How to diagnose uterine cancer in the early stages. How to promptly detect signs of uterine cancer in the early stages

The first place in incidence among gynecological cancers is uterine cancer, or endometrial cancer. In Russia, up to 16 thousand new cases of the disease are detected every year, and the number of cases is constantly increasing.

The pathology mainly affects women after 60 years of age, but can also occur at older ages. at a young age. About 40% of patients become ill before menopause. In the last decade, the incidence rate has increased most rapidly in women under 29 years of age.

The tumor is accompanied by the rapid onset of symptoms that force the woman to see a doctor. This results in up to 90% of uterine cancer cases being diagnosed at an early stage, which significantly improves the prognosis.

Causes and risk factors

For many cancer pathologies, the exact cause of their occurrence is unknown. This also applies to uterine cancer. Pathology is considered a “civilization disease” that arises under the influence of unfavorable external conditions, nutritional characteristics and lifestyle.

Factors predisposing to uterine cancer:

• late first menstruation;
• only after 55 years;
• long;
• and hormonally active tumor of these organs (Brenner's cancer);
• obesity;
• diabetes;
• long-term use of estrogen hormones without combination with gestagens;
• treatment with antiestrogenic drugs (Tamoxifen);
• lack of sexual activity or pregnancy;
• cases of illness in close relatives.

Endometrial cancer of the uterus occurs against the background of a complex of disturbances in hormonal balance, metabolism of fats and carbohydrates.

The main pathogenetic types of the disease:

• hormonal-dependent (in 70% of patients);
• autonomous.

In the first option, ovulation disorders in combination with obesity or diabetes lead to increased production of estrogen. Acting on the inner uterine layer - the endometrium, estrogens cause increased proliferation of its cells and their increase in size and change in properties. Gradually, hyperplasia becomes malignant, developing into precancer and uterine cancer.

Hormone-dependent uterine cancer is often combined with a tumor of the intestine, breast or ovary, as well as with ovarian sclerocystosis (Stein-Leventhal syndrome). This tumor grows slowly. It is sensitive to progestogens and has a relatively favorable course.

Signs that increase the risk of hormone-dependent cancer:

• infertility, late menopause, anovulatory bleeding;
• ovaries and hyperplastic processes in them (thecomatosis);
• obesity;
• improper treatment with estrogen, adrenal adenoma or cirrhosis of the liver, causing hormonal changes.

The autonomous variant often develops in postmenopausal women against the background of ovarian and endometrial atrophy. There is no hormonal dependence. The tumor is characterized by a malignant course, quickly spreading deep into the tissues and through the lymphatic vessels.

There is a genetic theory of cancer, according to which cell mutations are programmed into DNA.

Main stages of formation malignant tumor uterus:

• lack of ovulation and increased estrogen levels under the influence of provoking factors;
• development of background processes - polyps and endometrial hyperplasia;
• precancerous disorders - atypia with hyperplasia of epithelial cells;
• preinvasive cancer that does not penetrate beyond the mucous membrane;
• minimal penetration into the myometrium;
• pronounced form.

Classification

Cancer of the uterine body is classified depending on the size of the tumor, its penetration into muscle layer, proliferation in surrounding organs, damage to lymph nodes and the presence of distant metastases. Both the TNM staging system and the International Federation of Obstetricians and Gynecologists (FIGO) staging are used.

A tumor that does not extend beyond the endometrium is called preinvasive. It is designated as carcinoma in situ, Tis, or stage 0.

There are 4 stages of uterine cancer

1. The tumor affects only the body of the uterus:

• endometrium (T1a or IA);
• myometrium to half depth (T1b or IB);
• more than half the depth of the myometrium (T1c or IC).

2. Malignant cells are found in the cervix:

• only in the glandular layer (T2a or IIA);
• the tumor penetrates into the deep layers of the cervix (T2b or IIB).

3. The tumor spreads to the vagina, appendages or lymph nodes:

• damage to the outer serous layer of the uterus and/or appendages (T3a or IIIA);
• spread to the vagina (T3b or IIIB);
• there are metastases to the pelvic or peri-aortic lymph nodes (N1 or IIIC).

4. Stage 4 uterine cancer with metastases:

• into the bladder or rectum (T4 or IVA);
• to the lungs, liver, bones, distant lymph nodes (M1 or IVB).

In addition, different degrees of differentiation of tumor cells are distinguished: from G1 (high degree of cell maturity) to 3 (poorly differentiated tumor). The more pronounced the differentiation, the slower the tumor grows and the less likely it is to metastasize. With poorly differentiated cancer, the prognosis worsens.

Depending on the microscopic structure, the following morphological types of cancer are distinguished:

• adenocarcinoma;
• light cell;
• squamous;
• glandular squamous;
• serous;
• mucinous;
• undifferentiated.

The morphological type largely determines malignancy. Thus, the course of undifferentiated cancer is unfavorable, but with a squamous cell tumor the probability of recovery is quite high.

The neoplasm can grow exophytically (into the lumen of the uterus), endophytically (into the thickness of the muscle wall) or have a mixed nature.

Cancer is localized in the area of ​​the fundus and body of the uterus; tumors are found less frequently in its lower segment.

Symptoms

Often a patient consults a doctor when she experiences the first signs of uterine cancer. early stages. First of all, this is irregular bleeding in young women that does not coincide with the menstrual cycle. Postmenopausal women experience uterine bleeding. Young patients develop light leucorrhoea.

Bleeding occurs not only with endometrial cancer, but also with many other diseases. There are difficulties associated with this early diagnosis illness, especially in young women. They can be observed for a long time about.

Other symptoms of uterine cancer appear in later stages. When blood accumulates in the organ cavity, pain appears in the lower abdomen. Long-term pain syndrome occurs when the tumor grows on the appendages and spreads throughout the peritoneum.

Copious watery or mucous discharge due to uterine cancer is typical for older women.

If the bladder is damaged, frequent painful urination may occur. If the rectum is involved, constipation, pain during bowel movements, and blood in the stool appear.

General signs of cancer pathology are weakness, deterioration in performance, nausea, lack of appetite, weight loss.

How quickly does uterine cancer develop?

With a high degree of differentiation, the tumor grows slowly over several years. Poorly differentiated forms have high speed proliferation of malignant cells. In this case, a clinically significant tumor can develop within several months.

Metastasis

The spread of cancer cells is possible through the lymphatic tract, blood vessels and peritoneum.

Lymphogenic metastasis occurs in the nearest (regional) pelvic lymph nodes. At an early stage and high differentiation (G1-G2), the probability of lymph node involvement does not exceed 1%. If cancer cells invade the myometrium, the risk of metastasis increases to 6%. If the tumor affects a large area, penetrates deep into the uterine wall or spreads to the cervix, metastases in the lymph nodes are found in 25% of patients.

Hematogenous metastasis occurs later. Tumor cells travel through blood vessels to the lungs, bones and liver.

Implantation metastases occur on the peritoneum and omentum when the outer layer of the uterus grows and the fallopian tubes are damaged.

Diagnostics

Screening studies for early detection of formation are not carried out. It is believed that for timely recognition you only need to be observed annually by a gynecologist.

Testing for tumor markers, the most common of which is CA-125, is not usually performed. It is considered an additional method for assessing the effectiveness of treatment and early detection of relapses.

The simplest diagnostic method is aspiration of the contents of the uterus with a special syringe and histological examination (). At an early stage, the information content of this method does not exceed 36%; with a widespread tumor, its signs can be detected in 90% of patients. To increase the accuracy of the study, it can be carried out repeatedly. Aspiration biopsy does not require dilatation cervical canal and is performed on an outpatient basis.

Instrumental diagnosis of uterine cancer:

• : The thickness of the endometrium in postmenopausal women should not exceed 4 mm.
• with a biopsy of a suspicious area of ​​the endometrium and its microscopic examination.

To determine the extent of the tumor and damage to the lymph nodes, it is carried out. Unlike ultrasound, the method helps to clarify the condition of the lymph nodes in 82% of patients.

An X-ray of the lungs is required to exclude metastases in them.

Is uterine cancer visible on ultrasound?

The doctor should be alerted to ultrasound data of the uterus if an increase in M-echo (endometrial thickness) of more than 4 mm in elderly women or 10-16 mm in patients before menopause is recorded.

If the M-echo value is more than 12 mm in young women, aspiration biopsy is prescribed. If this value is 5-12 mm, hysteroscopy and targeted biopsy are performed (taking material from a suspicious area).

If a tumor is detected on ultrasound, you can determine:

• size and contours of the uterus;
• myometrial structure;
• tumor location;
• depth of germination into the myometrium;
• damage to the internal pharynx, ovaries and lymph nodes.

Additional information is provided by color Doppler mapping - ultrasound examination of blood vessels, which allows one to assess the speed and intensity of blood flow in the vessels of the uterus and the tumor focus.

Hysteroscopy is the most important diagnostic method, allowing one to assess the severity and extent of the tumor and take material for histological analysis.

If uterine cancer is suspected, it is necessary to perform the walls of the cervical canal and endometrium.

How to detect uterine cancer with minimal lesion size?

Modern method detection of early stages of endometrial cancer - fluorescent diagnostics. Special substances are introduced into the body that selectively accumulate in cancer cells. When the inner surface of the uterus is irradiated with a laser, these substances begin to glow. This allows you to see tumor foci up to 1 mm and take a targeted biopsy. At an early stage, the sensitivity of such diagnostics reaches 80%.

The diagnosis is finally confirmed by uterine curettage. If the tumor is located in the upper part of the organ, it is recognized in 78% of cases, and with widespread lesions - in 100% of cases.

Uterine cancer must be differentiated from the following diseases:

• endometrial hyperplasia;

Treatment

If a woman is diagnosed with a malignant tumor of the reproductive system, the patient should be observed by a gynecological oncologist.

Treatment of uterine cancer is based on various combinations of three methods:

1. Operation.
2. Irradiation.
3. Drug therapy.

The main method of treatment performed at any stage of the disease is removal of the uterus and appendages. If there is a poorly differentiated tumor or it penetrates deeply into the muscular layer of the organ, the pelvic lymph nodes, which may contain metastases, are additionally removed.

The operation is performed in 90% of women with an early stage of the disease. For others, it is contraindicated due to severe concomitant diseases. Development of new methods surgical intervention allows you to expand the possibilities of surgical treatment.

If the tumor does not penetrate deeper than 3 mm, it can be removed by ablation (“cauterization”) during hysteroscopy. This way you can save the organ. However, the probability is not complete removal the lesion is quite high, therefore, after such treatment, regular monitoring by an oncologist in a specialized institution is necessary.

Radiation therapy for uterine cancer independent method Treatment is rarely used, only when it is impossible to remove the organ. Most often, radiation is given after surgery (adjuvant radiotherapy) to destroy any remaining cancer cells.

This combination is shown in following cases:

• deep germination of the neoplasm into the myometrium;
• spread to the cervical canal and cervix;
• metastases to lymph nodes;
• poorly differentiated or non-endometrioid tumor.

Modern treatment methods: radiotherapy – IMRT and brachytherapy. The IMRT method involves targeted irradiation of the tumor with minimal damage to surrounding tissue. Brachytherapy is the introduction of special radioactive substances into the tumor site that act directly on cancer cells.

For endometrial precancer in young women, hormonal therapy with progestins is possible. These hormones block the activating effect of estrogen on the tumor, preventing its further growth. Hormones are used for advanced (disseminated) cancer, as well as for its recurrence. Their efficiency does not exceed 25%.

At an early stage, taking hormones according to a certain scheme lasts about a year. The effectiveness of therapy is monitored using a biopsy. If the result is favorable, the normal menstrual cycle is restored over the next 6 months. Subsequently, a normal pregnancy is possible.

Chemotherapy is prescribed for poorly differentiated uterine cancer and non-endometrioid tumors, disseminated and recurrent cancer, if the tumor does not respond to the influence of gestagens. It is palliative in nature, that is, aimed at reducing severe symptoms caused by a tumor, but does not cure the disease. Drugs from the groups of anthracyclines, taxanes, and platinum derivatives are used. Postoperative (adjuvant) chemotherapy is not prescribed.

At home, a woman needs to rest more. Those around her must protect her from emotional stress. Nutrition for uterine cancer is complete and varied, excluding refined carbohydrates (sugar), limiting animal fats, fried and canned foods, spices, chocolate and other irritating foods. Dairy products and plant foods are very useful.

It is believed that some plants help cope with the tumor or improve the patient’s well-being:

• green tea;
• turmeric;
• beet;
• tomatoes;

Treatment tactics depending on stage

The question of how to cure uterine cancer is decided by the doctor after a thorough analysis of all the diagnostic information received. This largely depends on the stage of the tumor.

For stage 1 cancer, complete removal of the uterus and appendages is used (total hysterectomy and).

This operation is carried out if all of the following conditions are met:

• moderate and high tumor differentiation;
• the formation occupies less than half of the organ cavity;
• the depth of myometrial growth is less than 50%;
• there are no signs of tumor spread throughout the peritoneum (no cancer cells were found in peritoneal washings).

If the depth of penetration into the muscle layer is more than half its thickness, intravaginal radiation therapy is prescribed after surgery.

In all other cases, removal of the genital organs is complemented by excision of the pelvic and, in some cases, para-aortic lymph nodes. Nodes located near the aorta are punctured during surgery and an urgent histological examination is performed. Based on its results, a decision is made to remove these formations.

After surgery, radiation is used. If surgery is not possible, only radiation therapy is used, but the effectiveness of such treatment is lower.

Hormonal therapy is not used at stage 1.

For stage 2 cancer, patients are advised to remove the uterus, appendages, pelvic (sometimes para-aortic) lymph nodes and postoperative radiation therapy. Irradiation is carried out according to a combined scheme: intravaginally and remotely.

For stage 3 cancer, combined surgical and radiation treatment is performed. If the tumor has grown into the walls of the pelvis, its complete removal is impossible. In this case, radiation therapy is prescribed through the vagina and remotely.

If radiotherapy and surgery are contraindicated, treatment depends on the hormonal sensitivity of the tumor: either progestins or chemotherapy are prescribed.

For stage 4 tumors, palliative chemotherapy in combination with hormones is used. These substances help destroy distant metastases of cancer in other organs.

Recurrence of the tumor is also treated with the use of hormones and chemotherapy. For recurrent lesions located in the pelvis, palliative radiotherapy is performed. Relapses most often occur during the first 3 years after treatment. They are localized mainly in the vagina, lymph nodes and distant organs.

Uterine cancer and pregnancy

During pregnancy, pathological changes are almost impossible to recognize. Tumor growth during pregnancy is most often not observed. However, uterine cancer during pregnancy can be accompanied by miscarriage, placental abruption, fetal death and severe bleeding. In these cases, emergency delivery is performed followed by hysterectomy.

If a young woman has completed the full course of treatment with good results, she may become pregnant in the future. To restore fertility, doctors prescribe courses hormone therapy, restoring normal reproductive function.

How long do they live with uterine cancer?

This depends on the stage of detection of the disease and sensitivity to hormones. With the hormone-dependent variant, 85-90% of patients live for 5 years or more. In the autonomous form in elderly women, this figure is 60-70%. However, in the 3rd stage of any form, life expectancy of more than 5 years is recorded in a third of patients, and in the 4th stage - only in 5% of cases.

How quickly does cervical cancer develop? For each woman with this diagnosis, the disease develops differently, so at the first ailment it is necessary to seek help from a specialist.

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How quickly do different types of cervical cancer develop?

How long cervical cancer will develop depends on many factors, including the environment, lifestyle, and nutrition.

Cervical cancer

This disease is not a rapidly developing disease. The whole process can take 10 or even 20 years. However, there are cases of rapid growth tumor cells. Therefore, you should not delay with this; the first signs should be a reason to contact a specialist. Using special equipment, it is possible to diagnose a precancerous condition, which is much easier to cure.

Note! If treatment is not started in time, then it is likely that after 10 years the tumor will enter an advanced and more dangerous stage, which can no longer be treated.

According to statistics, 0.3% of women have an advanced stage of malignant neoplasm. This means that metastases have begun to penetrate other organs and tissues, thus disrupting their functioning.

Squamous cell carcinoma

Despite the fact that this form of tumor is asymptomatic, it can be diagnosed during a routine examination by a gynecologist. Over time, the cancer tumor begins to grow, and then the first symptoms appear. Squamous cell carcinoma is a tumor in which immature cells are formed, and they multiply very quickly, so the course of the disease from the first to the last stage occurs rapidly.

Adenocarcinoma

This type of tumor is hormone dependent and is most common in menopausal women. The neoplasm is aggressive in nature and begins to metastasize to other organs, lymph nodes and blood. After this, the development of the disease is rapid.

Exophytic cancer

A malignant tumor of this form is noticeable already in the first stages. Pathology occurs with visible symptoms, these are seals and growths on the neck.

Endophytic cancer

This type of malignant neoplasm is already in an advanced stage. The whole process takes place in the uterus itself, so diagnosis will require special equipment.

A malignant tumor has the ability to grow quickly and extend beyond the uterus itself. It metastasizes into human organs and tissues, and is also transported in the blood throughout the body. In this case, the lymph nodes are affected.

How quickly does cervical cancer develop by stage?

To begin with, we can distinguish the zero stage, or precancerous condition. Having noticed it at the first stage, there is a 100% guarantee of its complete removal from the body. IN in this case cancer will develop with little change in the epithelium. This process happens slowly.

First stage

Cancer cells begin to grow and a tumor forms. The neoplasm does not affect nearby organs and tissues. Metastases may spread to the cervical canal.

Second stage

The tumor is significant in size and, in the absence of proper treatment, begins to grow beyond the uterus. The pelvis and vagina are affected.

Third stage

The tumor grows more and more, they affect the ureters and metastasize to the lymph nodes. Metastases also grow in the pelvic area and other nearby organs. The tumor also affects the walls of the vagina.

Fourth stage

This is a severe form of malignant tumor, in which metastases penetrate the bladder and rectum. At this stage of development of the tumor, metastases can affect the lungs, liver, kidneys and bones. How long it takes for stage 4 cervical cancer to develop will depend on the body. To a greater extent, the progression of the disease occurs very quickly, and the lymph nodes are also affected.

How quickly does cervical cancer develop from a precancerous condition?

How long will it develop? cancer, depends on a number of factors, including the histology of the neoplasm, existing pathologies, body resistance, etc.

The onset of a malignant tumor is preceded by dysplasia, when epithelial cells are modified and block the work of healthy cells. Most often this happens in the transition zone, i.e. in the place where the cervix and the cervical canal meet.

It is quite difficult to say exactly how quickly uterine cancer develops in the body. Therefore, it is worth undergoing an annual examination by a specialist. If cancer cells are not removed in time, then within 2 years, or even less, a malignant tumor will appear, which will become increasingly difficult to cure.

The progression of cervical cancer may take 2 years and during this time go through all 4 stages, or may not show signs for 10 years. However, you should not rely on universal statistics; in each case, the entire process of development of a neoplasm occurs differently. There are cases when dysplasia did not move further and went away on its own over time. It is best to contact a specialist and be observed by him, especially if there are predisposing factors for the development of cancerous tumor. On average, the minimum time for transition from stage to stage is 2 years.

How long it takes for cervical cancer to develop largely depends on the woman herself. Lifestyle, proper nutrition and regular monitoring by a specialist play a role here. If any discomfort occurs, you should consult a gynecologist who will conduct an examination and identify its cause. After all, the process of formation of cancer cells can be rapid, and late stages he is incurable. Therefore, it is very important to monitor your health.

Uterine cancer is a malignant neoplasm of endometrial cells, i.e., the tissues lining the organ. It is considered one of the most common forms of oncology. It is more often diagnosed in women over 60 years of age, and occurs in isolated cases at a young age.

It is considered the main cause of carcinogenesis. Predisposing factors include high body weight, body irradiation, hypertonic disease and ovarian pathologies.

Cancer of the uterine body has specific clinical manifestations, including uterine bleeding, which has nothing to do with menstruation, pronounced bleeding and discharge of leucorrhoea.

There are no problems establishing the correct diagnosis due to the characteristic symptoms of uterine cancer and the results of instrumental examinations. Not the last place in diagnosis is occupied by gynecological examination and laboratory tests.

Treatment is based on surgery, but must have a comprehensive approach. Additional therapeutic measures Consider chemotherapy and hormone replacement treatment.

According to the International Classification of Diseases, Tenth Revision, the disease has an individual code: the ICD-10 code will be C54.

Etiology

To date, the pathogenesis of cancer of the reproductive system remains unknown, however, experts in the field of gynecology and oncology believe that the most common cause of cancer development is hormonal imbalance.

Cancer of the uterine body can occur under the influence of such unfavorable factors:

• late attack;
• leakage;
• immunodeficiency states, in particular and;
• malignant;
• early onset of first menstruation;
• disorderly sex life;
• or other endocrinological pathologies;
• long-term use of hormonal substances;
• excessively high body weight;
• infertility;
• complete lack of sexual activity;
• period of bearing the first child;
• early labor;
• repeated termination of pregnancy;
• the woman has a precancerous condition - endometrial hyperplasia or uterine polyps;
• long-term irradiation of the pelvic organs.

The main risk group is women over 60 years of age and with a family history. This means that one of the close relatives must be diagnosed with cancer in the following organs:

• ovaries;
• mammary gland;
• colon;
• Cervix.

Classification

Clinicians identify two common types of cancer of the uterus:

1. Hormone dependent. Diagnosed in approximately 70% of situations and develops against the background active stimulation cavity tissues with female hormones (estrogens).
2. Autonomous cancer of the uterine body. Accounts for less than 30% of cases. Distinctive feature the fact that the tumor is found in elderly women who do not suffer from metabolic disorders, but have a history of uterine bleeding in the postmenopausal period and low body weight.

As the pathology progresses, it goes through several stages of development:

• functional disorders;
• morphological background changes;
• morphological precancerous transformations;
• malignant neoplasia.

Metastasis occurs in several ways:

• lymphogenous - para-aortic, inguinal and iliac lymph nodes are at risk;
• hematogenous - cancer cells are found in the lungs, liver and skeletal system;
• implantation - is realized when the tumor grows into the myometrium and perimeter or as a result of involvement of the greater omentum and visceral peritoneum in the pathoprocess.

The main classification is represented by the existence of several degrees of severity of the oncological process:

• 0 degree uterine cancer - considered a precancerous condition;
• 1st degree uterine cancer - the neoplasm does not spread beyond the organ, but grows into the endometrium; signs may be completely absent or resemble other gynecological disorders;
• uterine cancer stage 2 - the cancer process involves the cervix, endocervix and cervical stroma;
• uterine cancer stage 3 - characterized by the presence of local and regional metastases (the ovary, serous membrane, vagina and lymph nodes undergo metastasis);
• uterine cancer stage 4 - there is damage to the large intestine, bladder, distant internal organs and lymph nodes.

How long patients live after complex therapy depends on the stage at which the tumor is diagnosed.

Cancer can differ in microscopic structure, against which the tumor can be of the following types:

• clear cell carcinoma;
• squamous cell carcinoma;
• glandular squamous cell carcinoma;
• serous cancer;
• mucinous cancer.

The oncological process happens:

• highly differentiated;
• moderately differentiated;
• poorly differentiated;
• undifferentiated.

Morphological types largely determine the degree of malignancy and prognosis. For example, undifferentiated cancer has the most unfavorable course, while squamous cell tumors are easy to treat and have a high probability of recovery.

Cancer growth in the uterus has several growth options:

• exophytic - germination into the lumen of the organ;
• endophytic - the tumor grows into the thickness of the muscle wall;
• mixed.

Symptoms

Uterine cancer can be completely asymptomatic for a long time. The following are the first signs of uterine cancer in the early stages:

• heavy menstruation;
• mild pain in the lower abdomen;
• inability to conceive a child for a long time;
• menstrual irregularities - periods become irregular and acyclic.

During the postmenopausal period, symptoms of uterine cancer in women will be quite specific - scanty or heavy uterine bleeding.

Signs of late stage uterine cancer:

• increased pain in the lower part of the anterior wall of the abdominal cavity;
• spread of pain to the sacrum and lumbar region;
• copious discharge leucorrhoea having a foul odor;
• intestinal disorder;
• the presence of pathological impurities in the stool - blood and mucus;
• frequent and painful urge to urinate;
• a sharp decline body weight, despite normal or increased appetite;
• an increase in the size of the abdomen due to the accumulation of a large amount of fluid in the abdominal cavity;
• attacks of nausea and vomiting;
• pain and discomfort during sexual intercourse.

When the lesion is complicated by the spread of metastases, clinical picture will be supplemented by signs of damage to one or another internal organ. For example, if the skeletal system is involved in the oncological process, the symptoms of endometrial cancer of the uterus will be supplemented by frequent fractures.

Diagnostics

If symptoms of uterine cancer occur, it is necessary to seek qualified help from a gynecologist as soon as possible, who will prescribe instrumental and laboratory diagnostic measures. The doctor must carry out primary diagnostic procedures:

• studying the medical history of not only the patient, but also her close relatives - to search for a provocateur or confirm the fact of influence genetic predisposition;
• familiarization with life history - to identify a provocateur that has nothing to do with other diseases;
• manual and instrumental gynecological examination;
• deep palpation of the anterior wall of the abdominal cavity;
• a detailed survey - to identify the severity of symptoms, which will indicate the type and stage of cancer.

The most informative laboratory tests:

• blood chemistry;
• general analysis urine and blood;
• samples to determine cancer markers;
• hormonal tests;
• microscopic examination of feces;
• vaginal smear culture.

The following instrumental procedures can accurately confirm the diagnosis of uterine cancer:

• hysteroscopy;
• X-ray of the sternum;
• Ultrasound of the pelvic organs and peritoneum;
• colonoscopy;
• cystoscopy;
• CT and MRI;
• excretory urography;
• diagnostic laparoscopy.

The first signs and symptoms of uterine cancer may resemble the development of other pathologies. During differential diagnosis Oncology must be distinguished from the following diseases:

Often women are interested in the question of whether uterine fibroids can develop into cancer. Myoma is usually not dangerous and does not become malignant. However, cancerous degeneration is possible under the influence of unfavorable factors - poor lifestyle, irregular sexual contacts and peritoneal injuries.

Treatment

The choice of treatment tactics is influenced by several factors:

• stage of the oncological process;
• the severity of symptoms and signs of uterine cancer;
• morphological structure of the pathological focus.

Treatment for uterine cancer will be complex:

• surgery;
• radiation therapy;
• oral administration of hormonal substances;
• chemotherapy.

If stage 1 uterine cancer is diagnosed, a procedure such as endometrial ablation is usually used. In other cases, the operation may have the following options:

• panhysterectomy;
• excision of the uterus followed by bilateral adnexectomy or lymphadenectomy;
• bougienage of the cervical canal.

Prevention and prognosis

To prevent women from developing cancer of the reproductive system, it is necessary to adhere to the following general preventive measures:

• complete renunciation of addictions;
• engaging in protected sex only;
• correct and balanced diet;
• proper application medicinal substances;
• body weight indicators are within normal limits;
• prevention of body exposure;
• timely detection and treatment of gynecological and endocrine pathologies which can cause the development of cancer;
• visit a gynecologist at least 4 times a year - to detect the first signs of uterine cancer as early as possible.

Cancer of the uterine body has an ambiguous prognosis, which depends on the stage of progression of the tumor at which the diagnosis was made and treatment began. If stage 1 uterine cancer is diagnosed, the five-year survival rate is 98%, stage 2 is approximately 70%, stage 3 is on average 30%, and stage 4 is only 5%.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

Uterine cancer is a malignant neoplasm that develops from the endometrium (cylindrical epithelium that covers the internal cavity of the reproductive organ).

In recent decades, there has been a steady increase in the incidence of cancer pathologies of the female genital area throughout the world, including such common ones as uterine cancer.

Among malignant neoplasms in women, this pathology ranks second, second only to breast cancer. According to statistics, today about 2-3% of women develop endometrial cancer during their lifetime.

Cancer of the uterine body can develop at any age, but it mainly affects women over 45 years of age ( average age patients who first consulted a doctor about symptoms of endometrial cancer – 60 years old).

To understand the causes and mechanisms of development of uterine cancer, consider the anatomy and physiology of the female reproductive organ.

Anatomy and physiology of the uterus

The uterus is an unpaired organ of the female reproductive system, responsible for bearing and giving birth to a child.

In front of the uterus, located deep in the pelvis, is the bladder, and behind is the rectum. This proximity causes the occurrence of urination and defecation disorders in the presence of pronounced pathological processes in the uterus.

The normal dimensions of the non-pregnant uterus are relatively small (length about 8 cm, width 4 cm and thickness up to 3 cm). The reproductive organ is pear-shaped; its structure consists of a fundus, a body and a neck.

From above, in the area of ​​the expanded fundus of the uterus, the fallopian tubes flow into the right and left, through which the egg enters the organ cavity from the ovary (as a rule, the process of fertilization occurs in the fallopian tube).
Downwards, the body of the uterus narrows and passes into a narrow canal - the cervix.

The uterus is pear-shaped and consists of three layers, such as:

• endometrium (inner epithelial layer);
• myometrium (the muscular lining of the uterus, the contractions of which ensure the birth of a child);
• parametrium (superficial shell).

In women of the reproductive period, the endometrium undergoes cyclic transformations, externally manifested by regular menstruation. Constant renewal of the superficial functional layer is ensured by the inner basal layer of the endometrium, which is not rejected during menstrual bleeding.

Growth, blossoming and rejection of the functional layer of the endometrium are associated with cyclic changes in the level female hormones in the blood, which are secreted by the female sex glands - the ovaries.

The production of hormones is controlled by a complex neuro-endocrine regulatory system, so any nervous or endocrine disorders in the female body have a detrimental effect on the functioning of the endometrium and can cause serious diseases, including uterine cancer.

What factors increase the risk of developing uterine cancer?

Factors that increase the risk of developing uterine cancer include:

• unfavorable heredity (presence of endometrial cancer, ovarian cancer, breast or colon cancer in close relatives);
• late menopause;
• no history of pregnancy;
• ovarian tumors that produce estrogen;
• treatment of breast cancer with tamoxifen;
• long-term oral contraception using dimethisterone;
• replacement therapy estrogens;
• irradiation of the pelvic organs.

Causes and mechanisms of development of uterine cancer

There are two most common types of uterine cancer: hormone-dependent and autonomous. It has been proven that genetic predisposition plays a significant role in the development of both variants.

Hormone-dependent endometrial cancer– the most common form of the disease (about 70% of all cases of diagnosed pathology), which develops due to increased stimulation of the epithelium of the uterine cavity by female sex hormones - estrogens.

An increased content of estrogen is often observed in metabolic and neuroendocrine disorders, therefore, risk factors for the development of hormone-dependent endometrial cancer include diabetes mellitus, obesity and hypertension (the combination of these pathologies is especially dangerous).

Clinically, hyperestrogenism is manifested by the following symptoms:

• menstrual irregularities with uterine bleeding;
• hyperplastic processes in the ovaries (follicular cysts, stromal hyperplasia, etc.);
• infertility;
• late onset of menopause.

It should be noted that estrogen levels may also increase with serious illnesses liver, when the metabolism of sex hormones is disrupted (chronic hepatitis, cirrhosis of the liver).

In addition, significant hyperestrogenism is observed with hormone-producing ovarian tumors, hyperplasia or adenoma of the adrenal cortex, as well as with the artificial introduction of estrogens into the body (treatment of malignant breast tumors with tamoxifen, estrogen replacement therapy in postmenopause, etc.).

As a rule, hormone-dependent malignant endometrial tumors are highly differentiated and therefore characterized by slow growth and a relatively low tendency to metastasize. Primary multiple development of malignant tumors (in the ovaries, in the mammary gland, in the rectum) often occurs.
The development of hormone-dependent endometrial cancer can be divided into several stages:

• functional disorders associated with hyperestrogenism (menstrual irregularities, uterine bleeding);
• benign hyperplasia (growth) of the endometrium;
• precancerous conditions (atypical hyperplasia with stage III epithelial dysplasia);
• development of a malignant tumor.

Autonomous endometrial cancer occurs in less than 30% of cases. This pathogenetic variant develops in patients who do not suffer from metabolic disorders. The risk group consists of elderly women with reduced body weight who have a history of uterine bleeding during the postmenopausal period.

The mechanisms of development of autonomous endometrial cancer are still not fully understood. Today, many experts associate the occurrence of pathology with deep violations in the immune field.

Autonomous cancer of the uterine body is often represented by poorly differentiated and undifferentiated tumors. Therefore, the course of this pathogenetic variant is less favorable: such tumors are characterized by more rapid growth and give metastases earlier.

How is the stage of uterine cancer determined?

In accordance with classification of the International Federation of Obstetricians and Gynecologists (FIGO) There are four stages of development of uterine cancer.

Stage zero (0) is considered to be atypical endometrial hyperplasia, which, as has already been proven, will inevitably lead to the development of a malignant tumor.

The first stage (IA-C) is said to occur when the tumor is limited to the body of the uterus. In such cases there are:

• Stage IA – the tumor does not grow deep into the myometrium, being limited to the epithelial layer;
• Stage IV – the tumor penetrates the muscular layer of the uterus, but does not reach the middle of its thickness;
• Stage ІС – carcinoma grows through half of the muscular layer or more, but does not reach the serous membrane.

At the second stage, endometrial cancer grows into the cervix, but does not spread beyond the organ. In this case they share:

• Stage ІІА, when only the glands of the cervix are involved in the process;
• Stage II, when the stroma of the cervix is ​​affected.

The third stage of the disease is diagnosed in cases where the tumor extends beyond the organ, but does not grow into the rectum and bladder and remains within the pelvis. In such cases there are:

• Stage III, when carcinoma grows into the outer serosa of the uterus and/or affects the uterine appendages;
• Stage III, when there are metastases in the vagina;
• Stage III, when metastases have occurred in nearby lymph nodes.

At the fourth stage of development, the tumor grows into the bladder or rectum (IVA). The last stage of development of the disease is also spoken of in cases where distant metastases have already occurred outside the pelvis (internal organs, inguinal lymph nodes, etc.) - this is already stage IVB.

In addition, there is still a generally accepted International system TNM classification, which allows you to simultaneously reflect in the diagnosis the value primary tumor(T), tumor involvement of lymph nodes (N) and the presence of distant metastases (M).

The size of the primary tumor can be characterized by the following indicators:

• T is - corresponds to the zero stage of FIGO;
• T 0 – the tumor is not detected (completely removed during the diagnostic study);
• T 1a – carcinoma is limited to the body of the uterus, with the uterine cavity not exceeding 8 cm in length;
• T 1b – carcinoma is limited to the body of the uterus, but the uterine cavity exceeds 8 cm in length;
• T 2 – the tumor spreads to the cervix, but does not extend beyond the organ;
• T 3 – the tumor extends beyond the organ, but does not grow into the bladder or rectum and remains within the pelvis;
• T 4 – the tumor grows into the rectum or bladder and/or extends beyond the pelvis.

Tumor involvement of lymph nodes (N) and the presence of distant metastases (M) are determined by the indices:

• M 0 (N 0) – no signs of metastases (damage to lymph nodes);
• M 1 (N 1) – metastases were detected (affected lymph nodes were detected);
• M x (N x) – there is not enough data to judge metastases (tumor damage to the lymph nodes).

So, for example, diagnosis T 1a

N 0 M 0 - means that we are talking about a tumor limited to the body of the uterus, the uterine cavity does not exceed 8 cm in length, the lymph nodes are not affected, there are no distant metastases (stage I according to FIGO).

In addition to the above classifications, the G index is often given, characterizing the degree of tumor differentiation:

• G 1 – high degree of differentiation;
• G 2 – moderate degree of differentiation;
• G 3 – low degree of differentiation.

The higher the degree of differentiation, the better the prognosis. Poorly differentiated tumors are characterized by rapid growth and an increased tendency to metastasize. Such carcinomas are usually diagnosed at later stages of development.

How does uterine cancer metastasize?

Cancer of the uterine body spreads lymphogenously (through lymphatic vessels), hematogenously (through blood vessels) and implantation (in the abdominal cavity).

As a rule, metastases of uterine cancer appear in the lymph nodes first. The fact is that lymph nodes are a kind of filters through which interstitial fluid passes.

Thus, the lymph nodes act as a barrier to tumor spread. However, if the “filter” is significantly contaminated, the tumor cells settled in the lymph nodes begin to multiply, forming metastases.
In the future, it is possible for malignant cells to spread from the affected lymph node to more distant areas of the lymphatic system ( inguinal lymph nodes, lymph nodes near the aorta, etc.).

Cancer of the uterine body begins to spread hematogenously, when the tumor grows into the blood vessels of the organ. In such cases, individual malignant cells are transported through the bloodstream to distant organs and tissues.

Most often, hematogenous metastases in uterine cancer are found in the lungs (more than 25% of all types of metastases), ovaries (7.5%) and bone tissue (4%). Less commonly, foci of malignant tumors are found in the liver, kidneys and brain.

The uterine cavity communicates with the abdominal cavity through the fallopian tubes, so the appearance of implantation metastases is possible even before the primary tumor invades the serous membrane of the uterus. The detection of malignant cells in the abdominal cavity is an unfavorable prognostic sign.

What factors influence the ability of uterine cancer to metastasize?

The risk of metastases depends not only on the stage of development of the disease, but also on the following factors:

• localization of the tumor in the uterine cavity (the risk of developing metastases ranges from 2% when localized in the upper-posterior part of the uterus to 20% when localized in the infero-posterior part);
• age of the patient (in patients under 30 years of age, metastases practically do not occur; at the age of 40-50 years, the probability of developing metastases is about 6%, and in women over 70 years old - 15.4%);
• pathogenetic variant of uterine cancer (with a hormone-dependent tumor - less than 9%, with an autonomous tumor - more than 13%);
• degree of differentiation of a malignant tumor (for highly differentiated tumors - about 4%, for poorly differentiated tumors - up to 26%).

What are the symptoms of uterine cancer?

The main symptoms of body cancer are uterine bleeding, leucorrhoea and pain. It should be noted that in 8% of cases, the early stages of development of a malignant tumor are completely asymptomatic.

The clinical picture of uterine cancer differs between women of reproductive and non-reproductive age. The fact is that acyclic bleeding varying degrees severity (scanty, spotting, abundant) occurs in approximately 90% of cases of this pathology.

If the patient has not yet reached menopause, then the initial stages of the pathology can be diagnosed by suspecting the presence of a malignant process due to menstrual irregularities.

However, acyclic uterine bleeding in women of reproductive age is nonspecific and occurs in various diseases (ovarian pathology, disorders of neuroendocrine regulation, etc.), so the correct diagnosis is often made late.

Uterine bleeding.
The appearance of uterine bleeding in postmenopausal women is a classic symptom of uterine cancer, so in such cases, as a rule, the disease can be detected at relatively early stages of development.

Beli
These discharges characterize another characteristic symptom of uterine cancer, which most often appears when the primary tumor is of significant size. In some cases, the discharge may be heavy (leukorrhea). The accumulation of leucorrhoea in the uterine cavity causes nagging pain in the lower abdomen, reminiscent of pain during menstruation.

Purulent discharge
With cervical stenosis, suppuration of leucorrhoea can occur with the formation of pyometra (accumulation of pus in the uterine cavity). In such cases, a characteristic picture develops (bursting pain, increased body temperature with chills, deterioration in the patient’s general condition).

Watery discharge
Abundant watery leucorrhoea is most specific for uterine cancer; however, as clinical experience shows, a malignant tumor can also manifest itself as bloody, bloody-purulent or purulent discharge, which, as a rule, indicates a secondary infection. As the tumor disintegrates, the leucorrhoea takes on the appearance of meat slop and an unpleasant odor. Pain unrelated to bleeding and leukorrhea appears already in the later stages of development of uterine cancer. When a tumor grows into the serous membrane of the genital organ, a pain syndrome of a gnawing nature occurs; in such cases, as a rule, the pain often bothers patients at night.

Pain
Often, pain syndrome appears in a widespread process with multiple infiltrates in the pelvis. If the tumor compresses the ureter, lower back pain appears, and attacks of renal colic may develop.

With a significant size of the primary tumor, pain is combined with disturbances in urination and defecation, such as:

• pain when urinating or defecating;
• frequent painful urge to urinate, which is often of an orderly nature;
• tenesmus (painful urge to defecate, usually not resulting in the release of feces).

What diagnostic procedures are necessary to undergo if uterine cancer is suspected?

Diagnosis of uterine cancer is necessary to draw up an individual treatment plan for the patient and includes:

• establishing a diagnosis of malignant neoplasm;
• determining the exact location of the primary tumor;
• assessment of the stage of disease development (prevalence of the tumor process, the presence of tumor-affected lymph nodes and distant metastases);
• determining the degree of differentiation of tumor tissue;
• study of the general condition of the body (the presence of complications and concomitant diseases that may be contraindications to one or another type of treatment).

Typical complaints
Diagnosis of uterine cancer begins with a traditional survey, during which the nature of the complaints is clarified, the history of the disease is studied, and the presence of risk factors for the development of a malignant endometrial tumor is determined.

Gynecological examination
The doctor then conducts an examination on a gynecological chair using mirrors. Such an examination allows us to exclude the presence of malignant neoplasms of the cervix and vagina, which often have similar symptoms (spotting, leucorrhoea, aching pain lower abdomen).

After conducting a two-manual vaginal-abdominal wall examination, it will be possible to judge the size of the uterus, the condition of the fallopian tubes and ovaries, and the presence of pathological infiltrates (seals) in the pelvis. It should be noted that this examination will not detect pathology in the early stages of the disease.

Aspiration biopsy
The presence of a malignant neoplasm in the uterine cavity can be confirmed using aspiration biopsy, which is performed on an outpatient basis.

In women of reproductive age, manipulation is performed on the 25-26th day of the menstrual cycle, and in postmenopausal women - on any day. Aspiration is performed without dilating the uterine canal. This is a minimally invasive (low-traumatic) and absolutely painless technique.

Using a special tip, a catheter is inserted into the uterine cavity, through which the contents of the uterus are aspirated (sucked in with a syringe) into a Brown syringe.

Unfortunately, the method is not sensitive enough for the early stages of uterine cancer (it detects pathology in only 37% of cases), but with common processes this figure is much higher (more than 90%).

Ultrasound
The leading method in diagnosing uterine cancer today is ultrasonography, which reveals malignant neoplasms in the early stages of development and allows you to determine:

• precise localization of the tumor in the uterine cavity;
• type of tumor growth (exophytic - into the uterine cavity or endophytic - germination into the wall of the organ);
• the depth of tumor growth into the muscular layer of the uterus;
• the spread of the process to the cervix and surrounding tissue;
• defeat by the tumor process of the uterine appendages.

Unfortunately, when ultrasound examination It is not always possible to examine the pelvic lymph nodes, which are targets for early metastasis of uterine cancer.

Therefore, if a common process is suspected, ultrasound data are supplemented with the results computer or magnetic resonance imaging, which allow us to judge with extreme accuracy the condition of the organs and structures of the pelvis.

Hysteroscopy
The list of mandatory tests for suspected uterine cancer includes hysteroscopy with targeted biopsy. Using an endoscope, the doctor examines the inner surface of the uterus and collects tumor tissue for histological examination. The accuracy of such a study reaches 100%, in contrast to other methods of obtaining material to determine tumor differentiation.

In the early stages of the disease, such a new promising method of endoscopic diagnosis as fluorescence study using tumor-tropic photosensitizers or their metabolites (aminolevulinic acid, etc.). This method makes it possible to detect microscopic neoplasms up to 1 mm in size using the preliminary introduction of photosensitizers that accumulate in tumor cells.

Hysteroscopy is usually accompanied by separate gynecological curettage of the uterus. First, the epithelium of the cervical canal is scraped, and then fractional curettage of the uterine cavity is performed. This study allows us to obtain data on the condition of the epithelium various departments the uterine cavity and cervical canal and has a fairly high diagnostic accuracy.

All patients with suspected uterine cancer undergo general examination of the body, to obtain information about contraindications to a particular method of treating a malignant tumor. The examination plan is drawn up individually and depends on the presence of concomitant pathologies.

If distant metastases are suspected, additional research(Ultrasound of the kidneys, x-ray of the chest organs, etc.).

When is surgical treatment of uterine cancer indicated?

The treatment plan for uterine cancer is prescribed individually. Since the majority of patients are elderly women suffering from serious diseases (hypertension, diabetes mellitus, obesity, etc.), the choice of treatment method depends not only on the stage of development of the malignant tumor, but also on the general condition of the body.

The surgical method is the main one in the treatment of uterine cancer in the early stages of development, with the exception of cases of severe concomitant pathology, when such intervention is contraindicated. According to statistics, about 13% of patients suffering from uterine cancer have contraindications to surgery.

The scope and method of surgical intervention for uterine cancer is determined by the following main factors:

• stage of tumor development;
• degree of differentiation of tumor cells;
• patient's age;
• presence of concomitant diseases.

Are organ-conserving surgeries performed for uterine cancer?

Organ-conserving operations for uterine cancer are performed less frequently than, for example, for breast cancer. This is due to the fact that the majority of patients are postmenopausal women.

In young women with atypical endometrial aplasia (FIGO stage zero), endometrial ablation.

In addition, this manipulation may be indicated in selected cases of stage 1A disease (endometrial tumor that does not spread beyond the mucous membrane) and in elderly patients with severe concomitant diseases that prevent a more traumatic intervention.
Endometrial ablation is the total removal of the uterine mucosa along with its basal germinal layer and the adjacent surface of the muscular layer (3-4 mm of myometrium) using controlled thermal, electrical or laser effects.

The removed uterine mucosa is not restored, therefore, after endometrial ablation, secondary amenorrhea (absence of menstrual bleeding) is observed, and the woman loses her ability to bear children.

Also in young women in the early stages of developing uterine cancer During hysterectomy surgery, the ovaries can be preserved(only the uterus is removed fallopian tubes). In such cases, the female reproductive glands are preserved to prevent the early development of menopausal disorders.

What is hysterectomy surgery and how does it differ from hysterectomy?

Uterine amputation
Supravaginal amputation of the uterus (literally cutting off the uterus) or subtotal hysterectomy is the removal of the body of the reproductive organ while preserving the cervix. This operation has a number of advantages:

• the operation is more easily tolerated by patients;
• ligamentous material is preserved, which prevents prolapse of the internal pelvic organs;
• lower likelihood of developing complications from urinary system;
• Violations in the sexual sphere are less common.

The operation is indicated for young women in the earliest stages of the disease, in cases where there are no additional risk factors for developing cervical cancer.

Hysterectomy
Hysterectomy or total hysterectomy is the removal of the uterus along with the cervix. The standard scope of surgery for stage I uterine cancer according to FIGO (the tumor is limited to the body of the uterus) is removal of the uterus along with the cervix and appendages.

At the second stage of the disease, when the likelihood of malignant cells spreading through the lymphatic vessels is increased, the operation is supplemented with bilateral lymphadenectomy (removal of the pelvic lymph nodes) with a biopsy of the para-aortic lymph nodes (to exclude the presence of metastases in the lymph nodes located near the aorta).

What is open (classical, abdominal), vaginal and laparoscopic hysterectomy?

Operation technique
Classic or open abdominal hysterectomy is referred to as when the surgeon gains access to the uterus by opening the abdominal cavity in the lower abdomen. This operation is performed under general anesthesia, so the patient is unconscious.

Abdominal access allows surgical interventions of varying volumes (from supravaginal amputation of the uterus to total hysterectomy with removal of the uterine appendages and lymph nodes).
The disadvantage of the classical technique is the increased traumatic nature of the operation for the patient and a fairly large scar on the abdomen.

A vaginal hysterectomy is the removal of the uterus through back wall vagina. Such access is possible in women who have given birth and with small tumor sizes.

Vaginal hysterectomy is much easier to tolerate by the patient, but a significant disadvantage of the method is that the surgeon is forced to act almost blindly.

This disadvantage is completely eliminated with the laparoscopic method. In such cases, the operation is performed using special equipment. First, gas is injected into the abdominal cavity so that the surgeon can gain normal access to the uterus, then laparoscopic instruments to remove the uterus and a video camera are inserted into the abdominal cavity through small incisions.

Doctors monitor the entire course of the operation on a monitor, which ensures maximum accuracy of their actions and safety of the operation. The uterus is removed through the vagina or through a small incision in the front wall of the abdomen.

Using the laparoscopic method, any volume of surgery can be performed. This method is optimal because it is best tolerated by patients. In addition, complications are significantly less common with laparoscopic hysterectomy.

When is radiation therapy for uterine cancer indicated?

Radiation therapy for uterine cancer is usually used in combination with other measures. This treatment method can be used before surgery to reduce tumor volume and reduce the likelihood of metastasis and/or after surgery to prevent relapses.

Indications for radiation therapy may include the following conditions:

• transition of the tumor to the cervix, vagina or surrounding tissue;
• malignant tumors with a low degree of differentiation;
• tumors with deep damage to the myometrium and/or with spread of the process to the uterine appendages.

In addition, radiation therapy can be prescribed in the complex treatment of inoperable stages of the disease, as well as in patients with severe concomitant pathologies, when surgery is contraindicated.
In such cases this method treatment makes it possible to limit tumor growth and reduce the symptoms of cancer intoxication, and, consequently, prolong the patient’s life and improve its quality.

How is radiation therapy performed for uterine cancer?

For uterine cancer, external and internal irradiation is used. External irradiation is usually carried out in a clinic using a special device that directs a beam of high-frequency rays to the tumor.

Internal irradiation is carried out in a hospital, in which special granules are inserted into the vagina, which are fixed with an applicator and become a source of radiation.

According to indications, combined internal and external irradiation is possible.

What side effects occur during radiation therapy for uterine cancer?

Reproducing cells are the most sensitive to radioactive radiation, which is why radiation therapy destroys, first of all, intensively reproducing cancer cells. In addition, to avoid complications, a targeted effect on the tumor is carried out.

However, some patients do experience some side effects, such as:

• diarrhea;
• frequent urination;
• pain during urination;
• weakness, increased fatigue.

The patient should report the appearance of these symptoms to the attending physician.
In addition, in the first weeks after radiation therapy, women are advised to refrain from sex life, since during this period there is often increased sensitivity and soreness of the genital organs.

When is hormone therapy for uterine cancer indicated?

Hormone therapy is used for hormone-dependent uterine cancer. In this case, the degree of differentiation of tumor cells is preliminarily assessed and using special laboratory tests The sensitivity of a malignant tumor to changes in hormonal levels is determined.

In such cases, antiestrogens (substances that somehow suppress the activity of female sex hormones - estrogens), gestagens (analogs of female sex hormones - estrogen antagonists) or a combination of antiestrogens and gestagens are prescribed.

As an independent method of treatment, hormone therapy is prescribed to young women for initial stages highly differentiated hormone-sensitive cancer of the uterine body, as well as in the case of atypical endometrial hyperplasia.

In such situations, hormone therapy is carried out in several stages. The goal of the first stage is to achieve complete healing from oncological pathology, which must be confirmed endoscopically (endometrial atrophy).
At the second stage, using combined oral contraceptives restore menstrual function. In the future, they achieve complete rehabilitation of ovarian function and restoration of fertility (ability to bear children) according to an individual scheme.

In addition, hormone therapy is combined with other methods of treating uterine cancer for common forms of hormone-sensitive uterine cancer.

What side effects can occur during hormone therapy for uterine cancer?

Unlike others conservative methods treatment of uterine cancer, hormone therapy is usually well tolerated.

Hormonal changes can cause central dysfunction nervous system, in particular sleep disturbances, headaches, increased fatigue, decreased emotional background. For this reason this type Treatments are prescribed with great caution to patients who are prone to depression.

Sometimes, during hormone therapy, signs of pathology of the digestive tract appear (nausea, vomiting). In addition, metabolic disorders are possible (feeling of hot flashes, swelling, acne).

Unpleasant symptoms from the cardiovascular system such as increased blood pressure, palpitations and shortness of breath appear less frequently.

It should be noted that increased arterial pressure is not a contraindication to hormone therapy, but it should be remembered that some drugs (for example, oxyprogesterone capronate) enhance the effect of antihypertensive drugs.

The occurrence of any side effects should be reported to your doctor; tactics for dealing with unpleasant symptoms are selected individually.

When is chemotherapy indicated for uterine cancer?

Chemotherapy for uterine cancer is used exclusively as a component complex treatment in advanced stages of the disease.

In such cases, the CAP regimen (cisplastin, doxorubicin, cyclophosphamide) is most often used for maintenance therapy.

What complications can develop during chemotherapy for uterine cancer?

Chemotherapy uses drugs that inhibit dividing cells. Since antitumor drugs have a systemic effect, in addition to the intensively multiplying cells of the tumor tissue, all regularly renewed tissues come under attack.

The most dangerous complication of chemotherapy is the inhibition of proliferation of blood cells in bone marrow. Therefore, this treatment method oncological diseases is always carried out under laboratory control of the blood condition.

The effect of anticancer drugs on epithelial cells the digestive tract is often manifested by such unpleasant symptoms as nausea, vomiting and diarrhea, and the effect on the epithelium hair follicles– hair loss.

These symptoms are reversible and completely disappear some time after stopping the drugs.
In addition, each medical drug from the group of antitumor drugs has its own side effects, which the doctor informs patients about when prescribing a course of treatment.

How effective is treatment for uterine cancer?

The effectiveness of therapy for uterine cancer is assessed by the frequency of relapses. Most often, the tumor recurs during the first three years after the end of primary treatment (in every fourth patient). At a later date, the relapse rate decreases significantly (up to 10%).

Cancer of the uterine body recurs mainly in the vagina (more than 40% of all relapses) and in the pelvic lymph nodes (about 30%). Tumor foci often occur in distant organs and tissues (28%).

What is the prognosis for uterine cancer?

The prognosis for uterine cancer depends on the stage of the disease, the degree of differentiation of tumor cells, the age of the patient and the presence of concomitant diseases.

IN Lately It was possible to achieve a fairly high five-year survival rate in patients with uterine cancer. However, this only applies to women who sought help in the first and second stages of the disease. In such cases, the five-year survival rate is 86-98% and 70-71%, respectively.

The survival rate of patients in the later stages of the disease remains stable (about 32% in the third stage, and about 5% in the fourth).

All things being equal, the prognosis is better in young patients with highly differentiated hormone-dependent tumors. Of course it's heavy concomitant pathology significantly worsens the prognosis.

How can you protect yourself from uterine cancer?

Prevention of uterine cancer includes the fight against avoidable risk factors for the development of pathology (elimination of excess weight, timely treatment of liver diseases and metabolic-endocrine disorders, identification and treatment of benign changes in the endometrium).

In cases where benign endometrial dysplasia cannot be treated conservative treatment, doctors advise turning to surgical methods (endometrial ablation or hysterectomy).

Since the prognosis for uterine cancer largely depends on the stage of the disease, great importance has so-called secondary prevention, aimed at timely diagnosis malignant tumor and precancerous conditions.

is a disease that occurs in many places. In addition, in terms of prevalence, this disease ranks fourth after breast, skin, and gastrointestinal cancer. It is necessary to note the age when maximum risks appear: from forty to sixty years.

Diabetes, immunodeficiency virus, early intimate contacts, and the onset of menopause in late age, menstruation disorders, infertility, early first birth, various venereal diseases, prolonged and frequent use protective agents against pregnancy, frequent change of sexual partners.

Conditions that are dangerous for female body and most often, in the absence of timely and adequate action, they become causes of cancer and deserve special attention. Such conditions are erosions, scars after childbirth, ulcers, epithelial growths in the form of polyps and condylomas, chronic inflammation.

What symptoms may there be

The clinical picture, first of all, suggests the existence of leucorrhoea and pain. However, usually the data clinical manifestations appear only at the stage of tumor disintegration, namely at a late stage. In some situations, signs of uterine cancer practically do not appear long time.

The consistency of leucorrhoea can be mucous or watery, may include blood clots, and may differ in the presence of unpleasant odor. When the disease is advanced, blood appears in significant quantities. Delayed discharge and the development of infection lead to purulent leucorrhoea, which manifests itself with an odor. In the last two stages, the situation with discharge worsens, as rottenness appears.

Bleeding may occur once or become regular, which suggests frequent recurrence. The volume of discharge also varies significantly: insignificant or significant. For cervical cancer, the most common bleeding is bleeding, which occurs during intimate contact, examination, lifting heavy objects, and douching. During menopause, spotting is most often an indicator of a malignant neoplasm.

Pain syndrome manifests itself only in the later stages, when the cancer involves the lymph nodes, as well as pelvic tissue with infiltrates.

General symptoms Uterine cancer, including sudden weight loss, manifests itself only in advanced stages.

Signs of cancer

Signs of cancer depend on the situation related to menstruation and the woman's age.

Heavy bleeding may occur during menstruation. This occurs in the presence of menstruation and cancer. Menstruation becomes irregular.

After menopause, a complete absence of menstruation is expected, and the first signs are bloody, purulent discharge, which allows one to immediately identify cancer. The discharge may be abundant or scanty.

At the first suspicion of a disease, you should contact an experienced physician. You must remember that treatment of advanced stages is difficult.

Only if the symptoms are recognized in a timely manner does the treatment promise a high level of effectiveness.

Stages of the disease

The stages of uterine cancer allow us to determine the degree of danger of the disease and assess the possibility favorable outcome.

1. The first stage of cancer is a tumor that forms on the surface of the uterus. At this time destruction occurs lymphatic vessels. As a result, a woman may experience discharge that is a worrying sign. Wherein painful sensations completely absent. If you are diagnosed with early stage uterine cancer, the chances of full recovery turn out to be maximum.
2. The second stage of the uterus involves serious damage to cancer cells of the uterus. Cancer spreads from the body to the cervix. At this stage, bloody discharge appears, which is usually contact. This is due to the fact that the tumor leads to destruction blood vessels. As a result, the symptoms of the disease become more pronounced. At the second stage, a woman may face serious disorders of the reproductive system. Treatment remains possible and reproductive functions can be preserved.
3. At the third stage, cancer develops outside the uterus, and there are two options for the course of the disease. The oncological process can affect the vagina or parametric tissues of the peritoneum. In some cases, the lesions occur simultaneously. Unfortunately, the disease can go beyond certain boundaries. Now life is at serious risk.
4. The fourth stage leads to damage to neighboring organs. Metastases can appear in the liver, lungs, and spine. The infestation is large and serious, so the chances of success are minimal.

Features of surgical treatment

Cancer must be treated through surgery, which can have a high level of success.

Many patients must undergo removal of not only the uterus, but also its appendages. In some cases, lymph nodes located in the pelvis are also removed. In some cases, combined treatment is required, including surgery with radiation performed remotely and intracavitary gamma therapy. Radiation irradiation of the affected organs can be carried out before surgery, which is recommended in the third stage. Radiation therapy may be independent method, which is used only in case of local spread of the oncological process and contraindications to surgery.

Therapeutic agents intended to effectively fight a tumor are usually prescribed for the third and fourth stages of the disease, as well as for neoplasms that differ in differentiation.

Most often, two types of treatment are successful: combined radiation therapy and extirpation of the uterus and appendages.

Treatment is determined by the stage of the disease:

1. At stage 1-A, which involves microinvasive oncology, it is necessary to extirpate the uterus, as well as its appendages.
2. At stage 1 (the process involves only the cervix), irradiation is necessary, either remote or intracavitary. Then it is necessary to remove the uterus and its appendages. The intervention promises to be expanded. In this case, surgical intervention may be performed first, and then gamma therapy.
3. At the second stage, when the disease develops in the upper part of the vagina and there is a risk of spreading to the body of the uterus, the main technique is radiation therapy. Surgery is performed extremely rarely.
4. At the third stage, radiation therapy is performed.
5. At the fourth stage, irradiation is necessary, but its purpose is palliative maintenance of the body.

Symptomatic treatment allows you to successfully treat the disease.

What to do after treatment and in case of relapses

After treatment, it is necessary to carry out a diagnosis of the pelvic organs, as well as give a smear for analysis. In addition, to maintain a woman’s good health, radiography of organs is required chest, intravenous pyelography, ultrasound examination.

During the first twelve months you should visit a doctor once every three months, for five years - every six months, after five years - annually.

What is the best way to deal with relapses? If the oncological process is limited or localized, removal of the uterus is required. The amount of work is determined by the characteristics of the patient’s condition. Chemotherapy is required for distant metastases. Radiation therapy allows treatment for palliative purposes.

Consequences of cancer for women

In cancer, survival, which reaches five years after serious illness, after surgery, is determined by the stage of the disease. The survival rate ranges from forty-five percent to eighty-four.

In case of relapses, a quarter of sick women can be treated with radiation therapy, which is aimed at all pelvic organs.

With relapses with metastases, cure almost never occurs. The therapeutic effect depends on the characteristics of the body, but the result usually does not last long.

In stage four, the 5-year survival rate is only nine percent.

It should be noted that the result of treatment largely depends on how effectively it is carried out and how correct the treatment was selected.

Early diagnosis of cancer with subsequent prevention is possible only through regular examinations. At the same time, a certain regularity of prevention is assumed. For example, women who have already celebrated their 30th birthday should see an experienced physician at least twice a year. In any case, prevention is required after the start of intimate life.

Identifying dangerous conditions Regular examinations and tomography contribute to ultrasonic type, as well as a cytological examination. Treatment for uterine cancer can be avoided thanks to preventive measures.

Treatment of women's diseases is truly important. Only with this approach can the risk of developing cancer be reduced. This treatment must be carried out in a timely manner. Among common features For these diseases, it is necessary to note their chronic course, the presence of constant symptoms, and the lack of the desired effect from anti-inflammatory treatment. Only radical methods can be effective. Radical methods can reduce mortality by six times.

To successfully eliminate the disease, you should stop smoking and carry out full prevention of STDs.

Involving an examination of the cervix, it will allow you to recognize and understand the true position of the woman and determine optimal actions to eliminate unnecessary risks.