CANCERS

Marie Curie - twice Nobel Prize winner - together with Dr. Claudius Régaud, led the way in this field by founding in 1909 the 1st cancer hospital – Institut Curie. By 1920 they had invented and introduced the first radiotherapy treatments (use of radio-active source to kill the tumors).

Still operational today, Institut Curie brings together both research and medical teams on the same site, proving that France continues to be at the forefront of the fight against cancer.

The French medical ecosystem dedicated to the fight against cancer, has continued to break new ground using the latest technologies : chemotherapy in the 50s, proton-therapy in the 90s and in more recent years with the introduction of immunotherapy, precision medicine, DNA and AI (artificial intelligence) to improve the detection of tumors and eliminate the threat.

There are currently 318 research centers and over 877 highly qualified hospitals and clinics which are authorized by the French medical regulator - Haute Autorité de Santé -  to treat cancer patients. They work together on a daily basis, collaborating closely with their European and foreign counterparts, to adapt the most efficient protocols and care strategies to fight cancer.

These highly qualified French teams, along with numerous ground breaking ventures, account for their leading edge skills, ranking France as one of the world's leaders in the fight against cancer, with an investment of € 16 billion / USD 20 billion every year.

Among the 877 authorized hospitals and clinics, 762 are specialized in gynaecological cancers, 691 in breast; 636 in urinary/bladder, 582 in ENT (Ear-Nose-Throat), 529 in adult leukemia, 520 in skin, 494 in lung, 484 in kidney, 447 in thyroid, 437 in prostate, 418 in testicles, 323 in stomach and esophagus, 247 in pancreas, 176 in bones, 132 taking care of leukemic children and young adults, 54 performing brain tumor surgery.

In 2018, they welcomed 1.2 million patients for analysis or treatment, performed 2.7 million chemotherapy sessions, 0.7 million RCP (mandatory by law collegial Multi-disciplinary Decision Meetings) to determine the most efficient care path for each cancer patient. 

In this field, C3Medical is proud to be a close and privileged partner with Institut Curie, managing its international patient activity.

MALIGNANT EYE TUMORS

Conjunctival, palpebral and orbital tumors

Eye tumors require a multidisciplinary approach to optimize the chances of recovery.

  • Tumors of the eyelids include basal cell carcinomas, which are by far the most frequent, and which, in most cases, have an excellent prognosis. These tumors are malignant locally, but do not produce metastases. Initial surgery is the standard treatment. If performed early on, the patient can recover with minimal surgical after-effects. In more advanced forms, broader surgery with immediate reconstruction of the eyelid is recommended. The histological results are discussed in a multidisciplinary consultation meeting. Forms that are very advanced locally can also benefit from radiotherapy or in some cases targeted therapy.
  • Other malignant tumors of the eyelid are rarer and more aggressive, and can produce metastases, such as epidermoid carcinoma, sebaceous carcinoma or Merkel cell carcinoma. These tumors are usually treated with a combination of surgery and radiotherapy. Here again, they benefit from a multidisciplinary approach and recent biological advances.
  • Malignant tumors of the conjunctiva include lymphoma, severe dysplasia and conjunctival carcinoma, pre-cancerous melanosis and conjunctival melanoma. These lesions are rare but potentially serious, and require early, appropriate treatment. Conjunctival carcinomas are epithelial tumors whose prognosis depends on the initial size, prior surgeries, the number of local relapses and the histological aggressiveness. When the tumor is treated using a combination of surgery and disc or proton radiotherapy, it can be very well controlled locally with few after-effects for the eye, and lymph node relapse and metastases can be prevented. These tumors may also benefit from chemotherapy or immunotherapy (Interferon alfa-2b), with collyrium in addition.
  • Conjunctival melanomas are aggressive malignant tumors. They are similar to skin melanomas, but a lot rarer. These tumors occur most frequently subsequent to a pre-cancerous state known as Reese melanosis or after degeneration of a former nevus or even de novo. The tumor is generally pigmented and grows rapidly on a subject with fair skin at the age of around 50. Treatment requires a specialized center and involves surgical removal followed by additional radiotherapy, the terms of which will be discussed in a multidisciplinary consultation meeting. The search for mutations (BRAD, RAS, KIT) means that, if there are metastases, targeted therapy or appropriate immunotherapy is administered. Research in conjunctival melanoma is being conducted on mutations found in tumors.
  • Conjunctival lymphoma usually has a good prognosis when associated with the mucous membranes (MALT lymphoma). There are rarer, more aggressive forms. The diagnosis is performed by simple biopsy, and treatment is then discussed in a multidisciplinary consultation meeting with hematologists and radiotherapists.
  • Tumors of the eye socket are rare and a lot more polymorphous. All types of tumor may be found in the eye socket. The diagnosis is often based on a biopsy or removal analyzed by a seasoned anatomopathologist.
  • Malignant eye tumors, strictly speaking, include primitive tumors (retinoblastoma in children, choroidal melanoma, primitive lymphoma of the eye socket in adults) and choroidal metastases from a cancer located elsewhere, such as the breast, lung or colon. The diagnosis is established by an ophthalmologist specializing in eye tumors based on clinical and echographical evidence. Biopsy of the eye is always a delicate endeavor, but is proposed in certain cases when the diagnosis is difficult.

Source: https://institut-curie.org/liste/different-types-cancer

Uveal melanoma

What is uveal melanoma?

Uveal melanoma is a rare tumour, but the most frequent primary malignant tumour of the eye in adults, with 500 to 600 new cases per year in France.

The main risk is the onset of hepatic metastases, other metastatic locations being rarer or occurring later. It may occur de novo or through degeneration of a choroidal naevus. This is why patients with a large choroidal naevus usually benefit from early detection and regular monitoring of the optical fundus.

Melanoma of the eye may be discovered during a routine examination of the fundus or via the occurrence of recent visual problems such as lowering of visual acuity, a spot in the visual field (scotoma), flashes of light, or visual field loss (retinal detachment).

Tumours posterior to or “straddling the equator” can be treated with proton therapy: under general anaesthetic in the operating theatre, the surgeon identifies the tumour and inserts tantalum clips which will serve to guide the proton beam. Whenever possible, a puncture is made with a fine needle during the operation to better characterise the tumour biologically.

An endoresection (surgical ablation of the tumour scar tissue) is sometimes carried out after proton therapy to avoid complications, in particular neovascular glaucoma. For small anterior tumours, brachytherapy treatment with iodine 125 may be proposed.

These radiotherapy treatments control the tumour locally in 95% of cases. Prolonged monitoring of the ocular scar is essential. Complications (cataracts, glaucoma, radiation retinopathy) are possible and require ophthalmological treatment.

Enucleation or surgical ablation of the eye is reserved for the largest tumours. An extended assessment is necessary to search for distant metastases, particularly involving the liver.

Conjunctival, palpebral and orbital tumours
These tumours are usually treated with a combination of surgery and radiotherapy. Here again, they benefit from a multidisciplinary approach and recent biological advances.

Source: https://institut-curie.org/liste/different-types-cancer

Breast cancers

Understanding breast cancer

Breast cancer is a tumour which develops from the cells that form the mammary gland. It is known as a heterogeneous disease, because there are several types of tumour. Each tumour calls for a specific treatment.

  • It is called a carcinoma in situ if the cancerous cells are confined to the level of the breast channels or lobules.
  • If the cancerous cells have crossed the so-called "basal" membrane of the channels or lobules and invaded the neighbouring tissues, it is an infiltrating carcinoma. The cancerous cells may propagate either in the lymph nodes under the armpit, or through the veins.
  • Progress in research has now made it possible to distinguish 3 major types of tumour: Luminal A or B type cancer, HER2 type cancer and basal-like cancer. Determining the type of tumour makes it possible to now offer more appropriate treatments.
  • Two genes contributing to susceptibility to breast cancer have been identified, called BRCA1 and BRCA2. 60,000 women are thought to carry one of these two genetic mutations. They may be transmitted by either of the parents and significantly increase the risk of one day developing breast or ovarian cancer. Women identified as carriers of one of these mutations are offered suitable monitoring.

The treatment of breast cancer depends on the extent of the cancer at the time of diagnosis.

It usually includes removal of the tumour (or of the breast, if the cancer has spread) and the nearby lymph nodes. Today, the sentinel lymph-node technique (removing the lymph node closest to the breast) makes it possible to determine during surgery whether or not it is necessary to remove the entire lymph-node chain.

Surgery is often complemented by chemotherapy and radiation therapy.

Thanks to the progress made in treatments as well as in screening carried out for women aged 50 to 74 years, the five-year survival rate after diagnosis is around 90%.

Source : https://institut-curie.org/liste/different-types-cancer

Lung cancers

What is lung cancer?

In 2012 there were 39,500 new cases of lung cancer in France, of which 28,200 in men and 11,300 in women, with an increase due to female smoking, in particular among young women.

Smoking is one of the principal risk factors, but cancer can arise in patients who have never smoked. Other factors come into play: professional exposure (asbestos), cannabis and atmospheric pollution.

Two major types of lung cancer have been distinguished: small cell carcinoma and others called non-small-cell carcinoma. The latter are classed as adenocarcinoma, epidermoid carcinoma or undifferentiated carcinoma.

Non-small cell carcinoma are differentiated according to genetic alterations in the tumor; some of these alterations must be searched for systematically, since they will predict the effectiveness of targeted biotherapies.

Immunotherapy is a treatment that aims to stimulate the patient’s immune response against cancerous cells, and is part of the range of tools available to treat lung cancer.

Thus, lung cancer is a multiple entity, the prognosis and treatment of which will be very different from one patient to another since they are increasingly adapted to tumor characteristics and to the patient him/herself: this is the principle of personalized care.

Progress has been made in all oncology disciplines, requiring close collaboration among all specialties: for diagnosis, with progress in imaging (such as Positron emission tomography), in biology with precise characterization of molecular alterations, in interventional radiology (radiofrequency), for treatment, with mini-invasive surgery or surgery with several teams, with conformal and stereotaxic radiotherapy or targeted therapies and immunotherapy.

Source: https://institut-curie.org/liste/different-types-cancer

Soft tissue sarcomas

What are soft tissue sarcomas?

In fact, there is not one but MANY types of soft tissue sarcoma. This tumour develops in the non-bony support tissues or the wall of the abdominal organs. It presents multiple facets at molecular, histological, clinical and prognostical level: in total, there are some 50 sub-types of sarcomas.

These are relatively rare cancers: they represent around 1% of all cancers in France, i.e. 4,000 to 5,000 patients per year. Some 55% of sarcomas are situated in the limbs, 45% in the deep regions of the trunk and abdomen and 5% in the head and neck.

The speed of progression of these tumours depends on their grade: rapid if it is high, but very slow if the grade is low. Sometimes 10 or more years elapse before they are discovered or become symptomatic. They are also characterised by large volumes, with diameters that sometimes reach several dozen centimetres when they are situated in the abdomen. Contrary to received wisdom, size is not a prognostic factor.

The symptoms are not always very explicit. When the tumour is situated in the abdomen, the symptoms are linked to the compression it causes: coughing, increased abdominal girth, vague pains and so on. In the limbs, they are often characterised by a painless mass, which may lead to delays in diagnosis or sometimes to errors (diagnosis of a hematoma, benign tumour or the like).

The diagnosis is based on imaging tests (MRI for tumours of the limbs and scans for the abdominal area) and on biopsies. Since these tumours are relatively little-known, the diagnosis may be difficult: when in doubt, it is recommended that the patient go to expert centre such as Institut Curie in order to make a diagnosis and propose suitable treatment.

The treatment of primary sarcomas chiefly involves surgical ablation of the tumour. This surgery is highly specific, and many international studies have shown that the surgeon’s experience is fundamental. Depending on the nature, stage and location of the tumour, the surgery may be complemented by radiotherapy (sarcomas of the limbs) and/or chemotherapy.

With optimal treatment, 75% of patients are still alive five years after diagnosis. But it is crucial to first consult a specialist in sarcomas: if the surgery is performed badly, it becomes very difficult to fix the situation, and the chances of survival without recurrence diminish drastically.

Source: https://institut-curie.org/liste/different-types-cancer

Skin cancers

What are skin cancers?

The term ‘skin cancer’ covers two distinct types of skin tumor:

  • Basal or spindle-cell carcinomas (also called epithelial cancer), which affects the epithelial cells that produce keratin. Basal cell forms of cancer are by far the most frequent, representing some 70% of cases for nearly 100,000 diagnosed cases each year in France. These tumors have a favorable prognosis. Treatment generally consists of surgical ablation. If the tumor is not fully removed, there is a risk of local recurrence. However, these tumors do not metastasize.
  • Melanoma, which affects the cells that produce melanin. In 2015, estimates show that more than 14,000 cases of skin melanoma were diagnosed in France (source: INCa).

 

Skin cancers affect both men and women and have become increasingly common since 1980. This increase is undoubtedly due to the sun-exposure fad: exposure to UV radiation is a proven risk factor in the occurrence of skin cancer.

While carcinomas appear to result mainly from prolonged sun exposure, heavy doses of sun (as in sunburn), especially in childhood, promote the development of melanomas.

The incidence seems to have decreased slightly in recent years, certainly thanks to large-scale efforts to encourage prevention and more and more frequent use of sun protection, both physical (hats, t-shirts, etc.) and chemical (sunscreen).

Early detection is one of the most important factors in treating skin melanoma. Each year, the French dermatologists’ union organizes an awareness day. The earlier treatment begins, the better the chance of a cure.

There are signs to watch for, and everyone can monitor their own skin. Melanoma generally takes the form of a flat, pigmented (black or brown) spot. In 15% to 20% of cases, it appears in an existing mole whose appearance changes. Consult a dermatologist about any mole or black spot on the skin that changes. Only after this initial consultation, if a risk does exist, the physician may direct you to Institut Curie. 

Source: https://institut-curie.org/liste/different-types-cancer

DIGESTIVE CANCERS

What are digestive cancers?

With over 42,000 new cases diagnosed each year in France, colon and rectal cancers are by far the most common primary cancers of the digestive tract. This frequency justifies the introduction a few years ago of systematic screening for people aged 50 to 74 (as with breast cancer screening for women). If there are no particular risk factors, this screening involves a test every two years to search for a microscopic hemorrhage in the stool, which, if positive, is followed by a colonoscopy.

Pancreatic cancer has become much more common in recent decades. It is now the second most-common digestive cancer, ahead of stomach and esophageal cancer. Primary cancers of the small intestine are exceptional.

Primary cancers of the liver are rare and generally exacerbate the development of an underlying liver disease. Patients with cirrhosis, for which there are many causes, are the most at risk. In the liver, there can also be tumors known as liver metastases, since they come from another cancer that has spread to the liver. These are more frequent than primary cancers of the liver. They can be isolated or part of a spread to other organs (such as the lung) and/or the peritoneum (known as peritoneal carcinomatosis).

The symptoms that reveal digestive cancers depend on the organ affected.

A small number of these cancers occur due to genetic predisposition. These are known as hereditary forms of cancer. Hereditary forms of colon and rectal cancer are the most frequent. There are different types, the most common being Lynch syndrome (also known as HNPCC syndrome) and familial adenomatous polyposis. There are also hereditary forms of pancreatic and stomach cancer. In all cases, it is vital to identify individuals that have these genetic predispositions, given the impact for their own treatment (screening and sometimes specific therapy) and for that of their relatives.

Source: https://institut-curie.org/liste/different-types-cancer

ENT (Ear, nose and throat) cancers

What are ENT cancers?

Predisposing factors are clearly identified. At the top of the list are smoking, alcohol and some viruses, such as HPV16 in young people. Cancer is a serious disease whose cure will depend on whether it is localised or, on the contrary, has metastasized with extended lesions. The five-year cure rate varies between 20% and 80%.

There are many types of ENT cancers. They are generally classed according to the location of the tumour.

  • Buccal cavity: tongue, jaw, floor of the mouth, cheek, palate and lips.
  • Oropharynx: tonsils, soft palate, base of the tongue and vallecula.
  • Larynx: vocal cords, epiglottis, ventricular folds and subglottis.
  • Hypopharynx and laryngeal lips: piriform sinus, posterior pharyngeal wall, retro-arytenoid region and mouth of the oesophagus.
  • Facial bones: nose, nasal fossa, sinuses, base of the skull, orbit and infratemporal fossa.
  • Nasopharynx: region situated behind the nasal fossae and the sinuses.
  • Salivary glands: parotid, principal and accessory salivary glands.
  • Thyroid tumours.
  • Cutaneous tumours of the face and neck.
  • Sarcomas and other rare or exceptional tumours.

Source: https://institut-curie.org/liste/different-types-cancer

Tumors of the central nervous system and skull base

What are primary tumors of the central nervous system and skull base?

Among tumors that develop in the brain and spinal cord, we must first distinguish between primary tumors that initially develop in the central nervous system, and brain metastasis that occurs secondarily among patients who already have cancer in another organ (breast, lung, kidney, melanoma, etc.).

Institut Curie is leading center for these tumors, and has developed multidisciplinary expertise integrating diagnosis and therapeutic treatment. 

Primary tumors of the central nervous system in children, adolescents and young adults

These are rare tumors whose classification is rapidly evolving based on anatomopathology and molecular biology. The therapeutic strategy for treatment is personalized, and may include surgery, chemotherapy, targeted therapy, and/or high-precision radiotherapy via X-ray or proton beam.

Malignant primary tumors of the central nervous system in adults

  • Malignant primary tumors of the central nervous system are mainly represented among adults by glial tumors, both low-grade and high-grade.
  • Rare tumors such as medulloblastomas, ependymomas, intracranial germ-cell tumors, and pineal region tumors are most commonly observed among young adults, but can appear at any age.
  • Primary cerebral lymphoma is rare. Institut Curie coordinates with AP-HP, the French national expert network for these tumors.

Benign primary tumors of the central nervous system in adults

These tumors develop particularly in the pituitary gland region and include:

  • Craniopharyngiomas.
  • Pituitary adenomas.
  • Meningiomas.

These are treated with complementary approaches to neurosurgery using high-precision radiotherapy technologies, via X-ray or proton beam, that optimize protection of the normal tissues surrounding these benign tumors.

Primary tumors of the skull base 

Since they grow in bone, skull base tumors such as chordomas, chondrosarcomas, and osteosarcomas require specific expertise for their local treatment, which is divided between Institut Curie radiotherapists and neurosurgeons. Their removal is difficult and often incomplete, and postoperative radiation therapy is needed. Since they are often resistant, they require a high dose to control the disease, calling for the use of high-precision techniques such as proton therapy, the standard treatment.

What are the warning symptoms?

Symptoms depend on the seat and extent of the lesion:

  • In the brain, these cancers can lead to headaches, vomiting, neurological problems such as difficulty walking, motor deficits, etc., and epileptic fits.
  • In rarer cases, the red flag is a visual disturbance or endocrine disruption.
  • In the spine, the symptoms can be pain, disturbed sensation, and motor disorders.

A physician should be consulted when these symptoms appear, so that a brain scan or brain and/or spinal MRI can be conducted as soon as possible. In most cases, a biopsy is needed to confirm the diagnosis and clarify the tumor’s histological and molecular parameters. Since the tumors are often operated on immediately, the biopsy can be done at the same time. This analysis helps pinpoint the severity of the tumor. These elements are crucial for providing appropriate care. 

Source: https://institut-curie.org/liste/different-types-cancer

Gynaecological cancers

What is gynaecological cancer?

Endometrial cancer
The most frequent type is cancer of the endometrium, the body of the uterus (as opposed to the cervix). There were 7,300 new cases in 2012, the last official figure of the Institut national du cancer (Inca). It mainly affects women aged between 60 and 70, peaking at age 68. The odds are increased by obesity, diabetes and a higher than average oestrogen level (relative hyperoestrogenia). There is a familial form in 6% of cases, called Lynch syndrome, which also associates a risk of colon and ovarian cancer and cancer of the biliary and urinary tracts. This cancer has a good prognosis at a localised stage and the mortality rate has tended to diminish over the last few years. The treatment consists of surgery, with or without radiotherapy depending on the stage, and chemotherapy for advanced forms.

Ovarian cancer
Ovarian cancer affected 4,600 women in 2012, at a median age of 65 years. There is a genetic risk: 5-10% of patients with ovarian cancer carry mutations of the BRCA1 or 2 genes. In this case, the disease may appear earlier, at around 50 years. These genetically predisposed women may be monitored so that a lesion can be detected as early as possible. They may also be offered preventive ablation of the ovaries and fallopian tubes.

This disease is often diagnosed quite late, at an advanced stage, since it is “silent” or manifested by non-specific symptoms: pain, bleeding, intestinal transit disorders and heaviness in the lower abdomen. It may be revealed by an imaging test and dosage of a marker called CA 125 in the blood, which makes it possible to monitor the evolution of the disease. If the disease is not extensive, the treatment consists of surgery to remove ovaries, uterus, various chains of ganglia and any other visible lesions in order to eliminate the macroscopic disease. This surgery is followed in the vast majority of cases by chemotherapy. If the cancer has spread, chemotherapy is applied first in order to reduce the size and number of lesions, and then followed by surgery to remove all the lesions.

Cervical cancer
3,000 women are diagnosed with cervical cancer every year. But its frequency has been decreasing steadily for 20 years, thanks to regular pap-smear screening, which makes it possible to detect precancerous lesions. In 95% of cases, cervical cancer resulting from these precancerous lesions is caused by an infection by a papilloma virus (HPV) transmitted sexually 15-20 years earlier. This is why young girls are now offered a vaccination against this virus between ages 11 and 14. A follow-up is possible up to the age of 19.

But cervical cancer is still associated with high mortality: 1,100 deaths in 2012. Yet precancerous lesions can be treated before they become cancerous. A conical biopsy can be carried out, with the inner cone of the cervix affected by lesions removed. When cancer is confirmed but is not very advanced, the treatment consists of surgery to remove the uterus and the pelvic lymph nodes. In young women who wish to become pregnant and whose cancer is not very advanced, fertility-preserving treatment can be given. In advanced forms, the treatment consists instead of a combination of radiotherapy and chemotherapy followed in some cases by surgery.
Lastly, cancer of the vulva and the vagina represent less than 5% of female cancers. They occur mainly in post-menopausal women, at around age 70 on average. It is generally preceded by a precancerous phase. These precancerous lesions arise on a pre-existing skin condition, lichen sclerosus, or are caused by the HPV virus. If detected early, they can be treated by excision, or drugs in the case of HPV infection. At a cancerous stage, the treatment is surgical, sometimes followed by radiotherapy. Survival for this cancer is excellent if the disease has not reached the lymph nodes.

Source: https://institut-curie.org/liste/different-types-cancer

Urogenital cancers

Urogenital cancers are varied, since they include tumors of the kidney and bladder, and, in men, of the prostate and testicle.  Urogenital cancers differ widely. Treatment strategies are adapted to each patient and determined via a multidisciplinary consultation meeting.

  • Prostate cancer is the most frequent of these cancers, with almost 70,000 new cases per year in France. It occurs in men most frequently after the age of 65, but mortality rates are low, and patients often recover or keep it under control as a chronic disease over the long term. Prostate cancer is suspected when there is an increase in the prostate-specific antigen (PSA) in the blood, and is then diagnosed via additional tests, namely biopsies and MRIs. These elements, along with a clinical examination, also enable the stage and aggressiveness of the tumor to be clarified. According to these criteria, the intensity of symptoms, the general state of health and age, the patient may be offered several different options, from basic monitoring to a curative treatment through surgery, radiotherapy and/or hormone therapy. Chemotherapy is indicated in advanced and/or metastatic forms. Sometimes there may be a choice from among the various treatments, and the patient’s preferences are taken into consideration.
  • Another cancer affecting men, testicular cancer (a little over 2,300 cases per year in France), is most frequent in young adults aged between 20 and 30. About 96% of patients make a full recovery. The patient should consult a physician after the appearance of swelling or an increase in volume of one of the testicles. The physician performs a manual exam of the testicles, an ultrasound and a search for blood markers. Surgical removal of the affected testicle is the initial treatment. Before this procedure, as a precaution the patient will be asked to give a semen sample to be stored in a “bank” after freezing. Other therapies may be used to complete the treatment plan, including chemotherapy and even radiotherapy, or surgery of abdominal-pelvic masses or remaining lymph nodes.
  • Kidney cancer (around 10,500 cases per year) affects twice as many men as women, and most frequently after the age of 65. It is sometimes diagnosed by chance, revealed by an imaging test carried out for a different reason. The physician will establish the diagnosis after a clinical exam and abdominal scan. Treatments include surgery and chemotherapy. There are familial forms of kidney cancer; a genetic analysis is therefore often carried out when the disease is diagnosed in a patient aged 30 or 40. If a hereditary predisposition is found, the other members of the family may be closely monitored.
  • Bladder cancer (almost 12,000 cases per year in France) is linked mainly to smoking and to exposure to some toxic products used in industry. It affects twice as many men as women, mostly over the age of 70. The proportion of women affected is increasing due to their rise in tobacco use. The symptom that often suggests bladder cancer is the presence of blood in the urine. The need to urinate frequently and burning sensations, without urinary infection or stones, are two of the later signs. The diagnostic exams involve an ultrasound of the urinary tract, a urine analysis, and bladder exploration via cystoscopy (which can be followed by a surgical resection) for diagnosis and sometimes for treatment.

Several types of treatment are available depending on each case: surgery (removal of the bladder, construction of a new bladder or installation of a colostomy bag), chemotherapy, or more targeted treatments via immunotherapy or radiotherapy.

Source: https://institut-curie.org/liste/different-types-cancer

Cancer in the elderly

There is no official age at which people are deemed “elderly,” but the boundary is often set at the age of 70-75 in oncology. Contrary to popular belief, the incidence of cancer is generally higher in the elderly, sometimes with a significant risk of progression. Increasing life expectancies give more time for cancer to appear, while aging weakens the defences against tumour development.

With age, other health problems arise. These “co-morbidities” can complicate the management of cancer: the application of standard treatments is not always possible and requires numerous adjustments. We must therefore be armed with a more comprehensive assessment of the patient’s health status, carried out in close collaboration with a geriatrician, to approach the physiological reserves needed to tolerate the envisaged cancer treatments, whatever they may be: surgery, radiation therapy or medical treatments. This is what is known as a “comprehensive geriatric assessment”, which is just as important as an accurate analysis of the tumour, including its genome analysis, to arrive at a personalised comprehensive care-management strategy.

This is not always necessary, but is normally conducted if the patient is fragile, particularly when the proposed treatments present a risk of significant side effects (e.g. chemotherapy or major surgery). It identifies health problems that must be taken into account prior to treatment. This is the rationale for geriatric oncology.

Source: https://institut-curie.org/liste/different-types-cancer

Improving care through research

Since the department was created in 1977, research has been conducted at Institut Curie to improve the understanding of pediatric tumors. 

Understanding the mechanisms of the development of childhood cancer is essential to curing more children while limiting side effects to a minimum.

Childhood cancers have some specific features: 

  • They develop from embryonic tissue, in developing organs or tissues, whereas adult cancers occur mainly in tissue that is renewing or ageing.
  • The same tumor may have multi-tissue components.
  • The impact of childhood exposure to environmental mutagen factors is limited, and, in most cases, the role of genetic instability is probably also limited.
  • These cancers progress very quickly, in just a few weeks or sometimes days, which is not an indicator of their severity.
  • Tumors in children are relatively “simple” from a genetic standpoint. The cells are younger and have undergone fewer alterations caused by the environment. 

It is therefore essential to develop basic research geared specifically toward pediatric cancers. Only when their development mechanisms are thoroughly understood can care be improved. 

Research in pediatric oncology, whether basic, translational or clinical, has 3 main objectives: 

  • Finding new therapeutic options by targeting cancer cells or their environment, in particular using immunotherapy.
  • Developing more specific therapies to reduce side effects and recurrence.
  • Defining the risks associated with each tumor better. 

Source: https://institut-curie.org/liste/different-types-cancer

Brain tumors

Mr. Célio Pouponnot, PhD. Researcher, is coordinating a PIC3i program whose goal is to find new ways of improving the effectiveness of radiotherapy in young children with brain tumors.  

This program involves exploring the feasibility of two approaches currently being developed by teams from Institut Curie to reduce side effects and to increase the efficiency of radiotherapy. 


Source: https://institut-curie.org/liste/different-types-cancer 

Ewing tumors

Ewing tumors are a form of bone sarcoma that affects growing adolescents.  

A few years ago, Olivier Delattre’s team identified the genetic alteration that causes this pediatric cancer.  
It is a translocation occurring, in 85% of cases, between chromosomes 11 and 22, causing synthesis of an abnormal EWS-FLI-1 protein.  

Research on this genetic alteration is now used to establish diagnosis of Ewing tumors. Today the team is seeking to understand how the protein acts alone or in combination with two other genetic alterations more recently discovered in this same laboratory, and which characterize very aggressive forms of Ewing sarcoma.  

Research is continuing in order to characterize the normal cell that causes these cancers and to better understand why the occurrence of these tumors varies according to human populations. 


Source: https://institut-curie.org/liste/different-types-cancer

Neuroblastoma

Neuroblastoma is a tumor of the sympathetic nervous system in children.  

Some tumors will progress, whereas others, including those that have metastasized, will shrink on their own, and we don"t know why.  

Two hypotheses are currently being explored: the immune response of the body, which manages to rid itself of the tumor, or an intrinsic feature of the tumor.  

In 2008, the identification of activating mutations of the ALK gene in some sporadic and familial neuroblastomas was a major breakthrough in understanding the disease and paved the way to potential targeted treatments.  

Two mutations that keep the ALK receptor permanently activated are frequently observed. Researchers have developed mouse models, each carrying one of the two mutations, to study their role during embryonic development and in the occurrence of cancers. 


Source: https://institut-curie.org/liste/different-types-cancer

Rhabdoid tumors

Rhabdoid tumors are aggressive tumors that develop in very young children.

They occur due to a single mutation responsible for inactivating the Smarcb1 gene, discovered by Mr. Olivier Delattre’s laboratory in 1998, which makes it a "simple" cancer model.  

The Smarcb1 protein regulates the compaction of certain regions of the genome, and this allows certain genes to be read or not. If it is absent, the genome remains compact and the cells remain at a stage close to that of stem cells.  

Using a mouse model, research continues to try to decipher the mechanisms responsible. 


Source: https://institut-curie.org/liste/different-types-cancer

Medulloblastoma

Medulloblastoma is a tumor that develops in the cerebellum of young children.  

Pediatric oncology research has been strengthened recently with the arrival of Mr. Olivier Ayrault, of PhD. Researcher, and his team. 

For example, they have uncovered the role of the Atoh1 and Huwe1 proteins in its occurrence, which offers up new therapeutic options to counteract their effect in the development of this tumor.

At the same time, developing new proteomic approaches to better characterize the different types of medulloblastoma. 


Source: https://institut-curie.org/liste/different-types-cancer  

Retinoblastoma

Retinoblastoma is an eye tumor with a 99% survival rate in Western countries, especially thanks to proton-therapy treatment where Institut Curie / Orsay Proton Therapy Center is world leader in this field. 

Research is focusing on the development of less harmful treatments such as photo-sensitization.  

Chemists at Institut Curie are working to develop photosensitive molecules, known as photosensitizers, that can be activated by visible light. 


Source: https://institut-curie.org/liste/different-types-cancer

Surgery

What is surgery?

Generally speaking, surgery is indicated in the treatment of most tumours. It is usually the first phase of treatment, but is sometimes preceded and/or followed by chemotherapy and/or radiotherapy.

Cancer surgery naturally involves removing the tumour as precisely as possible. But it is also usually complemented by a lymph-node dissection: the surgeon removes as much as possible of the lymph nodes which drain the tumour and are therefore liable to be affected in their turn.

For breast cancer, the sentinel lymph node technique allows a single lymph node to be removed. If it appears healthy, the others will be preserved, whereas if it is affected, the lymph node chain will be removed.

These operations are usually practised under the same anaesthetic. The analysis of these lymph nodes will also help decide upon the follow-up to the surgical intervention (chemotherapy, radiotherapy etc.).

 

Surgery treatment at Institut Curie

  • Institut Curie has specialist surgeons for various types of cancers: ENT, digestive, sarcoma, gynaecological, breast and ophthalmologic. Institut Curie is the national centre for retinoblastoma treatment and the leading healthcare centre for choroidal melanoma. More than 4,000 patients with breast cancer were treated at Institut Curie in 2014. Some cancers cannot be operated on in situ. This applies in particular to thoracic and brain cancers. The treatment can however be carried out at Institut Curie: the patient will be operated on in one of our partner establishments and will then return to continue their treatment.
  • Outpatient surgery (the patient enters the hospital to be operated on in the morning and leaves the same day) is developing, and is one of the priorities for the coming years. For the time being, it is mainly carried out for ophthalmology, senology and small digestive surgery procedures. The idea is for the patient to return to their usual environment more rapidly, which is more reassuring for them.
  • Institut Curie forms part of RENAPE, a network of experts in peritoneal carcinomatosis care, i.e. the treatment of some abdominal cancers which have spread to surrounding tissues. This type of cancer requires very special care, which few centres are able to offer. The treatment consists in particular of performing intra-peritoneal hyperthermal chemotherapy (IPHC). This innovative technique significantly improves life expectancy for this type of cancer, which until recently had a very poor prognosis. The existence of a department of supportive care is particularly important in helping patients in their convalescence after this type of intervention: physiotherapists and dieticians in particular will be of great help to the patient.
  • Institut Curie also has an innovative wounds and healing department, a real boon for patients who have undergone major surgery, as well as for the surgeons. The dressings consultation is very reassuring to patients, who no longer need to look for a surgery in town to carry out this special service.

The anaesthetics team is trained in the most innovative techniques. General and locoregional anaesthetics are regularly used. But less common approaches, such as hypnotherapy, are also being developed for the patients’ comfort.

 

Source : https://institut-curie.org/liste/treatments

Reconstructive surgery and cancer

Reconstruction, in which cases?

Breast cancer affects more than 55,000 people each year.

One-third of patients will be treated by mastectomy (complete ablation of the breast). Reconstruction techniques form an integral part of the treatment for these cancers. Ablation and reconstruction may sometimes be carried out during the same operation (immediate mammary reconstruction) or deferred (secondary mammary reconstruction), depending on the other treatments that may be necessary.

The reconstruction may call for a prosthetic implant identical to those used in plastic surgery. More and more often, however, it is carried out using the patient’s own tissue. This is known as autologous reconstruction. The results are often more natural and satisfactory and require fewer subsequent re-interventions.

The surgeons use “flaps.” This may be a so-called pedicle flap like the grand dorsal muscle (back muscle), which is partially detached while preserving the blood vessels (artery and vein) that nourish it, then reversed onto the anterior surface of the thorax to reconstruct the breast’s volume and shape. A free flap, completely removed and then grafted, may also be used.

The most frequently performed technique is called the DIEP, for Deep Inferior Epigastric Perforator flap. It consists of removing a quantity of fat and skin from the abdomen as well as the artery and vein that vascularise them, and reattaching the artery and vein to the blood vessels on the thorax, via micro-surgery. The tissues are then remodelled to obtain the shape and volume of a breast. The breast can also be reconstructed by removing and reinjecting fat taken from the patient (lipomodelling).

These reconstructive surgical techniques may also be used in the case of conservative treatment (when only the tumour is removed and the breast preserved) to prevent and treat aesthetic after-effects (deformation, loss of volume, mammary asymmetry and pain) as well as treatment of after-effects (radiotherapy, chemotherapy).

 

Cancers of the vulva, vagina and cervix may also require the use of reconstructive surgery techniques in order to fill in the operated-upon region or to reconstruct a vagina with flaps.

In the case of testicular cancer, the ablation of a testicle may lead to its replacement with an implant.

Tumours of the eyeball or eyelids also benefit from reconstructive surgery techniques, either for the reconstruction of a lower or upper lid or to fill in an eye socket when the eye has been removed. It is necessary to apply techniques that make it possible to remove the tumour, conserve the protective eye functions and preserve facial aesthetics. Lipomodelling may be useful in improving the aesthetic appearance of patients who wear an ocular prosthesis. Free or pedicle flaps may also be used

Head and neck cancers pose a complex problem due to the vital nature of the organs treated (oesophagus, trachea), their essential functions (speech, swallowing, chewing) and the major aesthetic after-effects of such surgery. Reconstruction techniques are absolutely essential here in order to provide satisfactory cancer surgery while ensuring that functions are preserved. For example, a free fibula flap (bone taken from the leg) enables a jaw to be reconstructed, a free cutaneous flap taken from the inside of the upper arm enables a palate or a trachea to be reconstructed, a free flap of dorsal muscle fills in the base of a skull, and a free flap of intestine (jejunum) helps to reconstruct an oesophagus.

Skin cancers, in particular melanomas, may also require the application of reconstructive surgery to fill the operated region. Local cutaneous flaps, pedicle flaps or skin grafts may be necessary here for this surgery to be performed successfully.

 

Source: https://institut-curie.org/liste/treatments

Radiotherapy

What is radiotherapy? 

  • Radiotherapy may be applied for curative purposes, to treat the patient, or for palliative reasons, to treat metastases, especially in the brain, or to relieve pain from bone metastases. It is sometimes used alone, for example to treat some brain, lung or gynecological tumors that cannot be removed surgically. It is also regularly used in combination with surgery and drug treatments as part of a multidisciplinary approach. Radiotherapy can often help avoid disfiguring surgery and thus save the affected organ (breast, rectum, ENT organs).

Several types of radiation are possible.

  • External radiotherapy is the most frequent form. It involves delivering an electron, photon or proton beam (protontherapy) via particle accelerator into the volume of the tumor.
  • Brachytherapy involves putting radioactive sources in contact with or inside tumors, for more targeted treatment. It can be prescribed for certain prostate, gynecological, anal canal and eye cancers.

The main biological effect of ionizing radiation is to break the DNA strands of the tumor cells – either directly or through the formation of free radicals – which leads to the death of these cells.

Every radiation treatment requires a period of preparation, during which the specialist makes a precise calculation of the volumes to be irradiated based on scans performed in the treatment position, sometimes merged with MRI or PET-scan images. These images also make it possible to locate the healthy organs adjacent to the treated volume and to draw up a personalized treatment plan for each patient.

The precision of the treatment’s delivery and the quality controls implemented are crucial to ensuring the most effective results possible.

The estimated dosimetry is prepared by dosimetrists, checked by medical physicists and validated by radiotherapy oncologists. The treatment plan’s parameters are verified by the radiophysicist.

The positioning of the patient on the treatment table is carefully checked every day. The dose actually received is systematically measured and compared to the planned dose. Throughout treatment, a weekly medical consultation provides for strict medical follow-up.

 

Source: https://institut-curie.org/liste/treatments

Chemotherapy and Hormone therapy

What is Chemotherapy?

The purpose of chemotherapy is to kill the cancerous cells. It may be prescribed:

  • As an adjuvant treatment once the tumour has been removed, to ensure that no cancerous cells remain.
  • As a neo-adjuvant treatment, to reduce the size of the tumour before surgery: this helps to limit potential after-effects linked to the surgery.
  • In the case of metastatic disease, to treat the whole organism.

There are many types of chemotherapy, which are used according to the characteristics of the cancer.

Chemotherapy is frequently administered intravenously. It is usually performed in the form of sessions lasting from a few minutes to several hours, in a day hospital. The sessions are repeated every two to three weeks.

Chemotherapy can also be administered orally in the form of a tablet, which can be taken at home.

Chemotherapies have one major drawback: they are unable to make a distinction between cancerous cells and healthy cells. They therefore destroy a large part of the rapidly renewed cells of the organism. This explains the many possible side effects, such as loss of hair, problems with the nails or skin, and nausea. Oftentimes, chemotherapy also causes a temporary decrease in the immune defences, so patients must therefore be given advice on how to react in case of infection.

 

What is Hormone therapy?

Some cancers, in particular various breast and prostate cancers, are sensitive to sex hormones, and the latter stimulate the growth of cancerous cells. By blocking the hormone receptor on these cancerous cells, they are prevented from proliferating.

Some side effects may arise, such as vaginal dryness or a drop in libido, but these are totally reversible when treatment has ended. Hormone therapy is usually very effective, in particular for the treatment of hormone-dependent breast cancers (almost three-quarters of all such cancers), for which it is often prescribed in addition to chemotherapy. It has caused a drop in mortality linked to breast cancer.

Source: https://institut-curie.org/liste/treatments

Protontherapy

What is protontherapy?

It is an external radiotherapy which uses the energy of a proton beam to destroy tumor cells. Due to the physical properties of this beam, the radiation dose delivered to the tumor can be increased, while the dose delivered to the healthy tissues close to the tumor is minimized.

A proton (part of the nucleus of an atom) has a positive charge and a weight, contrary to X-photons. It can therefore be directed precisely at its target thanks to magnetic lenses. It thus deposits its total energy at a determined depth corresponding to the tumor.

So-called classic radiotherapy uses several proton beams to treat a tumor. Here, a single proton beam can reach the tumor while sparing the healthy tissue located near it.

This form of radiotherapy makes it possible to deliver large doses to destroy radiation-resistant tumors close to sensitive organs, such as malignant intraocular tumors and tumors of the base of the skull and the spinal column.

In particular, it helps reduce the volume of healthy tissues crossed by the rays compared to photons, and in some clinical situations helps to reduce the risk of toxicity.

It is a type of radiotherapy particularly suitable for radiation of some tumors in children and young adults.

 

Source: https://institut-curie.org/liste/treatments

Immunotherapy

What is immunotherapy?

Immunotherapy involves using the immune system to eliminate cancer cells, just as it works to attack bacteria and viruses. Rather than targeting the cancer cells directly, this treatment teaches the immune system to recognize and destroy them. This type of treatment can target various cells involved in the immune response.

Immunotherapy covers several therapeutic approaches and has been very successful in recent years. Some immunotherapy treatments are already authorized and others are still being assessed.

  • Therapeutic vaccines against cancer: Traditional vaccines specifically activate the immune system so that it can defend itself against bacteria or viruses. Vaccines against cancer teach the immune system to attack cancer cells. This teaching process involves presenting the immune system with a protein located on the tumors. The only approved vaccine to date treats advanced forms of prostate cancer. Others are still being studied.
  • Unlocking the immune system to enable it to attack cancer cells: This is the strategy that has been the most highly developed in recent years. Everything started from a simple observation that cancer cells are able to bypass the immune system by activating immune response inhibitors known as immune checkpoints. There are already several treatments using antibodies capable of blocking the action of the immune checkpoints and thus “unlocking” the immune system to enable it to reject tumors. These treatments have already proven effective in several tumor locations, among others in lung cancer, melanoma and kidney cancer. Today, the majority of patients unfortunately don’t respond to these treatments and research must continue to increase the number of people that can benefit from immunotherapy. Some options are already promising, and a number of trials are underway to expand the list of cancers than can be cured using immunotherapy. 

Source: https://institut-curie.org/liste/treatments

Targeted therapies

What are targeted therapies?

Targeted therapies have revolutionised anti-cancer treatment. They consist of targeting a particular part of the cancerous cell and blocking that target, which is involved in the information chain responsible for cell proliferation. The cancerous cell can thus no longer replicate itself.

These therapies are therefore based on the molecular profile of the tumour and no longer on its location: the same therapy can function for cancers on different organs if they carry the same molecular particularity. To find out, it is necessary to analyse the DNA of the cancerous cell and go in search of anomalies for which a targeted therapy may serve. They are often prescribed in addition to chemotherapy.

Today, some 30 targeted therapies exist, divided into several families:

- the antibodies, which attack a specific target at the surface of the cell;

- the inhibitors, which instead enter the cell to block a reproduction phase; and in 2013 another type, based on immune checkpoint inhibitors, underwent rapid development.

The researchers realised that the cancerous cells sometimes had the power to lower the immune defences that could have flushed them from the organism.

Some therapies now make it possible to block the lymphocyte receptors sensitive to cancerous attacks: they are not eliminated, and can continue to exterminate the cancerous cells. The treatment thus helps the organism to defend itself against cancer.

These techniques are now producing promising results in the treatment of cancers which usually have a poor prognosis, such as some lung and bladder cancers.

Source: https://institut-curie.org/liste/treatments

MALIGNANT EYE TUMORS

Conjunctival, palpebral and orbital tumors

Eye tumors require a multidisciplinary approach to optimize the chances of recovery.

  • Tumors of the eyelids include basal cell carcinomas, which are by far the most frequent, and which, in most cases, have an excellent prognosis. These tumors are malignant locally, but do not produce metastases. Initial surgery is the standard treatment. If performed early on, the patient can recover with minimal surgical after-effects. In more advanced forms, broader surgery with immediate reconstruction of the eyelid is recommended. The histological results are discussed in a multidisciplinary consultation meeting. Forms that are very advanced locally can also benefit from radiotherapy or in some cases targeted therapy.
  • Other malignant tumors of the eyelid are rarer and more aggressive, and can produce metastases, such as epidermoid carcinoma, sebaceous carcinoma or Merkel cell carcinoma. These tumors are usually treated with a combination of surgery and radiotherapy. Here again, they benefit from a multidisciplinary approach and recent biological advances.
  • Malignant tumors of the conjunctiva include lymphoma, severe dysplasia and conjunctival carcinoma, pre-cancerous melanosis and conjunctival melanoma. These lesions are rare but potentially serious, and require early, appropriate treatment. Conjunctival carcinomas are epithelial tumors whose prognosis depends on the initial size, prior surgeries, the number of local relapses and the histological aggressiveness. When the tumor is treated using a combination of surgery and disc or proton radiotherapy, it can be very well controlled locally with few after-effects for the eye, and lymph node relapse and metastases can be prevented. These tumors may also benefit from chemotherapy or immunotherapy (Interferon alfa-2b), with collyrium in addition.
  • Conjunctival melanomas are aggressive malignant tumors. They are similar to skin melanomas, but a lot rarer. These tumors occur most frequently subsequent to a pre-cancerous state known as Reese melanosis or after degeneration of a former nevus or even de novo. The tumor is generally pigmented and grows rapidly on a subject with fair skin at the age of around 50. Treatment requires a specialized center and involves surgical removal followed by additional radiotherapy, the terms of which will be discussed in a multidisciplinary consultation meeting. The search for mutations (BRAD, RAS, KIT) means that, if there are metastases, targeted therapy or appropriate immunotherapy is administered. Research in conjunctival melanoma is being conducted on mutations found in tumors.
  • Conjunctival lymphoma usually has a good prognosis when associated with the mucous membranes (MALT lymphoma). There are rarer, more aggressive forms. The diagnosis is performed by simple biopsy, and treatment is then discussed in a multidisciplinary consultation meeting with hematologists and radiotherapists.
  • Tumors of the eye socket are rare and a lot more polymorphous. All types of tumor may be found in the eye socket. The diagnosis is often based on a biopsy or removal analyzed by a seasoned anatomopathologist.
  • Malignant eye tumors, strictly speaking, include primitive tumors (retinoblastoma in children, choroidal melanoma, primitive lymphoma of the eye socket in adults) and choroidal metastases from a cancer located elsewhere, such as the breast, lung or colon. The diagnosis is established by an ophthalmologist specializing in eye tumors based on clinical and echographical evidence. Biopsy of the eye is always a delicate endeavor, but is proposed in certain cases when the diagnosis is difficult.

Source: https://institut-curie.org/liste/different-types-cancer

Uveal melanoma

What is uveal melanoma?

Uveal melanoma is a rare tumour, but the most frequent primary malignant tumour of the eye in adults, with 500 to 600 new cases per year in France.

The main risk is the onset of hepatic metastases, other metastatic locations being rarer or occurring later. It may occur de novo or through degeneration of a choroidal naevus. This is why patients with a large choroidal naevus usually benefit from early detection and regular monitoring of the optical fundus.

Melanoma of the eye may be discovered during a routine examination of the fundus or via the occurrence of recent visual problems such as lowering of visual acuity, a spot in the visual field (scotoma), flashes of light, or visual field loss (retinal detachment).

Tumours posterior to or “straddling the equator” can be treated with proton therapy: under general anaesthetic in the operating theatre, the surgeon identifies the tumour and inserts tantalum clips which will serve to guide the proton beam. Whenever possible, a puncture is made with a fine needle during the operation to better characterise the tumour biologically.

An endoresection (surgical ablation of the tumour scar tissue) is sometimes carried out after proton therapy to avoid complications, in particular neovascular glaucoma. For small anterior tumours, brachytherapy treatment with iodine 125 may be proposed.

These radiotherapy treatments control the tumour locally in 95% of cases. Prolonged monitoring of the ocular scar is essential. Complications (cataracts, glaucoma, radiation retinopathy) are possible and require ophthalmological treatment.

Enucleation or surgical ablation of the eye is reserved for the largest tumours. An extended assessment is necessary to search for distant metastases, particularly involving the liver.

Conjunctival, palpebral and orbital tumours
These tumours are usually treated with a combination of surgery and radiotherapy. Here again, they benefit from a multidisciplinary approach and recent biological advances.

Source: https://institut-curie.org/liste/different-types-cancer

Breast cancers

Understanding breast cancer

Breast cancer is a tumour which develops from the cells that form the mammary gland. It is known as a heterogeneous disease, because there are several types of tumour. Each tumour calls for a specific treatment.

  • It is called a carcinoma in situ if the cancerous cells are confined to the level of the breast channels or lobules.
  • If the cancerous cells have crossed the so-called "basal" membrane of the channels or lobules and invaded the neighbouring tissues, it is an infiltrating carcinoma. The cancerous cells may propagate either in the lymph nodes under the armpit, or through the veins.
  • Progress in research has now made it possible to distinguish 3 major types of tumour: Luminal A or B type cancer, HER2 type cancer and basal-like cancer. Determining the type of tumour makes it possible to now offer more appropriate treatments.
  • Two genes contributing to susceptibility to breast cancer have been identified, called BRCA1 and BRCA2. 60,000 women are thought to carry one of these two genetic mutations. They may be transmitted by either of the parents and significantly increase the risk of one day developing breast or ovarian cancer. Women identified as carriers of one of these mutations are offered suitable monitoring.

The treatment of breast cancer depends on the extent of the cancer at the time of diagnosis.

It usually includes removal of the tumour (or of the breast, if the cancer has spread) and the nearby lymph nodes. Today, the sentinel lymph-node technique (removing the lymph node closest to the breast) makes it possible to determine during surgery whether or not it is necessary to remove the entire lymph-node chain.

Surgery is often complemented by chemotherapy and radiation therapy.

Thanks to the progress made in treatments as well as in screening carried out for women aged 50 to 74 years, the five-year survival rate after diagnosis is around 90%.

Source : https://institut-curie.org/liste/different-types-cancer

Lung cancers

What is lung cancer?

In 2012 there were 39,500 new cases of lung cancer in France, of which 28,200 in men and 11,300 in women, with an increase due to female smoking, in particular among young women.

Smoking is one of the principal risk factors, but cancer can arise in patients who have never smoked. Other factors come into play: professional exposure (asbestos), cannabis and atmospheric pollution.

Two major types of lung cancer have been distinguished: small cell carcinoma and others called non-small-cell carcinoma. The latter are classed as adenocarcinoma, epidermoid carcinoma or undifferentiated carcinoma.

Non-small cell carcinoma are differentiated according to genetic alterations in the tumor; some of these alterations must be searched for systematically, since they will predict the effectiveness of targeted biotherapies.

Immunotherapy is a treatment that aims to stimulate the patient’s immune response against cancerous cells, and is part of the range of tools available to treat lung cancer.

Thus, lung cancer is a multiple entity, the prognosis and treatment of which will be very different from one patient to another since they are increasingly adapted to tumor characteristics and to the patient him/herself: this is the principle of personalized care.

Progress has been made in all oncology disciplines, requiring close collaboration among all specialties: for diagnosis, with progress in imaging (such as Positron emission tomography), in biology with precise characterization of molecular alterations, in interventional radiology (radiofrequency), for treatment, with mini-invasive surgery or surgery with several teams, with conformal and stereotaxic radiotherapy or targeted therapies and immunotherapy.

Source: https://institut-curie.org/liste/different-types-cancer

Soft tissue sarcomas

What are soft tissue sarcomas?

In fact, there is not one but MANY types of soft tissue sarcoma. This tumour develops in the non-bony support tissues or the wall of the abdominal organs. It presents multiple facets at molecular, histological, clinical and prognostical level: in total, there are some 50 sub-types of sarcomas.

These are relatively rare cancers: they represent around 1% of all cancers in France, i.e. 4,000 to 5,000 patients per year. Some 55% of sarcomas are situated in the limbs, 45% in the deep regions of the trunk and abdomen and 5% in the head and neck.

The speed of progression of these tumours depends on their grade: rapid if it is high, but very slow if the grade is low. Sometimes 10 or more years elapse before they are discovered or become symptomatic. They are also characterised by large volumes, with diameters that sometimes reach several dozen centimetres when they are situated in the abdomen. Contrary to received wisdom, size is not a prognostic factor.

The symptoms are not always very explicit. When the tumour is situated in the abdomen, the symptoms are linked to the compression it causes: coughing, increased abdominal girth, vague pains and so on. In the limbs, they are often characterised by a painless mass, which may lead to delays in diagnosis or sometimes to errors (diagnosis of a hematoma, benign tumour or the like).

The diagnosis is based on imaging tests (MRI for tumours of the limbs and scans for the abdominal area) and on biopsies. Since these tumours are relatively little-known, the diagnosis may be difficult: when in doubt, it is recommended that the patient go to expert centre such as Institut Curie in order to make a diagnosis and propose suitable treatment.

The treatment of primary sarcomas chiefly involves surgical ablation of the tumour. This surgery is highly specific, and many international studies have shown that the surgeon’s experience is fundamental. Depending on the nature, stage and location of the tumour, the surgery may be complemented by radiotherapy (sarcomas of the limbs) and/or chemotherapy.

With optimal treatment, 75% of patients are still alive five years after diagnosis. But it is crucial to first consult a specialist in sarcomas: if the surgery is performed badly, it becomes very difficult to fix the situation, and the chances of survival without recurrence diminish drastically.

Source: https://institut-curie.org/liste/different-types-cancer

Skin cancers

What are skin cancers?

The term ‘skin cancer’ covers two distinct types of skin tumor:

  • Basal or spindle-cell carcinomas (also called epithelial cancer), which affects the epithelial cells that produce keratin. Basal cell forms of cancer are by far the most frequent, representing some 70% of cases for nearly 100,000 diagnosed cases each year in France. These tumors have a favorable prognosis. Treatment generally consists of surgical ablation. If the tumor is not fully removed, there is a risk of local recurrence. However, these tumors do not metastasize.
  • Melanoma, which affects the cells that produce melanin. In 2015, estimates show that more than 14,000 cases of skin melanoma were diagnosed in France (source: INCa).

 

Skin cancers affect both men and women and have become increasingly common since 1980. This increase is undoubtedly due to the sun-exposure fad: exposure to UV radiation is a proven risk factor in the occurrence of skin cancer.

While carcinomas appear to result mainly from prolonged sun exposure, heavy doses of sun (as in sunburn), especially in childhood, promote the development of melanomas.

The incidence seems to have decreased slightly in recent years, certainly thanks to large-scale efforts to encourage prevention and more and more frequent use of sun protection, both physical (hats, t-shirts, etc.) and chemical (sunscreen).

Early detection is one of the most important factors in treating skin melanoma. Each year, the French dermatologists’ union organizes an awareness day. The earlier treatment begins, the better the chance of a cure.

There are signs to watch for, and everyone can monitor their own skin. Melanoma generally takes the form of a flat, pigmented (black or brown) spot. In 15% to 20% of cases, it appears in an existing mole whose appearance changes. Consult a dermatologist about any mole or black spot on the skin that changes. Only after this initial consultation, if a risk does exist, the physician may direct you to Institut Curie. 

Source: https://institut-curie.org/liste/different-types-cancer

DIGESTIVE CANCERS

What are digestive cancers?

With over 42,000 new cases diagnosed each year in France, colon and rectal cancers are by far the most common primary cancers of the digestive tract. This frequency justifies the introduction a few years ago of systematic screening for people aged 50 to 74 (as with breast cancer screening for women). If there are no particular risk factors, this screening involves a test every two years to search for a microscopic hemorrhage in the stool, which, if positive, is followed by a colonoscopy.

Pancreatic cancer has become much more common in recent decades. It is now the second most-common digestive cancer, ahead of stomach and esophageal cancer. Primary cancers of the small intestine are exceptional.

Primary cancers of the liver are rare and generally exacerbate the development of an underlying liver disease. Patients with cirrhosis, for which there are many causes, are the most at risk. In the liver, there can also be tumors known as liver metastases, since they come from another cancer that has spread to the liver. These are more frequent than primary cancers of the liver. They can be isolated or part of a spread to other organs (such as the lung) and/or the peritoneum (known as peritoneal carcinomatosis).

The symptoms that reveal digestive cancers depend on the organ affected.

A small number of these cancers occur due to genetic predisposition. These are known as hereditary forms of cancer. Hereditary forms of colon and rectal cancer are the most frequent. There are different types, the most common being Lynch syndrome (also known as HNPCC syndrome) and familial adenomatous polyposis. There are also hereditary forms of pancreatic and stomach cancer. In all cases, it is vital to identify individuals that have these genetic predispositions, given the impact for their own treatment (screening and sometimes specific therapy) and for that of their relatives.

Source: https://institut-curie.org/liste/different-types-cancer

ENT (Ear, nose and throat) cancers

What are ENT cancers?

Predisposing factors are clearly identified. At the top of the list are smoking, alcohol and some viruses, such as HPV16 in young people. Cancer is a serious disease whose cure will depend on whether it is localised or, on the contrary, has metastasized with extended lesions. The five-year cure rate varies between 20% and 80%.

There are many types of ENT cancers. They are generally classed according to the location of the tumour.

  • Buccal cavity: tongue, jaw, floor of the mouth, cheek, palate and lips.
  • Oropharynx: tonsils, soft palate, base of the tongue and vallecula.
  • Larynx: vocal cords, epiglottis, ventricular folds and subglottis.
  • Hypopharynx and laryngeal lips: piriform sinus, posterior pharyngeal wall, retro-arytenoid region and mouth of the oesophagus.
  • Facial bones: nose, nasal fossa, sinuses, base of the skull, orbit and infratemporal fossa.
  • Nasopharynx: region situated behind the nasal fossae and the sinuses.
  • Salivary glands: parotid, principal and accessory salivary glands.
  • Thyroid tumours.
  • Cutaneous tumours of the face and neck.
  • Sarcomas and other rare or exceptional tumours.

Source: https://institut-curie.org/liste/different-types-cancer

Tumors of the central nervous system and skull base

What are primary tumors of the central nervous system and skull base?

Among tumors that develop in the brain and spinal cord, we must first distinguish between primary tumors that initially develop in the central nervous system, and brain metastasis that occurs secondarily among patients who already have cancer in another organ (breast, lung, kidney, melanoma, etc.).

Institut Curie is leading center for these tumors, and has developed multidisciplinary expertise integrating diagnosis and therapeutic treatment. 

Primary tumors of the central nervous system in children, adolescents and young adults

These are rare tumors whose classification is rapidly evolving based on anatomopathology and molecular biology. The therapeutic strategy for treatment is personalized, and may include surgery, chemotherapy, targeted therapy, and/or high-precision radiotherapy via X-ray or proton beam.

Malignant primary tumors of the central nervous system in adults

  • Malignant primary tumors of the central nervous system are mainly represented among adults by glial tumors, both low-grade and high-grade.
  • Rare tumors such as medulloblastomas, ependymomas, intracranial germ-cell tumors, and pineal region tumors are most commonly observed among young adults, but can appear at any age.
  • Primary cerebral lymphoma is rare. Institut Curie coordinates with AP-HP, the French national expert network for these tumors.

Benign primary tumors of the central nervous system in adults

These tumors develop particularly in the pituitary gland region and include:

  • Craniopharyngiomas.
  • Pituitary adenomas.
  • Meningiomas.

These are treated with complementary approaches to neurosurgery using high-precision radiotherapy technologies, via X-ray or proton beam, that optimize protection of the normal tissues surrounding these benign tumors.

Primary tumors of the skull base 

Since they grow in bone, skull base tumors such as chordomas, chondrosarcomas, and osteosarcomas require specific expertise for their local treatment, which is divided between Institut Curie radiotherapists and neurosurgeons. Their removal is difficult and often incomplete, and postoperative radiation therapy is needed. Since they are often resistant, they require a high dose to control the disease, calling for the use of high-precision techniques such as proton therapy, the standard treatment.

What are the warning symptoms?

Symptoms depend on the seat and extent of the lesion:

  • In the brain, these cancers can lead to headaches, vomiting, neurological problems such as difficulty walking, motor deficits, etc., and epileptic fits.
  • In rarer cases, the red flag is a visual disturbance or endocrine disruption.
  • In the spine, the symptoms can be pain, disturbed sensation, and motor disorders.

A physician should be consulted when these symptoms appear, so that a brain scan or brain and/or spinal MRI can be conducted as soon as possible. In most cases, a biopsy is needed to confirm the diagnosis and clarify the tumor’s histological and molecular parameters. Since the tumors are often operated on immediately, the biopsy can be done at the same time. This analysis helps pinpoint the severity of the tumor. These elements are crucial for providing appropriate care. 

Source: https://institut-curie.org/liste/different-types-cancer

Gynaecological cancers

What is gynaecological cancer?

Endometrial cancer
The most frequent type is cancer of the endometrium, the body of the uterus (as opposed to the cervix). There were 7,300 new cases in 2012, the last official figure of the Institut national du cancer (Inca). It mainly affects women aged between 60 and 70, peaking at age 68. The odds are increased by obesity, diabetes and a higher than average oestrogen level (relative hyperoestrogenia). There is a familial form in 6% of cases, called Lynch syndrome, which also associates a risk of colon and ovarian cancer and cancer of the biliary and urinary tracts. This cancer has a good prognosis at a localised stage and the mortality rate has tended to diminish over the last few years. The treatment consists of surgery, with or without radiotherapy depending on the stage, and chemotherapy for advanced forms.

Ovarian cancer
Ovarian cancer affected 4,600 women in 2012, at a median age of 65 years. There is a genetic risk: 5-10% of patients with ovarian cancer carry mutations of the BRCA1 or 2 genes. In this case, the disease may appear earlier, at around 50 years. These genetically predisposed women may be monitored so that a lesion can be detected as early as possible. They may also be offered preventive ablation of the ovaries and fallopian tubes.

This disease is often diagnosed quite late, at an advanced stage, since it is “silent” or manifested by non-specific symptoms: pain, bleeding, intestinal transit disorders and heaviness in the lower abdomen. It may be revealed by an imaging test and dosage of a marker called CA 125 in the blood, which makes it possible to monitor the evolution of the disease. If the disease is not extensive, the treatment consists of surgery to remove ovaries, uterus, various chains of ganglia and any other visible lesions in order to eliminate the macroscopic disease. This surgery is followed in the vast majority of cases by chemotherapy. If the cancer has spread, chemotherapy is applied first in order to reduce the size and number of lesions, and then followed by surgery to remove all the lesions.

Cervical cancer
3,000 women are diagnosed with cervical cancer every year. But its frequency has been decreasing steadily for 20 years, thanks to regular pap-smear screening, which makes it possible to detect precancerous lesions. In 95% of cases, cervical cancer resulting from these precancerous lesions is caused by an infection by a papilloma virus (HPV) transmitted sexually 15-20 years earlier. This is why young girls are now offered a vaccination against this virus between ages 11 and 14. A follow-up is possible up to the age of 19.

But cervical cancer is still associated with high mortality: 1,100 deaths in 2012. Yet precancerous lesions can be treated before they become cancerous. A conical biopsy can be carried out, with the inner cone of the cervix affected by lesions removed. When cancer is confirmed but is not very advanced, the treatment consists of surgery to remove the uterus and the pelvic lymph nodes. In young women who wish to become pregnant and whose cancer is not very advanced, fertility-preserving treatment can be given. In advanced forms, the treatment consists instead of a combination of radiotherapy and chemotherapy followed in some cases by surgery.
Lastly, cancer of the vulva and the vagina represent less than 5% of female cancers. They occur mainly in post-menopausal women, at around age 70 on average. It is generally preceded by a precancerous phase. These precancerous lesions arise on a pre-existing skin condition, lichen sclerosus, or are caused by the HPV virus. If detected early, they can be treated by excision, or drugs in the case of HPV infection. At a cancerous stage, the treatment is surgical, sometimes followed by radiotherapy. Survival for this cancer is excellent if the disease has not reached the lymph nodes.

Source: https://institut-curie.org/liste/different-types-cancer

Urogenital cancers

Urogenital cancers are varied, since they include tumors of the kidney and bladder, and, in men, of the prostate and testicle.  Urogenital cancers differ widely. Treatment strategies are adapted to each patient and determined via a multidisciplinary consultation meeting.

  • Prostate cancer is the most frequent of these cancers, with almost 70,000 new cases per year in France. It occurs in men most frequently after the age of 65, but mortality rates are low, and patients often recover or keep it under control as a chronic disease over the long term. Prostate cancer is suspected when there is an increase in the prostate-specific antigen (PSA) in the blood, and is then diagnosed via additional tests, namely biopsies and MRIs. These elements, along with a clinical examination, also enable the stage and aggressiveness of the tumor to be clarified. According to these criteria, the intensity of symptoms, the general state of health and age, the patient may be offered several different options, from basic monitoring to a curative treatment through surgery, radiotherapy and/or hormone therapy. Chemotherapy is indicated in advanced and/or metastatic forms. Sometimes there may be a choice from among the various treatments, and the patient’s preferences are taken into consideration.
  • Another cancer affecting men, testicular cancer (a little over 2,300 cases per year in France), is most frequent in young adults aged between 20 and 30. About 96% of patients make a full recovery. The patient should consult a physician after the appearance of swelling or an increase in volume of one of the testicles. The physician performs a manual exam of the testicles, an ultrasound and a search for blood markers. Surgical removal of the affected testicle is the initial treatment. Before this procedure, as a precaution the patient will be asked to give a semen sample to be stored in a “bank” after freezing. Other therapies may be used to complete the treatment plan, including chemotherapy and even radiotherapy, or surgery of abdominal-pelvic masses or remaining lymph nodes.
  • Kidney cancer (around 10,500 cases per year) affects twice as many men as women, and most frequently after the age of 65. It is sometimes diagnosed by chance, revealed by an imaging test carried out for a different reason. The physician will establish the diagnosis after a clinical exam and abdominal scan. Treatments include surgery and chemotherapy. There are familial forms of kidney cancer; a genetic analysis is therefore often carried out when the disease is diagnosed in a patient aged 30 or 40. If a hereditary predisposition is found, the other members of the family may be closely monitored.
  • Bladder cancer (almost 12,000 cases per year in France) is linked mainly to smoking and to exposure to some toxic products used in industry. It affects twice as many men as women, mostly over the age of 70. The proportion of women affected is increasing due to their rise in tobacco use. The symptom that often suggests bladder cancer is the presence of blood in the urine. The need to urinate frequently and burning sensations, without urinary infection or stones, are two of the later signs. The diagnostic exams involve an ultrasound of the urinary tract, a urine analysis, and bladder exploration via cystoscopy (which can be followed by a surgical resection) for diagnosis and sometimes for treatment.

Several types of treatment are available depending on each case: surgery (removal of the bladder, construction of a new bladder or installation of a colostomy bag), chemotherapy, or more targeted treatments via immunotherapy or radiotherapy.

Source: https://institut-curie.org/liste/different-types-cancer

Cancer in the elderly

There is no official age at which people are deemed “elderly,” but the boundary is often set at the age of 70-75 in oncology. Contrary to popular belief, the incidence of cancer is generally higher in the elderly, sometimes with a significant risk of progression. Increasing life expectancies give more time for cancer to appear, while aging weakens the defences against tumour development.

With age, other health problems arise. These “co-morbidities” can complicate the management of cancer: the application of standard treatments is not always possible and requires numerous adjustments. We must therefore be armed with a more comprehensive assessment of the patient’s health status, carried out in close collaboration with a geriatrician, to approach the physiological reserves needed to tolerate the envisaged cancer treatments, whatever they may be: surgery, radiation therapy or medical treatments. This is what is known as a “comprehensive geriatric assessment”, which is just as important as an accurate analysis of the tumour, including its genome analysis, to arrive at a personalised comprehensive care-management strategy.

This is not always necessary, but is normally conducted if the patient is fragile, particularly when the proposed treatments present a risk of significant side effects (e.g. chemotherapy or major surgery). It identifies health problems that must be taken into account prior to treatment. This is the rationale for geriatric oncology.

Source: https://institut-curie.org/liste/different-types-cancer

Improving care through research

Since the department was created in 1977, research has been conducted at Institut Curie to improve the understanding of pediatric tumors. 

Understanding the mechanisms of the development of childhood cancer is essential to curing more children while limiting side effects to a minimum.

Childhood cancers have some specific features: 

  • They develop from embryonic tissue, in developing organs or tissues, whereas adult cancers occur mainly in tissue that is renewing or ageing.
  • The same tumor may have multi-tissue components.
  • The impact of childhood exposure to environmental mutagen factors is limited, and, in most cases, the role of genetic instability is probably also limited.
  • These cancers progress very quickly, in just a few weeks or sometimes days, which is not an indicator of their severity.
  • Tumors in children are relatively “simple” from a genetic standpoint. The cells are younger and have undergone fewer alterations caused by the environment. 

It is therefore essential to develop basic research geared specifically toward pediatric cancers. Only when their development mechanisms are thoroughly understood can care be improved. 

Research in pediatric oncology, whether basic, translational or clinical, has 3 main objectives: 

  • Finding new therapeutic options by targeting cancer cells or their environment, in particular using immunotherapy.
  • Developing more specific therapies to reduce side effects and recurrence.
  • Defining the risks associated with each tumor better. 

Source: https://institut-curie.org/liste/different-types-cancer

Brain tumors

Mr. Célio Pouponnot, PhD. Researcher, is coordinating a PIC3i program whose goal is to find new ways of improving the effectiveness of radiotherapy in young children with brain tumors.  

This program involves exploring the feasibility of two approaches currently being developed by teams from Institut Curie to reduce side effects and to increase the efficiency of radiotherapy. 


Source: https://institut-curie.org/liste/different-types-cancer 

Ewing tumors

Ewing tumors are a form of bone sarcoma that affects growing adolescents.  

A few years ago, Olivier Delattre’s team identified the genetic alteration that causes this pediatric cancer.  
It is a translocation occurring, in 85% of cases, between chromosomes 11 and 22, causing synthesis of an abnormal EWS-FLI-1 protein.  

Research on this genetic alteration is now used to establish diagnosis of Ewing tumors. Today the team is seeking to understand how the protein acts alone or in combination with two other genetic alterations more recently discovered in this same laboratory, and which characterize very aggressive forms of Ewing sarcoma.  

Research is continuing in order to characterize the normal cell that causes these cancers and to better understand why the occurrence of these tumors varies according to human populations. 


Source: https://institut-curie.org/liste/different-types-cancer

Neuroblastoma

Neuroblastoma is a tumor of the sympathetic nervous system in children.  

Some tumors will progress, whereas others, including those that have metastasized, will shrink on their own, and we don"t know why.  

Two hypotheses are currently being explored: the immune response of the body, which manages to rid itself of the tumor, or an intrinsic feature of the tumor.  

In 2008, the identification of activating mutations of the ALK gene in some sporadic and familial neuroblastomas was a major breakthrough in understanding the disease and paved the way to potential targeted treatments.  

Two mutations that keep the ALK receptor permanently activated are frequently observed. Researchers have developed mouse models, each carrying one of the two mutations, to study their role during embryonic development and in the occurrence of cancers. 


Source: https://institut-curie.org/liste/different-types-cancer

Rhabdoid tumors

Rhabdoid tumors are aggressive tumors that develop in very young children.

They occur due to a single mutation responsible for inactivating the Smarcb1 gene, discovered by Mr. Olivier Delattre’s laboratory in 1998, which makes it a "simple" cancer model.  

The Smarcb1 protein regulates the compaction of certain regions of the genome, and this allows certain genes to be read or not. If it is absent, the genome remains compact and the cells remain at a stage close to that of stem cells.  

Using a mouse model, research continues to try to decipher the mechanisms responsible. 


Source: https://institut-curie.org/liste/different-types-cancer

Medulloblastoma

Medulloblastoma is a tumor that develops in the cerebellum of young children.  

Pediatric oncology research has been strengthened recently with the arrival of Mr. Olivier Ayrault, of PhD. Researcher, and his team. 

For example, they have uncovered the role of the Atoh1 and Huwe1 proteins in its occurrence, which offers up new therapeutic options to counteract their effect in the development of this tumor.

At the same time, developing new proteomic approaches to better characterize the different types of medulloblastoma. 


Source: https://institut-curie.org/liste/different-types-cancer  

Retinoblastoma

Retinoblastoma is an eye tumor with a 99% survival rate in Western countries, especially thanks to proton-therapy treatment where Institut Curie / Orsay Proton Therapy Center is world leader in this field. 

Research is focusing on the development of less harmful treatments such as photo-sensitization.  

Chemists at Institut Curie are working to develop photosensitive molecules, known as photosensitizers, that can be activated by visible light. 


Source: https://institut-curie.org/liste/different-types-cancer

Surgery

What is surgery?

Generally speaking, surgery is indicated in the treatment of most tumours. It is usually the first phase of treatment, but is sometimes preceded and/or followed by chemotherapy and/or radiotherapy.

Cancer surgery naturally involves removing the tumour as precisely as possible. But it is also usually complemented by a lymph-node dissection: the surgeon removes as much as possible of the lymph nodes which drain the tumour and are therefore liable to be affected in their turn.

For breast cancer, the sentinel lymph node technique allows a single lymph node to be removed. If it appears healthy, the others will be preserved, whereas if it is affected, the lymph node chain will be removed.

These operations are usually practised under the same anaesthetic. The analysis of these lymph nodes will also help decide upon the follow-up to the surgical intervention (chemotherapy, radiotherapy etc.).

 

Surgery treatment at Institut Curie

  • Institut Curie has specialist surgeons for various types of cancers: ENT, digestive, sarcoma, gynaecological, breast and ophthalmologic. Institut Curie is the national centre for retinoblastoma treatment and the leading healthcare centre for choroidal melanoma. More than 4,000 patients with breast cancer were treated at Institut Curie in 2014. Some cancers cannot be operated on in situ. This applies in particular to thoracic and brain cancers. The treatment can however be carried out at Institut Curie: the patient will be operated on in one of our partner establishments and will then return to continue their treatment.
  • Outpatient surgery (the patient enters the hospital to be operated on in the morning and leaves the same day) is developing, and is one of the priorities for the coming years. For the time being, it is mainly carried out for ophthalmology, senology and small digestive surgery procedures. The idea is for the patient to return to their usual environment more rapidly, which is more reassuring for them.
  • Institut Curie forms part of RENAPE, a network of experts in peritoneal carcinomatosis care, i.e. the treatment of some abdominal cancers which have spread to surrounding tissues. This type of cancer requires very special care, which few centres are able to offer. The treatment consists in particular of performing intra-peritoneal hyperthermal chemotherapy (IPHC). This innovative technique significantly improves life expectancy for this type of cancer, which until recently had a very poor prognosis. The existence of a department of supportive care is particularly important in helping patients in their convalescence after this type of intervention: physiotherapists and dieticians in particular will be of great help to the patient.
  • Institut Curie also has an innovative wounds and healing department, a real boon for patients who have undergone major surgery, as well as for the surgeons. The dressings consultation is very reassuring to patients, who no longer need to look for a surgery in town to carry out this special service.

The anaesthetics team is trained in the most innovative techniques. General and locoregional anaesthetics are regularly used. But less common approaches, such as hypnotherapy, are also being developed for the patients’ comfort.

 

Source : https://institut-curie.org/liste/treatments

Reconstructive surgery and cancer

Reconstruction, in which cases?

Breast cancer affects more than 55,000 people each year.

One-third of patients will be treated by mastectomy (complete ablation of the breast). Reconstruction techniques form an integral part of the treatment for these cancers. Ablation and reconstruction may sometimes be carried out during the same operation (immediate mammary reconstruction) or deferred (secondary mammary reconstruction), depending on the other treatments that may be necessary.

The reconstruction may call for a prosthetic implant identical to those used in plastic surgery. More and more often, however, it is carried out using the patient’s own tissue. This is known as autologous reconstruction. The results are often more natural and satisfactory and require fewer subsequent re-interventions.

The surgeons use “flaps.” This may be a so-called pedicle flap like the grand dorsal muscle (back muscle), which is partially detached while preserving the blood vessels (artery and vein) that nourish it, then reversed onto the anterior surface of the thorax to reconstruct the breast’s volume and shape. A free flap, completely removed and then grafted, may also be used.

The most frequently performed technique is called the DIEP, for Deep Inferior Epigastric Perforator flap. It consists of removing a quantity of fat and skin from the abdomen as well as the artery and vein that vascularise them, and reattaching the artery and vein to the blood vessels on the thorax, via micro-surgery. The tissues are then remodelled to obtain the shape and volume of a breast. The breast can also be reconstructed by removing and reinjecting fat taken from the patient (lipomodelling).

These reconstructive surgical techniques may also be used in the case of conservative treatment (when only the tumour is removed and the breast preserved) to prevent and treat aesthetic after-effects (deformation, loss of volume, mammary asymmetry and pain) as well as treatment of after-effects (radiotherapy, chemotherapy).

 

Cancers of the vulva, vagina and cervix may also require the use of reconstructive surgery techniques in order to fill in the operated-upon region or to reconstruct a vagina with flaps.

In the case of testicular cancer, the ablation of a testicle may lead to its replacement with an implant.

Tumours of the eyeball or eyelids also benefit from reconstructive surgery techniques, either for the reconstruction of a lower or upper lid or to fill in an eye socket when the eye has been removed. It is necessary to apply techniques that make it possible to remove the tumour, conserve the protective eye functions and preserve facial aesthetics. Lipomodelling may be useful in improving the aesthetic appearance of patients who wear an ocular prosthesis. Free or pedicle flaps may also be used

Head and neck cancers pose a complex problem due to the vital nature of the organs treated (oesophagus, trachea), their essential functions (speech, swallowing, chewing) and the major aesthetic after-effects of such surgery. Reconstruction techniques are absolutely essential here in order to provide satisfactory cancer surgery while ensuring that functions are preserved. For example, a free fibula flap (bone taken from the leg) enables a jaw to be reconstructed, a free cutaneous flap taken from the inside of the upper arm enables a palate or a trachea to be reconstructed, a free flap of dorsal muscle fills in the base of a skull, and a free flap of intestine (jejunum) helps to reconstruct an oesophagus.

Skin cancers, in particular melanomas, may also require the application of reconstructive surgery to fill the operated region. Local cutaneous flaps, pedicle flaps or skin grafts may be necessary here for this surgery to be performed successfully.

 

Source: https://institut-curie.org/liste/treatments

Radiotherapy

What is radiotherapy? 

  • Radiotherapy may be applied for curative purposes, to treat the patient, or for palliative reasons, to treat metastases, especially in the brain, or to relieve pain from bone metastases. It is sometimes used alone, for example to treat some brain, lung or gynecological tumors that cannot be removed surgically. It is also regularly used in combination with surgery and drug treatments as part of a multidisciplinary approach. Radiotherapy can often help avoid disfiguring surgery and thus save the affected organ (breast, rectum, ENT organs).

Several types of radiation are possible.

  • External radiotherapy is the most frequent form. It involves delivering an electron, photon or proton beam (protontherapy) via particle accelerator into the volume of the tumor.
  • Brachytherapy involves putting radioactive sources in contact with or inside tumors, for more targeted treatment. It can be prescribed for certain prostate, gynecological, anal canal and eye cancers.

The main biological effect of ionizing radiation is to break the DNA strands of the tumor cells – either directly or through the formation of free radicals – which leads to the death of these cells.

Every radiation treatment requires a period of preparation, during which the specialist makes a precise calculation of the volumes to be irradiated based on scans performed in the treatment position, sometimes merged with MRI or PET-scan images. These images also make it possible to locate the healthy organs adjacent to the treated volume and to draw up a personalized treatment plan for each patient.

The precision of the treatment’s delivery and the quality controls implemented are crucial to ensuring the most effective results possible.

The estimated dosimetry is prepared by dosimetrists, checked by medical physicists and validated by radiotherapy oncologists. The treatment plan’s parameters are verified by the radiophysicist.

The positioning of the patient on the treatment table is carefully checked every day. The dose actually received is systematically measured and compared to the planned dose. Throughout treatment, a weekly medical consultation provides for strict medical follow-up.

 

Source: https://institut-curie.org/liste/treatments

Chemotherapy and Hormone therapy

What is Chemotherapy?

The purpose of chemotherapy is to kill the cancerous cells. It may be prescribed:

  • As an adjuvant treatment once the tumour has been removed, to ensure that no cancerous cells remain.
  • As a neo-adjuvant treatment, to reduce the size of the tumour before surgery: this helps to limit potential after-effects linked to the surgery.
  • In the case of metastatic disease, to treat the whole organism.

There are many types of chemotherapy, which are used according to the characteristics of the cancer.

Chemotherapy is frequently administered intravenously. It is usually performed in the form of sessions lasting from a few minutes to several hours, in a day hospital. The sessions are repeated every two to three weeks.

Chemotherapy can also be administered orally in the form of a tablet, which can be taken at home.

Chemotherapies have one major drawback: they are unable to make a distinction between cancerous cells and healthy cells. They therefore destroy a large part of the rapidly renewed cells of the organism. This explains the many possible side effects, such as loss of hair, problems with the nails or skin, and nausea. Oftentimes, chemotherapy also causes a temporary decrease in the immune defences, so patients must therefore be given advice on how to react in case of infection.

 

What is Hormone therapy?

Some cancers, in particular various breast and prostate cancers, are sensitive to sex hormones, and the latter stimulate the growth of cancerous cells. By blocking the hormone receptor on these cancerous cells, they are prevented from proliferating.

Some side effects may arise, such as vaginal dryness or a drop in libido, but these are totally reversible when treatment has ended. Hormone therapy is usually very effective, in particular for the treatment of hormone-dependent breast cancers (almost three-quarters of all such cancers), for which it is often prescribed in addition to chemotherapy. It has caused a drop in mortality linked to breast cancer.

Source: https://institut-curie.org/liste/treatments

Protontherapy

What is protontherapy?

It is an external radiotherapy which uses the energy of a proton beam to destroy tumor cells. Due to the physical properties of this beam, the radiation dose delivered to the tumor can be increased, while the dose delivered to the healthy tissues close to the tumor is minimized.

A proton (part of the nucleus of an atom) has a positive charge and a weight, contrary to X-photons. It can therefore be directed precisely at its target thanks to magnetic lenses. It thus deposits its total energy at a determined depth corresponding to the tumor.

So-called classic radiotherapy uses several proton beams to treat a tumor. Here, a single proton beam can reach the tumor while sparing the healthy tissue located near it.

This form of radiotherapy makes it possible to deliver large doses to destroy radiation-resistant tumors close to sensitive organs, such as malignant intraocular tumors and tumors of the base of the skull and the spinal column.

In particular, it helps reduce the volume of healthy tissues crossed by the rays compared to photons, and in some clinical situations helps to reduce the risk of toxicity.

It is a type of radiotherapy particularly suitable for radiation of some tumors in children and young adults.

 

Source: https://institut-curie.org/liste/treatments

Immunotherapy

What is immunotherapy?

Immunotherapy involves using the immune system to eliminate cancer cells, just as it works to attack bacteria and viruses. Rather than targeting the cancer cells directly, this treatment teaches the immune system to recognize and destroy them. This type of treatment can target various cells involved in the immune response.

Immunotherapy covers several therapeutic approaches and has been very successful in recent years. Some immunotherapy treatments are already authorized and others are still being assessed.

  • Therapeutic vaccines against cancer: Traditional vaccines specifically activate the immune system so that it can defend itself against bacteria or viruses. Vaccines against cancer teach the immune system to attack cancer cells. This teaching process involves presenting the immune system with a protein located on the tumors. The only approved vaccine to date treats advanced forms of prostate cancer. Others are still being studied.
  • Unlocking the immune system to enable it to attack cancer cells: This is the strategy that has been the most highly developed in recent years. Everything started from a simple observation that cancer cells are able to bypass the immune system by activating immune response inhibitors known as immune checkpoints. There are already several treatments using antibodies capable of blocking the action of the immune checkpoints and thus “unlocking” the immune system to enable it to reject tumors. These treatments have already proven effective in several tumor locations, among others in lung cancer, melanoma and kidney cancer. Today, the majority of patients unfortunately don’t respond to these treatments and research must continue to increase the number of people that can benefit from immunotherapy. Some options are already promising, and a number of trials are underway to expand the list of cancers than can be cured using immunotherapy. 

Source: https://institut-curie.org/liste/treatments

Targeted therapies

What are targeted therapies?

Targeted therapies have revolutionised anti-cancer treatment. They consist of targeting a particular part of the cancerous cell and blocking that target, which is involved in the information chain responsible for cell proliferation. The cancerous cell can thus no longer replicate itself.

These therapies are therefore based on the molecular profile of the tumour and no longer on its location: the same therapy can function for cancers on different organs if they carry the same molecular particularity. To find out, it is necessary to analyse the DNA of the cancerous cell and go in search of anomalies for which a targeted therapy may serve. They are often prescribed in addition to chemotherapy.

Today, some 30 targeted therapies exist, divided into several families:

- the antibodies, which attack a specific target at the surface of the cell;

- the inhibitors, which instead enter the cell to block a reproduction phase; and in 2013 another type, based on immune checkpoint inhibitors, underwent rapid development.

The researchers realised that the cancerous cells sometimes had the power to lower the immune defences that could have flushed them from the organism.

Some therapies now make it possible to block the lymphocyte receptors sensitive to cancerous attacks: they are not eliminated, and can continue to exterminate the cancerous cells. The treatment thus helps the organism to defend itself against cancer.

These techniques are now producing promising results in the treatment of cancers which usually have a poor prognosis, such as some lung and bladder cancers.

Source: https://institut-curie.org/liste/treatments