Endometrial cancer is the most common gynecological cancer, ranking 5th among cancers in women in terms of incidence.
This cancer generally occurs after the menopause.
The average age of patients at diagnosis was 68.
The main risk factors for endometrial cancer are obesity, diabetes and Tamoxifen treatment.
The diagnosis of endometrial cancer is suspected in the presence of post-menopausal vaginal bleeding, after gynaecological examination has ruled out cervical pathology.
Pelvic ultrasound exploration is then indicated to look for endometrial hypertrophy.
This requires a histological study of the endometrium by biopsy.
Diagnostic hysteroscopy is the major examination required to visualize the uterine cavity.
During this diagnostic hysteroscopy, a biopsy may be performed.
Anatomopathological diagnosis of endometrial cancer must precede extension assessment and therapeutic management.
Endometrial cancer is most often found in post-menopausal women, which is why any bleeding after menopause is suspicious and should be investigated.
MRI is particularly useful for assessing the extent of the disease prior to surgery, as it can assess the depth of invasion and any lymph node involvement.
This prognostic value is essential for adapting treatment (surgery, radiotherapy, chemotherapy).
Standard surgical treatment involves hysterectomy with bilateral adnexectomy by laparoscopy, or by laparotomy if uterine volume is too great.
Lymphadenectomy (lymph node dissection) is most often indicated, with pelvic and, in some cases, lumbo-aortic lymphadenectomy.
Radiotherapy and brachytherapy may be indicated depending on the stage of the disease, as determined by post-operative results.
Chemotherapy is used less frequently, mainly for patients with distant metastases or peritoneal carcinosis.
All cases are currently discussed at the RCP (Réunion de Concertation Pluridisciplinaire) with surgeons and oncologists (radiotherapists, chemotherapists), enabling appropriate, consensual management in line with the recommendations of learned societies.
90 % of uterine cancers are linked to HPV (Human papillomavirus) infection, and could be detected and prevented by regular, careful monitoring (cervico-vaginal smear and colposcopy).
Virus strains 16 and 18 are responsible for 70% of squamous cell cervical cancers (the most common form).
However, an HPV infection is not synonymous with cervical cancer, especially in young women, because HPV, like any virus, can disappear spontaneously: AN INFECTION IS NOT A LEECH.
Vaccination against the HPV virus should be offered systematically to all young girls in order to eradicate cervical cancer.
Cervical cancer is the second most common cancer in women and could be eradicated by proper prevention. .
Regular Pap smears and HPV testing enable early lesions (dysplasia, intraepithelial lesions) to be treated with minimally invasive surgery (conization or removal of a small portion of the cervix).
Colposcopy is an invaluable examination for identifying these cervical lesions under high magnification, so that they can be biopsied.
Cervical cancer can be discovered during a standard gynecological consultation and a cervico-vaginal smear test.
Cervical cancer can also be responsible for induced bleeding (sexual intercourse).
After diagnosis, a full workup is required to determine the extent of the disease and define the best treatment strategy.
Most cervical cancers are highly sensitive to radiation (radiotherapy).
In many cases, treatment will involve a combination of radio-chemotherapy and surgery (hysterectomy and lymph node dissection).
Cervical cancer has a local extension in the first instance, and its treatment is essentially surgical, supplemented by and/or brachytherapy (local radiotherapy of the vagina and parametrium), radiotherapy and chemotherapy.
In most cases, the surgical procedure will be complete, combining a hysterectomy, removal of the adnexa, and a complete lymph node curage (pelvic and lumbo-aortic).
Each case is currently discussed in a RCP (multidisciplinary consultation meeting) with surgeons, oncologists (radiotherapists, chemotherapists) and psychologists, enabling us to provide appropriate, consensual care.
Ovarian tumors can be benign (functional cysts, endometriotic cysts, etc.) or malignant (ovarian cancer).
In all cases, it is an anomaly in the growth of ovarian tissue.
The volume of the ovarian tumor varies according to its origin.
These may include diffuse fluctuating pelvic pain, acute pelvic pain in the event of complications, genital haemorrhage, abdominal enlargement, intestinal and urinary problems, and fatigue.
It may be discovered during a routine examination, an ultrasound scan or during pregnancy.
After a thorough clinical examination, an ultrasound scan will be performed, supplemented by a CT scan and MRI if necessary.
The difficulty lies in the fact that the malignant or benign origin is difficult to determine during radiology examinations.
In most cases, excision is necessary.
Benign functional cysts are typical and may benefit from simple surveillance with an ultrasound check at 3 months.
Cystectomy (removal of the cyst with preservation of the ovary)
Oophorectomy (removal of the ovary): most often by laparoscopy.
Ovarian cancer is the leading cause of death among malignant tumours of the pelvic genital tract.
The anatomical extension and intra-abdominal distribution routes also explain the seriousness of this cancer and its often late diagnosis, which in turn explains its dreadful prognosis.
Risk factors are still poorly understood. The use of oral contraceptives appears to reduce the risk of ovarian cancer.
Any suspected ovarian lesion should undergo a full extension workup prior to surgery, which will also enable the tumor to be staged.
Ultrasound can be used to make a diagnosis, but it alone cannot determine the extent of this tumour, which is intraperitoneal (in the abdominal cavity), or assess lymph node involvement.
MRI allows us to assess this extension, which will be reassessed during the operation, most often performed laparoscopically.
Only limited, low-grade tumors in young women can benefit from a limited surgical procedure, such as removal of the adnexa (tube + ovary) on one side only, to preserve the patient's fertility.
In most cases, the surgical procedure will be complete, combining hysterectomy, removal of the adnexa, omentectomy (removal of the omentum) and complete lymph node dissection (pelvic and lumbo-aortic).
Combining surgery and chemotherapy is essential, and can be done either before or after.
This decision is made on a case-by-case basis at a multidisciplinary consultation meeting between the surgeon and oncologists.
Border Line ovarian cancers are very special forms of ovarian cancer, as they do not penetrate deep into the ovarian tissue and therefore have a good prognosis.
In most cases, it is an anatomical pathological discovery following the removal of a cyst or ovary that was not suspected prior to surgery.
While surgery may be conservative in young women whose fertility is to be preserved, caution should be exercised in other cases, and a more radical procedure (hysterectomy +annexectomy +omentectomy) should be considered.
Dr Nadia Oukacha puts her expertise in gynecology, obstetrics and fertility at the service of every woman, combining listening, prevention and cutting-edge technology.
Each consultation begins with an in-depth discussion to understand your needs and establish a climate of trust.
A complete check-up, nutritional advice and psychological follow-up are adapted to your age and life situation.
Regular smear tests, screening and check-ups aim to anticipate risks and preserve your health over the long term.
Here you'll find answers to the most frequently asked questions about consultations, specialties, booking appointments and how the practice works.
You can book your consultation directly online via our website or by calling the practice on +212 606 12 12 13. A contact form is also available on the site.
Dr Oukacha specializes in :
Gynecology (consultations, pap smears, colposcopy, ultrasounds)
Obstetrics (pregnancy monitoring, ultrasound, amniocentesis)
Intimate and breast surgery
Fertility and medically assisted reproduction (MAP)
The practice is equipped for :
Gynecological and obstetrical ultrasounds
Cervico-vaginal smear
Colposcopy
Fertility assessment
Monday to Friday: 9:00 am - 5:00 pm
Saturday: 9:00 am - 1:00 pm
Sundays and public holidays: closed
The office is located in Casablanca, at 125 BD Brahim Roudani, 1st floor, Appt 11. An interactive map is available on the Contact page.
Access specialized gynecology, obstetrics and fertility care with confidence and simplicity.