20 ةثلاتلا ةلحرملا و % 4581 . انتاضيرم عيمجل هؤارجإ مت يدلا يسيئرلا حلاعلا يه ةحارجلا ربتعت ) وأ محرلل لماكلا لاصأتسلإا ضوحلا ةيوافمل و نيضيبملا لاصأتسإ عم ،لبهملا و محرلا لاصأتسإ ) . مت يليمكتلا جلاعلا لجأ نم و قملا يجراخلا يعاعشلإا جلاعلا ءارجإ تلااحرشع يف يعضوملا يعاعشلإا جلاعلاب نور . يستكت انه نم و ،هروطتل ىلولأا لحارملا يف ضرملا صيخشت مت اذّإ، ًاريبك حاجنلاب ئبنتلا ىقبي اماتخ و يف فيزنلا صوصخلاب و ، ىربك ةيمهأ محرلا ةيدغ مروب ةباصلإا تاملاع و رطاخمب ءاسنلا ةيعون باثمب ربتعي يدلا سأيلا نس ةلحرم إ ةملاع ة ن راذ .148
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