Revue Médicale Suisse

Inhibiteurs de la PARP : une meilleure sélection des patient-e-s

PARP inhibitors (PARPi) have established themselves as a class of essential anti-cancer drugs. They inhibit PARP proteins involved in DNA damage repair. Their anti-tumor action requires a concomitant abnormality in DNA damage repair, the homologous recombination deficiency (HRD). The genomic instability being too substantial, the tumor cell goes into apoptosis (concept of synthetic lethality). This last decade, the selection of patients benefiting from PARPi has been refined with convincing results for ovarian cancers, but also breast, prostate and pancreatic cancers. This article presents recent data that have impacted our clinical practice and the PARPi authorized in Switzerland.

Papillomavirus humain : dépistage des cancers du col et de l’anus

Cervical cancer is preventable through primary and secondary prevention. Vaccination against the human papillomavirus (HPV), the virus necessary for the development of precancerous lesions, can prevent most of them. Screening by cytology for these precancerous (or cancerous) lesions can be replaced by screening for certain types of HPV, high risk (HR-HPV), causing cervical cancer. The presence of HR-HPV on the cervix should raise suspicion of concomitant infection in the anus, as both epithelia are highly susceptible. This attitude is dictated by the increase incidence in anal cancer in the population, which is also HPV-dependent and therefore also potentially preventable through vaccination and screening.

Prise en charge du papillomavirus humain au cabinet médical : que faire pour les hommes ?

In primary care medicine, doctors may be facing with human papillomavirus (HPV)-related questions regarding prevention, screening or treatment, more so with women than with men. Through three clinical vignettes, this article aims to offer some clinical management recommendations in a primary care setting when HPV-related questions are raised by the male population.

Préservation de la ­fertilité chez les patientes présentant un ­cancer ­gynécologique

Gynecological cancers quite often affect young women who wish to preserve their fertility. In addition, with the advancement in age of first pregnancies, this problem has currently taken on a significant scale. Most often, fertility preservation is possible provided that the cancerous tumor is discovered at an early stage and of a non-aggressive histological nature. For uterine cancers (cervix and endometrium), surgery preserving uterine function (associated with hormone therapy for endometrial cancers) is often possible for early tumor stages. For ovarian cancers, indications for fertility preservation are rare and reserved for certain histological types, mainly borderline tumors.

Prise en charge initiale actuelle des ­carcinomes ovariens séreux de haut grade avancés

Ovarian cancers are gynecological cancers with a poor prognosis. Most ovarian cancers are high-grade serous carcinomas. It is now accepted that they are very often tubal in origin. Their management has undergone major advances in recent years. Their clinical manifestations are not very specific, and no screening test has yet -proved its worth, which explains why they are often diagnosed late. The diagnostic phase is essentially based on ultrasound and abdomino-pelvic CT scans, for reasons of ease of access. Other -examination modalities, such as MRI and above all PET-Ct, are playing an increasingly important role in the initial management of extension or thera-peutic follow-up. Even with notable advances in diagnosis and treatment, the overall prognosis remains poor.

Cancer de l’endomètre : entre modernité et immunothérapie

Frequent and with an increasing incidence in some territories, endometrial cancer is a complex disease leading to significant morbidity among affected patients. After years of research and the implementation of state-of-the-art molecular and gene assays significant breakthroughs were made. Through a better understanding of the underlying mechanisms of uterine carcinogenesis, a more precise and personalized risk stratification and the incorporation of immunotherapy, the treatment of endometrial cancer is experiencing significant improvements. This evolution, caries the genuine hope for an accurate selection of patients based on specific cancer-related characteristics, to tailor both treatment intensity and selection.

Expérience d’un groupe de parole pour les femmes porteuses de mutations [i]BRCA1/2[/i]

Mutations in the BRCA1/2 genes increase the risk of breast and ovarian cancer, leading to complex medical decisions (surveillance, risk-reducing surgery) and major psychological consequences. A support group for BRCA1/2 mutation carriers has been conducted at the CHUV since 2016 by a psychologist-psychotherapist, a genetic counselor, and a geneticist. This article presents the context and then develops some of the psychological issues raised by the participants, focusing in particular on the notions of risk, uncertainty, and guilt. The processes at work in the group, between identification and differentiation, allow for a valuable work of appropriation and subjectivation around the presence of this genetic mutation.

Oncologie : ce qui a changé en 2025

Among the many oncology breakthroughs, this article focuses on three significant advances that are particularly relevant to Switzerland: endometrial cancer, which is now better defined by molecular biomarkers, oncogeriatrics, which has become a standard in light of an aging population, and pancreatic cancer, for which solutions have long been lacking, but where early detection tools and new targeted therapies are finally emerging. These are three modern, concrete, and hopeful topics.

Autoprélèvement HPV et dépistage du cancer du col utérin

Carcinogenic human papillomavirus (HPV) infections cause the majority of cervical cancers (CC). While vaccination represents primary prevention, screening remains essential. HPV testing, more sensitive than cytology, is recommended as the primary method in some European countries. Among women aged ≥ 30 years, HPV selfsampling improves access to screening and can increase coverage of underscreened populations by up to 2.5-fold; several countries have adopted this approach. In Switzerland, where screening is opportunistic and only cytology is reimbursed, 30 % of women remain under-or unscreened. Introducing HPV self-sampling for underscreened women could contribute to the goals set by the World Health Organization. This review provides an overview of the situation in Switzerland and Europe regarding CC screening.

Traitements intrapéritonéaux de la carcinose ovarienne : proposition d’algorithmes décisionnels

Ovarian cancer is the first cause of death by gynecological cancer. Most of the patients are diagnosed with peritoneal carcinomatosis that represents a therapeutic challenge. Its management implies maximal cytoreductive surgery with survival benefit. Over the last three decades, several strategies of intra-peritoneal chemotherapy have been investigated. This includes intra-peritoneal adjuvant chemotherapy that is used mainly in North America, hyperthermic intraperitoneal chemotherapy (HIPEC) and more recently pressurized intraperitoneal aerosol chemotherapy (PIPAC). In the current article, we review the evidence in favor of each therapeutic approach, and we propose treatment algorithms depending on the clinical situation of ovarian cancer patients: upfront, platinum-sensitive and platinum-resistant relapse.