How does uterine cancer manifest? Uterine cancer: first signs, diagnosis, stages, treatment, prognosis

Uterine cancer is one of the main oncological diseases of women reproductive system. The disease is widespread and is in second place in the incidence of malignant neoplasms among women.

Despite its high prevalence, this disease is considered one of the favorable forms among malignant neoplasms.

Uterine cancer is a malignant neoplasm that develops in the area of ​​the uterine body from its various layers. The most a common option is cancer of the endometrial layer - the innermost.

The tumor can be of varying degrees of malignancy, which determines the degree of its growth and invasiveness. Malignancy depends on the degree of differentiation of cellular elements: highly differentiated, moderately differentiated, poorly differentiated cancer of the uterine body.

There are two options for tumor growth: endophytic - inside the uterine cavity, and exophytic - out. The early stages of the oncological process are considered:

• 0 – cancer in situ;
• 1A– the tumor is limited to the endometrium;
• 1B– the tumor grows into the myometrium by ½ of its thickness.

This video shows what uterine cancer looks like on an ultrasound:

Symptoms

Cancer of the uterine body is considered the most favorable oncological process in prognostic terms, since its five-year survival rate is more than 75%.

This is due to a large extent to the early diagnosis of the disease and the rapid development of the clinical picture and symptoms already in the initial stages of endometrial cancer, which makes it possible to timely identify the malignant process, its form and begin treatment.

Discharge

Discharge from the external genital tract is one of the first and most valuable symptoms of incipient endometrial cancer. The discharge can be of a very different nature, but most often it is bloody (uterine bleeding) outside the menstrual cycle.

Acyclic bloody issues- the first sign you need to pay attention to and contact an antenatal clinic. The cause of uterine bleeding in case of uterine body cancer can be foci of ulceration of the endometrial mucosa, as well as adenomyosis.

Often, uterine bleeding due to cancer is confused with dysfunctional uterine bleeding if the woman is still in her reproductive age group.

In postmenopausal age, discharge as a result of development and progression malignant neoplasm most often have a serous character. The so-called odorless leucorrhoea and other inflammatory signs- a characteristic sign of a malignant process in the uterus.

In rare cases, the disease is accompanied by copious discharge of serous discharge from the uterine cavity, which is called leukorrhea.

Discomfort

Second characteristic feature development cancer is a gradually increasing feeling of discomfort in the womb. At the most early stages discomfort may appear irregularly over long periods of time.

As the tumor grows, discomfort appears more and more often, and the intensity increases until pain. Discomfort often occurs in combination with discharge. In stage 1 cancer, discomfort is difficult to associate with any oncological process, so this symptom becomes pathognomic at stages 1A and 1B.

Itching and burning

In addition to discomfort, a sick woman is often bothered by a burning sensation and itching in the vaginal area and pubic symphysis.

Itching and burning are one of the first signs of cancer development. The cause of this symptom is the production of toxic components by cancer cells and local irritation of the sensitive nerve receptors of the internal and external genital organs of a woman, which leads to such an unpleasant symptom.

When complaints about the symptom of itching and burning are established, the following biologically active substances are often detected in a biochemical blood test: bradykin, serotonin, enkephalin, histamine. All these substances are pro-inflammatory agents and irritate sensitive nerve fibers.

Blood during sexual intercourse

Bloody discharge during sexual intercourse is another symptom characteristic of the early stage of the oncological process. Bloody discharge during sexual intercourse is scanty and may be accompanied by pain (daspareunia).

The release of blood from the external genital organs during sexual intercourse occurs as a result of a rush of blood to the internal genital organs, in particular to the uterus. Significant blood flow and dilation of the uterine vessels can provoke bleeding from the tumor growth area.

The tumor can be ulcerated due to rapid growth or grow into a local uterine vessel. With an increase in blood flow, as well as in combination with intense physical activity these factors can provoke uterine bleeding in endometrial cancer. Bleeding goes away on its own as a result of contraction of the uterine myometrium and narrowing of the diameter of blood vessels.

Scarlet blood during menstruation

This symptom occurs in women of reproductive age from 20 to 45 years. Scarlet blood indicates a high concentration of oxygen in it, which means that the blood flows from the arterial bed.

If you detect scarlet blood during menstruation, you must urgently contact the emergency gynecology department, since scarlet blood indicates the onset of uterine bleeding, which in some cases cannot be stopped on your own.

Diagnosis of pain during menstrual bleeding is difficult, since with cancer, scarlet blood released from the external genital tract is not accompanied by pain.

In any case, if red blood is detected during menstruation, you must contact the gynecology department and carry out a series of diagnostic procedures to identify the cause of the bleeding. And also eliminate it, since bleeding can lead to significant blood loss and anemic syndrome.

Cycle failures

Menstrual irregularity is not a pathognomic symptom, but is part of the clinical picture of uterine cancer. Acyclic bleeding is most often accompanied by the arterial type of bleeding and is not accompanied by pain.

When examining a woman for hormonal status a hormonal imbalance and the ratio of progesterone and estrogen may be detected. Hormonal imbalance contributes to the development of a precancerous condition and malignancy of the hyperplastic process in the endometrium.

Menstrual irregularities occur due to damage to the endometrium and its replacement with atypical tumor cells. As a rule, a condition preceding cancer - complex or simple adenomatous hyperplasia - contributes to cycle disruption. Cycle failure is most often observed in women with severe excess body weight and other concomitant hormonal disorders.

Pain

The pain syndrome appears later than all of the above. Women begin to notice pain at stage 1B, and then pain syndrome It only progresses and is permanent. Pain may occur during sexual intercourse or may be unrelated to any other symptoms.

A characteristic feature of uterine cancer is the absence of pain at the time of uterine bleeding outside the cycle, which provides good reasons for carrying out a full-fledged diagnostic study for the presence of endometrial malignancy.

As for the intensity of pain, this is a subjective sign and for each woman this symptom is individual, since everyone has a different pain threshold. The intensity of pain may depend on the rate of progression of the cancer process and the degree of invasiveness.

Painful sensations arise due to compression or destruction of the sensory nerve fibers of the uterus by atypical cells. Often, a woman cannot establish a clear localization of pain, since visceral sensitivity is poorly developed and the innervation of internal organs by sensitive nerve endings does not allow determining the exact localization of pain.

Typically, complaints relate to pain in the lower abdomen, in which case the pain syndrome should be considered in conjunction with other manifestations of the disease.

General manifestations

During the development of endometrial cancer, the cellular composition of the tumor, the growth pattern and the degree of differentiation of atypical tumor cells play an important role in the clinical picture and the timing of its formation.

The more invasive the malignant process is, the more pronounced the cellular atypia and the rate of cell proliferation, the faster the symptoms will appear, and the clinical picture will become bright and characteristic.

TO common features of the oncological process in the early stages can include the entire range of factors preceding the development of a malignant neoplasm. Metabolic syndrome associated with overweight or obesity, dyslepidemia, hormonal imbalance are additional criteria in establishing clinical diagnosis cancer of the uterine body.

Specific cancer markers can be detected in blood plasma, which can confirm tumor progression.

A timely visit to a specialist with the above symptoms allows you to quickly carry out a number of diagnostic procedures, refer the patient to the gynecological oncology department for hysteroscopy and taking material for a biopsy for absolute confidence in the presence of endometrial cancer.

If you find an error, please highlight a piece of text and click Ctrl+Enter.

Article outline

Uterine cancer is one of the most common diseases in gynecological oncology. The pathological process develops in the endometrium, cells are involved in it different types, and then it begins to spread throughout the body, affecting other organs and systems. It is most often detected in older women (after 40–45 years, the main risk group is 55–65 years), but in recent years there has been a trend toward “rejuvenation”—cases are recorded in patients under 30.

There are several reasons for the occurrence of this pathology; they will be described in detail. In gynecology, they are classified into a separate group - which, in the absence of adequate treatment, lead to the degeneration of cells into atypical ones. This is how education happens primary tumor. Subsequently, more and more tissues and organs are involved in the pathological process, and metastases appear. Based on histological characteristics, the disease is divided into different types. But the main method is the international classification, which is based on the size of the tumor and the degree of its spread.

It is important for women of any age to know what the first signs and symptoms may indicate the onset of a pathological process. Since uterine cancer, regardless of the type of pathology, can develop quite rapidly, you should first pay attention to any spotting or bleeding. This symptom is a sign of a variety of gynecological problems and dangerous in itself. In this case, it is characteristic of the period of transition from precancer to oncology, and can also be an independent signal of the development of the disease.

Patients who have already been diagnosed are concerned about the prospects: how quickly does the transition from a mild stage to a more severe one occur, how to treat it, and whether it can be cured at all. I am interested in what is the survival rate after surgery, the possibility of relapses, etc. Let's look at all these problems in detail. But before that, let us once again remind you of the importance of prevention and regular visits to the gynecologist. The disease rarely occurs spontaneously; it is usually preceded by other pathologies. Their timely detection and taking care of your health (including a routine visit to the gynecologist) is necessary to minimize the risks of cancer in the female reproductive system.

Cancer concept, statistics

What is uterine cancer? This is a pathological process that develops in the cells of the inner epithelial layer (endometrium) and leads to their degeneration into atypical ones. And in the future - to the emergence and development of malignant neoplasms. Accordingly, the normal functioning of the organ is disrupted, as cancer cells replace healthy ones. All tumors are divided into groups (stages of the disease) according to the system generally accepted in oncology (according to the degree of development, the presence of metastases, etc.). In gynecology, it is also customary to distinguish and consider separately:

• Cervical cancer: this pathology is isolated as a separate disease; the primary tumor develops directly on the cervix, and can subsequently grow both towards the vagina and towards the uterus itself.
• cancer of the uterus: in this case we are talking about damage to the mucous or muscular lining of the uterus. Depending on what type of cells was initially involved in the pathological process, several types of malignant tumors are also distinguished.

In this article we will consider in detail the oncology of the uterus itself; the pathology of the cervix will be discussed separately in the article cervical cancer.

Pathological proliferation of endometrial cells leads to the development cancerous tumor. Scientifically – uterine carcinoma, from lat. cancer uteri. In gynecological oncology, the following types of tumors are distinguished (classification is based on histology):

• endometrial cancer of the uterus (scientifically called)
• leiomysarcoma - the pathological process begins in muscle tissue organ.
• sarcoma (degeneration of connective tissue);
• glandular squamous cell carcinoma;
• clear cell;
• mucinous;
• serous;
• undifferentiated.

In fact, cells of any type can degenerate. Depending on how differentiated the cellular structures are, low-, medium- and highly differentiated neoplasms are distinguished.

According to statistics, cancer most often turns out to be adenocarcinoma. It can be hormonal (more common) or an autonomous type of development. In the first case, there is a connection between hormonal disorders, in the second, no obvious cause is identified; the provoking factors are standard causes for oncology (for example, hereditary predisposition).

According to statistics, in the structure of all cancer diseases, uterine pathology accounts for about 3%, if we take only the female population - up to 7.7% of the total. The hormonal type of tumors prevails over the autonomous type (ratio approximately 70%:30%). By age: most patients are over 40, more often detected at a later age ( average- about 60 years old).

Causes and risk factors

According to the gradation into autonomous and hormone-dependent types of oncology, the causes of uterine cancer can be associated with hormonal imbalance or develop as a result of exposure to other provoking factors. It should be understood that they only increase the risk of developing pathology, but are not the direct cause of the degeneration of cells into atypical ones. As with other cancers, there is no single mechanism. What causes cancer in each patient is determined individually; during diagnosis, all possible sources of influence on the cells are taken into account.

Risk factors for developing cancer are:

• Age-related changes. In this case, we are talking about processes that are somehow related to the function of the reproductive system: late menopause or too early maturation.
• Endocrine pathologies. Since the cause may be the degeneration of background and precancerous conditions of the uterus with a hormone-dependent etiology, this reason considered one of the main ones.
• Among the endocrine pathologies that provoke the development of cancer are: polycystic ovary syndrome (more than 12 follicles). Develops as a result of an imbalance of male and female hormones, resulting in disruption menstrual cycle, typical male secondary sexual characteristics appear (rough voice, abnormal hair growth, abdominal fat, etc.). An additional risk factor is obesity.
• Obesity due to hormonal disorders increases the risk of developing cancer by 2–3 times. The same result occurs when the diet is violated, if the diet is dominated by fatty food, as a result of which cancer can develop against the background of obesity resulting from poor nutrition and overeating.
• Long-term use of certain hormonal drugs. Hormone therapy is not always considered a provoking factor. For example, when taking contraceptives with a large amount of progestins, the risk is reduced by an average of 2 times. But long-term hormone replacement therapy in women over 55 years old, on the contrary, increases it by 2–3 times. Long-term use of medications that block estrogen-sensitive receptors also has a negative effect. Such drugs (for example, Tamoxifen) are prescribed for the treatment of breast cancer, but it is not recommended to use it for more than 2 years, otherwise the risk of damage to the uterus increases significantly (according to some sources, from 2 to 7).
• Hereditary predisposition in women is formed as a tendency to obesity, disruption of hormonal functions of the body, some have cancer in the form of primary multiple tumors.

These are the main influencing factors that can increase the risk of developing a malignant tumor. What else can it develop from? There is information about the onset of the disease against the background of: diabetes mellitus, adrenal adenoma. And also for severe liver diseases and irradiation of the pelvic organs. Women who have not given birth or who have one child are also included in the risk group.

At the moment, these are the main reasons associated with the development of cancer of the uterine body. Of all the above factors, background and precancerous conditions are clearly pathogenic, which sooner or later degenerate into oncology over time. The rest only contribute abnormal development cells.

Classification

Cancer cells can not only replace healthy ones and form clearly localized tumors, but also spread to neighboring tissues and organs (metastases), involving them in the pathological process. There are several classification options: International, according to the TNM system and the FIGO system, adopted by the International Federation of Obstetricians and Gynecologists. Since the International Classification, adopted back in 1971, is used most often, let’s consider how it evaluates a malignant tumor of the uterus.

Distinguish different stages oncology (four in total), there is also zero, which is not included in clinical classification, but is diagnosed as a hyperplastic process with suspected malignancy and is assessed according to histology. Let's consider all the stages, the definition of which is based on the degree of organ damage.

• Stage 1: the lesion is completely localized in the body of the uterus, the endometrium and myometrium are involved in the process, the size and degree of differentiation of the tumor are also important for classification;
• Stage 2: the tumor spreads not only to the body, but also to the cervix (into the glandular and/or deeper layers);
• Stage 3: further development leads to damage to the vagina, appendages and lymph nodes.
• at stage 4 of uterine cancer: a common oncological process that affects both nearby organs (rectum, bladder) and those located far from the primary tumor (liver, bones, lungs, distant lymph nodes).

As is clear from the description, the most dangerous are the last stages, especially stage 4 uterine cancer with metastases. When it comes to damage to lymph nodes distant from the primary tumor, the spread of oncology becomes unpredictable, treatment becomes extremely difficult, and the prognosis becomes unfavorable.

The FIGO classification describes the extent of pathology in more detail. Stage 2 uterine cancer is designated as IIA (with pathology of the glandular layer) and IIB (involving the deep layers of the cervix). At stage 1, the letters indicate the spread of cancer to the endometrium (A) or myometrium (B or C depending on the depth of the lesion).

If stage 3 uterine cancer affects the serosa and/or appendages, we are talking about the onset of the disease at this level (A); if the vagina is involved in the process (metastasis), it is assigned B, and metastasis to nearby lymph nodes is classified as C.

If stage 4 uterine cancer affects the intestines and bladder, it is designated by the letter A, in other cases - B. An additional parameter to describe this period of cancer development is the G index, which indicates the degree of non-squamous growth.

In fact, the entire gradation of tumor development and spread indicates the degree of damage to the body, from the formation of the primary tumor to the distant spread of metastases.

Metastasis

The danger of cancer is not only functional disorders in the functioning of organs and systems caused by the replacement of normal cells with atypical ones. The neoplasm spreads throughout the body, and this becomes too dangerous, as the disease becomes inoperable.

First, the tumor grows into nearby tissues (the organ itself or neighboring ones), i.e. it metastasizes. The mechanism of spread is as follows: modified cancer cells begin to separate from the primary tumor. These are the first metastases of uterine cancer, which is characterized by the onset of a pathological process in nearby organs (stage 3). The disease goes beyond the initially affected uterine body at stage 2, moving to the cervix, but degeneration occurs within one organ - in the uterus, although with the involvement of different types of tissue.

The transition from the third stage to the fourth means that the lymphatic system, the main “carrier” of atypical cells to distant organs, undergoes metastasis. Damage to the lymph nodes close to the primary tumor indicates a real danger of spread throughout the body. If distant ones are affected, then uterine cancer metastases can affect almost any organ (lungs, brain, etc.) or musculoskeletal system.

The initial stages of uterine cancer are relatively easy to treat surgically, since the tumor has a relatively clear localization. In the future, removal of the pathological focus is often difficult or even impossible, since in addition to the primary tumor, multiple metastases appear in the body, penetrating entire layers of tissues of different types. There are no clear contours, and the lymphatic system continues to spread cancer cells throughout the body. This process involves the hematogenous pathway (through the blood) of movement of cancer cells throughout the body.

Diagnostics

At what stage can cancer be identified and diagnosed? This is possible already at the earliest stages, when the pathological process is just beginning. In women who are absolutely healthy in gynecological terms, regular medical examinations help to identify almost any threat, even during a visual examination. If we are talking about patients with precancerous or background diseases, then they are prescribed a scraping or a biopsy is taken for histological examination. In the future, they are registered at the dispensary and are regularly checked.

Is cancer visible on ultrasound during examination? Yes, ultrasound helps to identify a pathological focus, like other diagnostic measures. Screening is rarely used to identify this pathology. Tumor markers help detect pathology; in addition, they are often used to assess the effectiveness of existing treatment and early detection of relapses. Let's consider everything possible ways, helping to detect cancer even at the very beginning.

Diagnosis of the disease:

• Inspection: any, even the most minor, violations that can be noticed visually serve as the basis for prescribing a series of tests;
• Cytological examination collected material helps to obtain reliable data about the presence of oncology. For cytology, the contents are taken after aspiration. But the effectiveness of this technique in the early stages is only about 36%; the method gives accurate results only when oncology is widespread (90% detection rate).
• Ultrasound examination: cancer is detected by this method in patients at any stage of pathology development. Deciphering the results of a transvaginal examination allows you to notice a tumor up to 2 cm in size. Changes in the size of the uterus (normally in women of reproductive age M-echo is from 10 to 16 mm, with menopause - no more than 7, in postmenopause - no more than 4) is a reason for further examination. That is, the answer to the question: can cancer be clearly seen during an ultrasound examination is positive. This is a reliable and reliable method of examination.
• Histology: sampling of material during hysteroscopy followed by histological examination allows you to obtain an accurate result. Endometrial and cervical canal scrapings are also sent for examination ( diagnostic curettage).
• Fluorescent diagnostics: endometriotic cancer in the earliest stages (the lesion is up to 1 mm) is clearly detected by the introduction of a contrast agent followed by ultraviolet illumination. Efficiency – up to 80%.
• MRI: the method is used for accurate assessment of volume in advanced oncology, it reflects well clinical picture in the lymph nodes, it is recommended to examine the pelvic organs to obtain an accurate clinical picture.

How it manifests itself

Symptoms of uterine cancer most often appear as early as later stages development. It can initially be recognized only during a gynecological examination or using modern diagnostic methods. This is the main danger: an asymptomatic course in patients who consider themselves healthy, in the absence of regular medical examinations, can lead to late detection, when the disease is actively progressing.

Take a closer look at all the symptoms of endometrial cancer below.

Symptoms of uterine body oncology are directly related to the degree of development and spread of the pathological process. Therefore, let’s consider what signs serve as the basis for an immediate visit to a gynecologist and a comprehensive examination.

Since cancer in the uterus practically does not manifest itself in the earliest stages, any bleeding not related to cancer may be a reason to suspect oncology. normal menstruation, especially during menopause and postmenopause. In 90% of cases, such bleeding is the first symptom of cancer. Therefore, let us consider in detail how spotting in case of uterine cancer can serve as a signal about the beginning of the pathological process:

1. If young girls experience disruptions in their cycle, then most often these moments, signaling the possibility of developing uterine cancer, are ignored. This is explained by two factors: there are many reasons for changes in the cycle (ranging from banal hypothermia to prolonged stress). In addition, this type of oncology is rare before the age of 30; patients of this age are not at risk. However, any disturbances in the normal menstrual cycle should be a reason to visit a gynecologist.
2. In women over 40, a variety of bleeding can be considered as obvious symptoms of uterine cancer, namely:
3. single or multiple;
4. scanty or abundant;
5. breakthrough or intermittent;
6. any contact (during examination, sexual intercourse, douching, lifting heavy objects).
7. In premenopause, disruption of the cycle and nature of menstruation is the norm, therefore alarming symptoms may be missed and cancer detected late. If, instead of the attenuation of menstruation, they intensify and become more frequent, you should consult a gynecologist.
8. During menopause, menstruation is completely absent, so any bleeding will help detect a tumor in the first stages of development.

It is necessary to monitor not only the nature of menstrual and non-menstrual bleeding. Danger signs- this is any discharge; in case of uterine cancer, it most often has an unpleasant odor. This smell has a purulent compartment, characteristic of late stage uterine cancer, third or fourth, when other pathological processes are added to the main disease.

Pain that begins with uterine cancer usually indicates the depth of the pathological process. As it develops, standard symptoms for oncology are added: digestive problems (lack of appetite, constipation or diarrhea, nausea and vomiting). Late symptom also considered: sudden weight loss, low-grade fever, increased fatigue, etc. They are characteristic of advanced oncology (common process, involvement of other organs and systems). If the last stage has arrived (how long people live with it will be indicated separately), then the symptoms can be very different, since each affected organ can give its own clinical picture.

The asymptomatic initial stage, when the cancer practically does not manifest itself, is usually detected during a gynecological examination. At the slightest suspicious changes, the doctor prescribes a series of tests. That is why such attention is paid to the need for medical examinations.

What is the danger

If we consider the possible consequences of uterine cancer, we can note:

• good curability in the early stages (with preservation of reproductive function);
• identification of a more common process may result in surgery (organ-preserving or without preserving the reproductive organ);
• inoperable tumors with metastases are difficult to treat drug treatment and lead to death.

Analyzing these facts, we can conclude that the main danger of the initial stages of oncology is an asymptomatic course. The main danger of complications during treatment for a developed pathological process is infertility (as a functional disorder or after removal of the uterus). Consequences of cancer last stages leads to global spread in the body and death. Another danger is the risk of relapse, especially if the provoking factor remains unchanged (for example, hormonal imbalance).

How to treat uterine cancer

Treatment of uterine cancer is directly related to the extent of detected pathology. When choosing a technique, the full clinical picture is taken into account: the size of the tumor, the degree of its spread, the presence or absence of a metastatic process, concomitant diseases. Only after a complete examination is a decision made on further tactics.

Is cancer curable with therapeutic agents? Most often, they are part of an overall comprehensive patient management plan. Separately, therapeutic methods are not always effective, but are often used when it is impossible to perform surgical intervention and as palliative therapy.

The surgical method is the main one for this type of oncology. If necessary, it is combined with radiation and chemotherapy. Organ-sparing surgery using ablation is possible if uterine cancer is in the early stages and the size of the tumor does not exceed 3 mm and has clear contours. But there remains a risk of incomplete removal, therefore, relapses are possible.

The uterus is removed even at the first stage; this method is considered the main one for cancer. As an alternative, other methods are chosen only if surgical intervention is impossible due to concomitant diseases (only 10%). The outcome in this case is not very favorable, chemotherapy and other methods are not particularly effective for this type of oncology, the risk further development too big.

Surgery to remove a malignant tumor is performed in different volumes:

• cancer in the initial stage (first): total hysterectomy and adnexectomy;
• for more severe pathologies: additional lymph nodes are removed;

If metastases of uterine cancer are detected and surgical intervention is impossible, courses of radiation and chemotherapy are prescribed.

Treatment of uterine cancer with therapeutic methods:

• hormone therapy: as an addition to other methods, provided that the malignant neoplasm is sensitive to such drugs;
• chemotherapy: in late stages and in combination with other drugs;
• : used actively after surgery, instead of it, if there are vital contraindications and for treating organs and tissues located near the tumor;
• brachytherapy: radioactive substances are injected directly into the tumor;

Total hysterectomy is considered the most effective in the early stages; in such cases, the risk of relapse is minimal, especially when using additional therapeutic methods(adjuvant radiotherapy, hormones to normalize their metabolism, etc.).

How long do you live with uterine cancer?

The prognosis for uterine cancer is directly related to two factors: the degree of development of the cancer and the age of the patient. If a tumor is detected in time and adequately treated in a woman under 50 years of age, the five-year survival rate is 91%, and after 70 years of age it is only 61%. Now let's look at how many people live with uterine cancer after surgery in accordance with the diagnosis.

Depending on the degree of tumor differentiation, 5 years without relapse are recorded:

• at low: 64%;
• at average: 86%;
• at high: 92%.

What are the prospects if the cancer has metastases? The patient can live 5 years without relapse:

• in 90% of cases, if stage 2 or stage 1 uterine cancer was diagnosed, that is, there were no metastases to the lymph nodes;
• in 54% of cases, if the cancer is accompanied by a metastatic process (stage 3 and stage 4).

For hormone-dependent and autonomous tumors, the five-year prognosis for life expectancy without relapse is 90% and 60%, respectively.

If stage 4 or 3 uterine cancer is detected, the prognosis is the least favorable. How long will a person live if uterine carcinoma is detected too late? The percentage of patients surviving for 5 years if an inoperable fourth stage was discovered is only 5%, with the third - about 30%.

If uterine body cancer is detected on time, how long the patient lives depends on the characteristics of the tumor, the course of the disease, relapses after treatment, etc. The possibility of surgical intervention is directly related to how long patients live in the future. This is explained by the low effectiveness of conservative therapy (cancer responds poorly to it compared to other types of oncology).

After surgery, the prognosis is much better, as evidenced by the average indicators: for grades 1 and 2 (operable stage): 98 and 70%, respectively. With an inoperable tumor, how long the patient will ultimately live depends on many factors (risk of relapse, type of tumor, extent of the pathological process, individual characteristics, concomitant diseases). The effectiveness of therapy and palliative treatment is also important.

How quickly does uterine cancer develop?

It is almost impossible to predict how quickly cancer will develop. Like all oncological diseases, this pathology can remain unchanged for years. And then begin to develop quickly and rapidly.

Since often patients are first diagnosed with a background disease or precancer, we can only speak with certainty about their long transition to oncology. Cases of a long-term stable state of a pathological focus in the zero stage have also been recorded.

A rather rapid spread of atypical cells in the body often occurs in the later stages, when the lymphatic and circulatory systems become involved. Especially if the medications taken are ineffective.

Help from folk remedies

Is it possible to cure cancer exclusively with folk remedies? There is no consensus on this issue. But if we analyze the causes and risk factors, we can assume that plants will help:

• normalizing hormonal levels;
• helping to cope with precursor diseases (polyposis, polycystic disease, etc.);
• providing vaginal sanitation (destruction of pathogenic microorganisms at the local level);
• containing vitamins A and B;
• at an inoperable stage: all plants that can relieve symptoms or fully replace medications prescribed by the attending physician.

That is, folk remedies for uterine cancer can be divided into two groups: preventive and analog herbal remedies. The use of unconventional methods in the treatment of any cancer has long been controversial. Traditional medicine usually considers herbal medicine as a complementary remedy. Since in the case of uterine cancer in the early stages, the most effective methods– surgical, then you should not risk replacing it with therapy using unconventional methods.

Treatment of uterine cancer with folk remedies is possible only after consultation with a doctor who sees the true clinical picture. For this pathology, herbal remedies based on:

• hemlock and celandine: both plants are poisonous, so the dosage regimen should be strictly followed. Hemlock is sold at the pharmacy ( alcohol solution), you can make a water tincture of celandine yourself;
• It is recommended to take shepherd's purse, bedstraw, horsetail herb, etc. internally in the form of infusions and decoctions;
• natural analogs of chemotherapy drugs: amygdalin is found in the kernels of bitter almonds and apricot kernels. Extracts from shark cartilage, shark liver oil and melatonin show good results. They can be found in the form of dietary supplements;
• ASD is used as an immunomodulator in palliative treatment;
• soda dissolved in water stabilizes the acidity level;
• Various herbal remedies are used for douching: calendula, horse sorrel, propolis, etc.

The effectiveness of various non-traditional methods as an independent treatment for oncology is questionable, so it is better to combine them with methods traditional medicine and after consultation with your doctor.

Uterine cancer and pregnancy

During pregnancy, uterine cancer is rarely detected; women of reproductive age under 30 rarely suffer from this disease. Is it possible to get pregnant if a pathological process is already underway in the body? The presence of a malignant neoplasm at the first stage does not cause symptoms, although there have been cases of tumors being detected after the woman became pregnant.

Therefore, we can conclude that the latent course of the disease does not interfere with conceiving a child with uterine cancer in the early stages of development. There are specific considerations for managing pregnant patients. Since surgical intervention is not discussed in this case, the pregnant woman is prescribed large doses of progestins. After achieving the goal - atrophy of the glands, the next stage begins. Hormone therapy is used to normalize the ovulatory cycle.

If oncology is detected in nulliparous women of reproductive age, the tactics of medical care will be aimed, if possible, at preserving function (therapy or organ-conserving surgery).

Prevention

Measures aimed at eliminating risk factors are considered as preventive measures. Balanced nutrition, normalization of hormonal levels, treatment of obesity, etc. will help avoid negative consequences.

The main preventative measure will be regular medical examinations; uterine cancer rarely occurs suddenly. Identification of precursor diseases in most cases makes it possible to prevent their degeneration into a malignant tumor.

Maintain proper nutrition

Nutrition for uterine cancer involves a balanced diet that does not contain fatty or spicy foods. Since such food is considered one of the risk factors, the same approach to nutrition is recommended for prevention. If obesity is recorded, then the diet should be aimed at losing weight.

The food should be dominated by products of plant origin. Nutritionists recommend vegetables and fruits for uterine cancer (saturating the body with vitamins), including legumes, whole grain cereals, spicy herbs, onions, garlic, turmeric, cabbage. They have proven themselves well in oncology. Heat treatment should be minimal, fats and proteins of animal origin are consumed in doses.

This disease is considered very common nowadays. Most often, the first signs and symptoms of cervical cancer found in women aged 30 to 55 years(in recent years this disease has become much “younger”). Although this pathology easy to diagnose, unfortunately, in almost half of patients it is detected in the later stages. Modern medicine offers several ways to solve the problem, including full recovery and restoration of the body. Practice shows that when timely treatment diseases in the early stages (without removal of the organ), in the future a woman can have healthy offspring.

In most cases, the disease develops against the background of precancerous conditions. The risk group for this disease includes women who neglect treatment of sexually transmitted infections and patients who do not follow the rules of personal hygiene.

Girls who begin to be sexually active can also get sick. early age(up to 16 years), when the cervical epithelium contains immature cells that easily degenerate into cancer. Scar changes on the organ mucosa, hormonal imbalance, smoking, drinking alcohol, exposure to radiation - all this significantly increases the risk of occurrence. Every year, this diagnosis is detected in 600,000 women around the world.

Causes

Regardless of what symptoms a woman experiences with cervical cancer, the source of the tumor is the healthy cells that cover this organ.

The main reasons are:

• human papillomavirus infection;
• infection with genital herpes, HIV, cytomegalovirus, chlamydia;
• diseases of the cervix (dysplasia, leukoplakia, erosion);
• lack of vitamin A and C in the body;
• weakened immune system;
• exposure to radiation and chemical toxins on the body;
• early abortions, curettage;
• scarring of uterine tissue;
• organ injuries;
• disorderly, unprotected sex life if the change of partners occurs more often than 2-3 times a year;
• stress.

The main threat is viruses that lead to mutations, and provoke the degeneration of healthy cells into cancerous ones. During the illness tumor cells can be transported with lymph to nearby The lymph nodes, thereby forming metastases. Despite the development and spread of the disease, symptoms of cervical cancer in women at this stage may be absent or mild.

Kinds

Depending on the type of affected epithelium, there are:

• squamous cell carcinoma(most common, the tumor is formed from squamous epithelial cells covering the vaginal part of the organ; due to a malfunction in the DNA structure during division, immature cancer cells are formed that are capable of dynamic reproduction);
• adenocarcinoma(the tumor affects the deep layers of the endocervix).

Squamous cell carcinoma is divided into 3 groups:

• keratinized (the tumor has a dense, keratinized structure);
• poorly differentiated (the tumor grows quickly and has a soft consistency);
• non-keratinizing (considered an intermediate stage between keratinizing and poorly differentiated cancer).

Main stages

• stage 0 - a precancerous condition, when pathogenic cells do not form a tumor, do not penetrate the tissue, but are located on the surface of the cervical canal;
• stage I (cancer cells penetrate deep into the tissues, the pathology does not affect the lymph nodes, the average size tumors 3-5 mm (IA) or up to 5 mm (IB));
• stage II (grows into the uterus, goes beyond its borders, does not affect bottom part vagina and pelvic wall);
• stage III (the tumor spreads beyond the cervix, up to the pelvic walls and the lower third of the vagina, observed);
• stage IV (the tumor is large in size, spreads from all sides of the cervix, affects the lymph nodes and neighboring organs).

Symptoms of cervical cancer

It is impossible to say exactly what is the first symptom of cervical cancer, since all manifestations of the disease are usually mild. In the early stages they may be absent altogether. As the tumor grows, warning signs and symptoms may occur. But at this moment the damage can reach neighboring organs. That is why women should undergo regular examinations by a gynecologist with mandatory colposcopy (microscopic examination of the condition of the cervix).

What are the symptoms and first signs of cervical cancer? The main ones include:

• bleeding after sexual intercourse, between menstruation, after menopause, immediately after examination by a gynecologist;
• copious whitish, cheesy vaginal discharge mixed with blood;
• purulent vaginal discharge with an unpleasant odor;
• increased duration of menstruation (more than 7 days);
• sharp pain in the lower abdomen;
• spasms radiating to the lower back;
• discomfort in the vagina during sexual intercourse;
• weight loss (up to 10-15 kg in a few weeks);
• problems with bowel movements;
• frequent or delayed urination;
• general weakness of the body;
• increased fatigue;
• swelling of the legs;
• temperature increase.

When examining the condition of the cervix due to cancer, ulcerations are diagnosed, as well as changes in the color of the cervix.

The signs and symptoms of cervical cancer listed above are not exact or necessary. They can also signal the presence of other gynecological diseases, so it is very important to conduct a comprehensive diagnosis by an experienced gynecologist.

Diagnostics

Any manifestation of symptoms in women should alert and to confirm or refute the diagnosis, it is necessary to conduct the following types of studies:

• oncological examination by a gynecologist (at least once every 6 months);
• cytological examination of scrapings from the surface of the cervix;
• PAP test (test for the presence of atypical cells);
• colposcopy;
• biopsy of cervical tissue;
• Schiller test (test with or acetic acid);
• Ultrasound of the pelvic organs - such a study allows you to determine the spread of the tumor in the pelvis, thus establishing the stage of the disease.

If signs and symptoms of cervical cancer are observed and the presence of the disease is suspected, the gynecologist prescribes related diagnostic procedures to exclude or confirm the spread of a malignant neoplasm to neighboring organs.

• MRI of the pelvic organs - performed in cases where ultrasound results do not accurately determine the spread of the disease;
• Ultrasound of the kidneys;
• Ultrasound of the liver;
• ultrasound examination of the bladder;
• X-ray of the lungs - performed to exclude or confirm the presence of distant metastases;
• irrigoscopy - examination of the colon using X-rays to determine the area of ​​​​distribution of the tumor;
• rectoscopy and cystoscopy - examination of the rectum and bladder, which allows you to determine whether these organs are affected by the tumor;
• intravenous urography is necessary to determine the “functionality” of this organ, since with cervical cancer, compression of the ureters often occurs, with further impairment of kidney function.

Treatment

Treatment of cervical cancer involves the following types of therapy:

• conization of the cervix (conical amputation), which involves removing the cone-shaped part of the cervix and the mucous membrane of the cervical canal;
• electrosurgical loop excision, when pathological tissue is removed with an electric knife, the pathogenic area is cauterized, and healthy tissue is formed in its place;
• high amputation, when the surgeon performs a radical removal of the cervix; the operation may involve removal of part of the vagina, pelvic lymph nodes;
• hysterectomy with complete or partial removal of the ovaries;
• radical hysterectomy, which involves removing the uterus, fallopian tubes, vagina, ovaries, and lymph nodes;
• radiation and chemotherapy;
• drug therapy;
• hormone therapy.

Radiation and chemotherapy are usually prescribed at the preoperative stage in order to reduce the size of the cancer tumor. The most common treatment is complex, which combines surgery, radiation and chemotherapy. For a long period of time, only the first two methods were used; recently it has been proven that combining all treatment methods significantly increases the effectiveness of the course of treatment.

Radiation is the leading method of treatment; it is especially often used if the patient has stage 3-4 of the disease and the tumor has been removed surgically impossible.

During the course, remote gamma therapy is used, which is supplemented by intracavitary irradiation of the cervix.

Chemotherapy is usually used as an adjunct to radiation. The results obtained are ambiguous: on the one hand, efficiency increases and it becomes possible to reduce the radiation dose, and therefore reduce the likelihood of the appearance of radio-induced formations. On the other hand, such combination treatment is poorly tolerated by patients and leads to side effects.

Complications

Such a disease can develop rapidly or be sluggish, but in each of these cases a number of complications may occur:

• compression of the ureters;
• stagnation of urine;
• development of hydronephrosis;
• the appearance of purulent infection of the urinary ducts;
• the occurrence of bleeding from the tumor or genital tract;
• the formation of fistulas, a kind of unnatural canals connecting the bladder or intestines to the vagina.

Prevention

In order not to understand what symptoms may indicate cervical cancer and look for what the first sign of such a disease is, you should carry out preventive measures in a timely manner. To this end, the following actions are being taken:

• regular examinations by a gynecologist - visual and bimanual (manual);
• colposcopy (at least once a year) - examination of the organ at a magnification of 7.5-40 times, allows you to see precancerous processes;
• passing a PAP test to detect atypical cells;
• timely treatment of sexually transmitted diseases;
• protected sexual acts;
• vaccination against cervical cancer with a four-component vaccine. (vaccination provides immunity for 3 years, is performed in several stages, is given to girls aged 9 to 12 years (before the onset of sexual activity, when infection with the virus has not yet occurred), as well as to older girls (from 13 to 26 years); average the cost of vaccination is from $400 per course).

Treatment of the disease should be carried out under the supervision of a gynecologist with a surgical profile, as well as an oncologist.

Forecast

Cervical cancer is a serious disease that leads to serious complications. The main threat is metastasis to the lymph nodes, other organs (kidneys, lungs, liver), removal of the uterus and, as a result, infertility. Chemotherapy, which is used to treat cancer, has toxic damage on organs and systems human body. The development of cancer can be prevented by undergoing preventive examinations with a gynecologist at least once every six months, as well as paying attention to the characteristic symptoms of cervical cancer in women.

The success of treating the disease depends on the age of the patient, general condition health, therapy chosen by the gynecologist and oncologist, stage and form of cancer. If oncology is diagnosed at an early stage, the prognosis is favorable, the disease can be cured surgical techniques, a woman can have healthy offspring in the future (pregnancy can be planned after 3 years, taking into account the absence of relapses).

Found a mistake? Select it and press Ctrl + Enter

Among all malignant neoplasms in women, uterine cancer is the most common, and its incidence and the number of young patients with this diagnosis are growing. Endometrial cancer is common to postmenopausal women, the average age of patients is 55-60 years, but it can also be found in young girls of fertile age. Features of hormonal levels during the postmenopausal period contribute to various hyperplastic processes of the endometrium. Such changes in the uterine mucosa most often become the “soil” on which cancer grows.

Since the presence of a tumor is accompanied by clinical manifestations already at an early stage, then the number of advanced forms (unlike cervical cancer) is small. The majority of neoplasms are detected quite early (more than 70% in the first stage of the disease), so such a tumor becomes a relatively rare cause of death. Endometrial cancer accounts for about 2-3% of all tumors of the female reproductive system.

Features of the anatomy and physiology of the uterus

Endometrial cancer of the uterus, often called simply uterine cancer, is a tumor that grows from the lining of the organ.

Knowing the basics anatomical structure uterus allows us to more accurately represent the essence of this insidious disease.

The uterus is an unpaired hollow organ, the main purpose of which is bearing a child and subsequent childbirth. It is located in the pelvic cavity, bordered in front by the bladder, and behind it is the wall of the rectum. This arrangement explains the appearance of a disorder of their function in the pathology of the internal female genital organs.

The body of the uterus (the upper section directly involved in pregnancy) consists of three layers:

• Endometrium – inner layer, the mucous membrane lining the surface of the uterus from the inside, subject to cyclical changes under the influence of female sex hormones and designed for favorable implantation of a fertilized egg in the event of pregnancy. Under pathological conditions, the endometrium becomes a source of cancer development.
• Myometrium– a middle, muscular layer that can increase during pregnancy and is extremely important in labor. Tumors of smooth muscle origin (benign leiomyomas and malignant leiomyosarcoma) can grow from the myometrium;
• Serosa- part of the peritoneum that covers the outside of the uterus.

The functioning of the endometrium is maintained through complex interactions between the nervous and endocrine systems. The hypothalamus, pituitary gland and ovaries produce hormones that regulate the growth, development and subsequent rejection of the endometrium during the menstrual phase of the cycle if pregnancy has not occurred. It is violations of the neuroendocrine regulatory mechanisms that most often become the cause of diseases of the female reproductive system, including endometrial cancer.

Risk factors for endometrial tumors

As is known, in healthy tissue the development of a tumor is very unlikely, so it is necessary to have disorders and predisposing factors that will cause a precancerous process and a tumor in the future.

Endometrial cancer occurs more often in women who have excess weight(obesity), with diabetes mellitus, arterial hypertension, and among disorders of the female reproductive system the following predominate:

1. Early onset of menstruation;
2. Late onset of menopause;
3. Absence or only childbirth in the past;
4. Infertility;
5. Neoplasms in the ovaries that can synthesize estrogen hormones;
6. Various menstrual cycle disorders.

causes of endometrial cancer of the uterus

It is known that female sex hormones (estrogens) can accumulate in adipose tissue, so their concentration may increase in obesity. This leads to excessive growth (hyperplasia) of the endometrium and polyp formation. Diabetes mellitus is accompanied by significant endocrine and metabolic changes, including those in the genital organs. Pathology of the ovaries, disturbances in the hormonal regulation of the menstrual cycle, including those caused by stress and nervous overload, also contribute to the occurrence of various changes in the uterine mucosa that precede tumors.

In addition, do not forget about hereditary factor, when various genetic abnormalities predispose to the development of breast, ovarian or endometrial cancers.

Precancerous changes and causes of endometrial tumors

The main cause of the tumor is most often an increase in estrogen levels, produced in the first phase of the menstrual cycle by the ovaries. These hormones promote the growth of the endometrium, increasing its thickness due to cell proliferation and the formation of convoluted glands necessary for the implantation of a fertilized egg. When there is a lot of estrogens, there is excessive growth of the endometrium (hyperplasia), increased proliferation (reproduction) of endometrial gland cells, which creates conditions for disruption of the division processes and the appearance of a tumor.

The processes that precede cancer are endometrial hyperplasiaand polyp formation. Most mature women have encountered such diagnoses at least once in their lives. The likelihood of tumor development as a result of these processes depends on the nature of the endometrial changes.

There are several types of hyperplasia:

• Simple non-atypical hyperplasia;
• Complex (adenomatous) non-atypical;
• Simple atypical hyperplasia;
• Complex (adenomatous) hyperplasia with atypia.

The first two options are characterized by excessive growth of the uterine mucosa with an increase in the number of glands in it. The term “adenomatous” means the presence of a large number of such glands, located close to each other and reminiscent of the structure of a benign glandular tumor - adenoma. Since the epithelial cells of the glands in this case do not differ from normal ones, these types of hyperplasia are called non-atypical (not accompanied by cell atypia) and are considered background processes that will not necessarily cause cancer, but may contribute to its development.

Simple and complex hyperplasia with atypia is a precancerous process, that is, the likelihood of developing a malignant tumor with such changes is quite high. Thus, in the presence of complex atypical hyperplasia, cancer develops in more than 80% of patients. Diagnosis of such changes requires special monitoring by gynecologists and appropriate treatment.

Polyps endometrium are focal growths of the mucous membrane and are most often found among elderly women. Since neoplastic (tumor) transformation of cells with cancer growth is possible in a polyp, it must also be removed.

Cancer that occurs against the background of hyperestrogenism is referred to as the so-called first pathogenetic type and it accounts for about 75% of all malignant neoplasms of the uterine body. Such tumors grow slowly, have a high degree of differentiation and a fairly favorable prognosis.

Sometimes a tumor develops without a previous hormonal imbalance, with a “healthy” endometrium. The reason for this phenomenon is unclear, but scientists have speculated about possible role immune disorders. This type of cancer is classified as second pathogenetic type(about a quarter of cases of cancer of the uterine mucosa). It has a poor prognosis, grows rapidly and is represented by highly malignant, poorly differentiated forms.

Third pathogenetic type Malignant endometrial tumors have recently begun to be identified and their development is associated with hereditary predisposition. This variant is usually combined with malignant tumors of the colon.

The age range of tumor development is noteworthy. Since hormonal disorders accompanied by hyperestrogenism are most often observed during the period of extinction of hormonal activity female body and the onset of menopause, it is not surprising that endometrial tumors are more common in mature and elderly women. In addition, the described underlying conditions and risk factors are also more often diagnosed in older patients. In this regard, even if 15-20 years have passed since the onset of menopause, one should not forget about the possibility of tumor development in long-nonfunctioning organs of the reproductive system.

There is an opinion that long-term use of hormonal drugs can lead to the development of a malignant tumor of the uterine cavity mucosa. As a rule, this effect is achieved by medications with a high dosage of the estrogen component. Since modern hormone therapy drugs contain fairly low concentrations of estrogen and progesterone, the likelihood of tumor growth with their use is minimal, but women taking them still need to be examined regularly.

Features of classification and staging of uterine cancer

There are several classifications of endometrial cancer, but in practical oncology the most applicable:

1. According to the TNM system developed by the International Union Against Cancer;
2. Staging proposed by the International Federation of Obstetricians and Gynecologists (FIGO).

TNM system implies a comprehensive assessment of not only the tumor itself (T), but also the lymph nodes (N), and also indicates the presence or absence of distant metastases (M). Simplified, it can be represented as follows:

• T0 – the tumor was completely removed during curettage and is not detectable;
• T1 – tumor within the body of the uterus;
• T2 – the tumor grows into the cervix;
• T3 – periuterine tissue and the lower third of the vagina are affected;
• T4 – cancer extends beyond the pelvis, grows into the bladder and rectum.

The nature of the lesion of the lymph nodes is described as N0 - no lesion was detected, N1 - metastases are detected by lymphography, N2 - lymph nodes are enlarged and palpable.

The presence or absence of distant metastases is designated as M1 or M0, respectively.

In addition, a special index G has been introduced, denoting degree of cancer differentiation:

• G1 denotes well-differentiated tumors;
• G2 – cancers of moderate differentiation;
• G3 – poorly and undifferentiated tumors.

The G index is extremely important in assessing the prognosis of the disease. The higher the degree of differentiation, the better the prognosis and effectiveness of the therapy. Poorly and undifferentiated tumors, on the contrary, grow quickly, rapidly metastasize and have an unfavorable prognosis.

In addition to TNM, another classification is used that distinguishes Stages of development of uterine cancer:

• stage I (A-C) – when the tumor grows within the body of the uterus;

• stage II (A-B) – the tumor reaches the cervix, grows into its mucosa and stroma;

• Stage III (A-C) characterizes a neoplasm growing within the small pelvis, possibly affecting the peritoneum covering the outside of the uterus, the ovaries with fallopian tubes, however, the bladder and rectum remain not involved in the pathological process;

• Stage IV (A-B), when the cancer reaches the walls of the pelvis and spreads to the wall of the bladder and rectum. During this period, distant metastases in other organs and lymph nodes can be detected.

Of no small importance is the histological type of structure of cancer of the uterine mucosa. Since the endometrium is a glandular tissue, the so-called adenocarcinoma(glandular cancer), occurring in almost 90% of cases, mainly among patients over 50 years of age. In addition to adenocarcinoma, squamous cell, glandular squamous cell carcinoma, undifferentiated and other variants are possible, which are much less common.

The stage of the disease is determined after surgical treatment and pathohistological examination of the removed tumor, lymph nodes, fiber and other tissues. This allows you to most accurately determine the extent of organ damage, as well as establish the histological structure of the tumor itself and the degree of its differentiation. Taking these data into account, a treatment regimen is drawn up and a further prognosis is determined.

Metastasis of endometrial cancer

Metastasis is the process of cancer spreading through the blood, lymph, and serous membranes. This happens because tumor cells, due to their altered structure, lose strong intercellular connections and easily break away from each other.

Lymphogenic metastasis characterized by the spread cancer cells with lymph flow from nearby and distant lymph nodes - inguinal, iliac, pelvic. This is accompanied by the appearance of new foci of tumor growth and an increase in the affected lymph nodes.

Hematogenous route is realized by spreading tumor emboli (clumps of cells circulating in the bloodstream) through vessels to other internal organs - lungs, bones, liver.

Implantation path metastasis consists in the spread of the tumor throughout the peritoneum when it grows into the wall of the uterus, periuterine tissue, and it is also possible to involve the appendages in this way.

The intensity of metastasis is determined by the size and growth pattern of the neoplasm, as well as the degree of its differentiation. The lower it is, the earlier and faster metastases will develop, not limited to regional lymph nodes.

How to suspect cancer?

The main signs characterizing the possible growth of a tumor in the uterine cavity are pain, dysfunction of the pelvic organs and the appearance of discharge from the genital tract, which are:

• Bloody;
• Purulent;
• Profuse leucorrhoea;
• Watery.

Uterine bleeding occurs in more than 90% of endometrial cancer cases. In women of reproductive age, these are acyclic bleeding not associated with menstruation, which can be quite long and heavy. Since this symptom is also characteristic of many other diseases and changes in the uterine mucosa, significant difficulties may arise in the timely diagnosis of cancer. This is partly due to the lack of oncological vigilance among gynecologists in relation to women who have not entered menopause. In an attempt to find other causes of bleeding, time may be lost, and the cancer will progress to an advanced stage of destruction.

In elderly patients during menopause, uterine bleeding is considered a classic symptom indicating the growth of a malignant neoplasm, so the diagnosis is usually made in the early stages of the disease.

Purulent discharge characteristic of large tumors, they appear during their disintegration (necrosis) or the addition of bacterial flora. This condition, when purulent discharge accumulates in the lumen of the uterus, is called pyometra. It is also not surprising that there is an increase in temperature, general weakness, chills and other signs of intoxication and inflammation.

Profuse leucorrhoea characteristic of large neoplasms, and watery discharge- enough specific sign growth of endometrial cancer.

Pain syndrome, accompanying endometrial tumors, is characteristic of late stages diseases, with a significant size of the tumor, its growth into the walls of the small pelvis, bladder or rectum. There may be persistent, quite intense, or cramping pain in the lower abdomen, sacrum and lower back, as well as disturbances in the process of emptying the bladder and intestines.

Lack of awareness among women about uterine cancer, lack of alertness among doctors regarding cancer, ignoring regular visits to the doctor or postponing them even when any symptoms appear, lead to loss of time and progression of the disease, which is detected in an advanced form. In such a situation, treatment is not always effective, and the risk of death from endometrial cancer increases.

Important to remember: self-healing in the presence of cancer is impossible, therefore only timely qualified assistance when the first symptoms of endometrial cancer appear is the key to a successful fight against it.

How to detect cancer?

If suspicious symptoms or complaints appear, a woman should first go to the antenatal clinic. Main diagnostic measures at the initial stage there will be:

• Gynecological examination in mirrors;
• Aspiration biopsy or separate diagnostic curettage of the uterine cavity and cervical canal;
• Ultrasound of the pelvic organs;
• Chest X-ray;
• General blood test, urine test, hemostasis study (coagulogram).

These simple and accessible manipulations make it possible to exclude or confirm the growth of a tumor, determine its size, location, type, and the nature of damage to neighboring organs.

At examination in mirrors The gynecologist will make sure that there is no damage to the vagina and cervix, palpate and determine the size of the uterine body, the condition of the appendages, and the location of the pathological focus.

At aspiration biopsy or curettage, it becomes possible to take tissue fragments with subsequent cytological or histological examination of the tumor. In this case, the type of cancer and the degree of its differentiation are determined.

Ultrasound can be used as a screening for uterine tumors in women of all age categories. The method is accessible for research by a wide range of people, provides a large amount of information, and is also simple and inexpensive to implement. During the study, the dimensions, contours of the uterus, and the condition of the cavity are clarified (the width of the so-called median M-echo is assessed). On ultrasound, an important criterion for cancer will be the expansion of the median M-echo, changes in the contours of the endometrium, and echogenicity.

To clarify data on tumor growth and the condition of other pelvic organs, it is possible to conduct CT and MRI. These procedures also make it possible to study the pelvic lymph nodes and identify metastases.

Rice. 1 - ultrasound examination, Fig. 2 - hysteroscopy, Fig. 3 - MRI

Hysteroscopy is a mandatory study if endometrial cancer is suspected. Its essence lies in the use of a special device - a hysteroscope, inserted into the uterine cavity and allowing one to examine its inner surface with magnification. Also, during the procedure, a targeted biopsy is necessarily taken from the affected area. The information content of the method reaches 100%. Hysteroscopy ends with separate curettage of the cervical canal and the uterine cavity, which makes it possible to evaluate the changes separately and correctly determine the location of tumor growth.

A new method for diagnosing endometrial cancer can be considered fluorescence study, which is accompanied by the introduction of special substances that accumulate in the tumor (photosensitizers) with subsequent registration of their accumulation. This method makes it possible to detect even microscopic foci of tumor growth that are inaccessible to detection using other methods.

The final and decisive stage of diagnosis for cancer of the uterine mucosa will be a histological examination of tissue fragments obtained by curettage or hysteroscopy. This makes it possible to determine the type histological structure tumor, the degree of its differentiation, and in some cases, the presence of tumor ingrowth into the muscular layer of the uterus and blood vessels.

The diagnosis is made after a comprehensive and comprehensive examination of the patient using all the required laboratory and instrumental techniques. Final staging is possible only after surgical treatment with the most accurate assessment of the nature of tissue changes.

From timely diagnosis to successful treatment

The main directions of treatment for uterine tumors are surgical removal of the affected organ, radiation therapy and the use of chemotherapy.

Surgery is complete removal uterus (extirpation) with ovaries, tubes and pelvic lymph nodes. If the operation is difficult or contraindicated, then it is permissible to use modern laparoscopic techniques, in particular hysteroresectoscopic ablation of the endometrium. The essence of the method is the destruction (removal) of the mucous membrane and several millimeters of the underlying muscle layer (myometrium). Such manipulation is possible in women with early forms of cancer in the presence of severe concomitant pathology, which does not allow extirpation or long-term hormone therapy.

During the operation, the ovaries are necessarily removed, regardless of the patient’s age, since they produce female sex hormones, and also often and early become the site of growth of metastases. After surgery, young women develop the so-called post-castration syndrome due to hormone deficiency, but its manifestations disappear after 1-2 months.

It is worth pointing out that more than 10% of patients are elderly and have severe concomitant lesions from the cardiovascular, endocrine system(arterial hypertension, diabetes, obesity, etc.), liver or kidneys. In some cases, these disorders also require correction, since the patient may simply not be able to tolerate surgery or chemotherapy.

If surgical treatment is necessary, for example, for a cardiovascular disease with the subsequent prescription of anticoagulants, then there is a risk of developing massive and dangerous bleeding from the tumor. At the same time, surgery to remove the tumor can lead to the patient’s death from heart complications. In such situations, so-called simultaneous operations are performed: a team of cardiac surgeons operates on the heart simultaneously with a team of oncologists who remove a tumor of the uterine body. This approach allows you to avoid many dangerous complications, and also makes it possible to carry out adequate and complete surgical treatment.

Radiation therapy

For uterine cancer irradiation may be one of the components combination treatment. As a rule, external beam radiation therapy is performed on the pelvic organs or a combined effect. Indications for this method of treatment are determined individually depending on the woman’s age, concomitant diseases, growth pattern and degree of cancer differentiation. For poorly differentiated tumors that grow deep into the endometrium and cervix, combined radiation exposure (external and intracavitary) is indicated.

Since the use of modern equipment allows to reduce the possibility of side effects to some extent, nevertheless radiation reactions inevitable. More often than others, the bladder, rectum, and vagina are affected, which is manifested by diarrhea, frequent and painful urination, and discomfort in the pelvis. If such symptoms appear, you must inform your oncologist.

Chemotherapy not used as a stand-alone method for the treatment of endometrial cancer, but in the composition combination therapy acceptable. The range of drugs effective against such tumors is very limited, and the most commonly used regimen is CAP (cyclophosphamide, doxorubicin and cisplatin). The drugs used in chemotherapy are toxic and have a cytostatic effect (inhibit cell proliferation), which is not limited to tumor tissue, so possible side effects in the form of nausea, vomiting, hair loss. These manifestations disappear some time after discontinuation of cytostatics.

An important approach in the treatment of uterine cancer is hormone therapy, which can be an independent stage in young patients in the initial stages of the disease. It is possible to prescribe antiestrogens, gestagens or their combinations. Treatment hormonal drugs It is well tolerated by patients and does not cause significant adverse reactions.

After the first stage, which lasts about a year, the doctor must make sure that there is no tumor growth (morphological examination of the endometrium and hysteroscopy). If all is well, then you can begin to restore ovarian function and a normal ovulatory menstrual cycle. For this purpose, combined estrogen-gestagen drugs are prescribed.

Prognosis and prevention

The main indicators influencing the prognosis of endometrial cancer are the degree of differentiation (from the result of histological postoperative examination) and the extent of the tumor in surrounding tissues and organs. Usually, at initial forms disease, the tumor is completely cured. Successful treatment is facilitated by early detection of the tumor.

Severe concomitant diseases and advanced age of patients not only greatly worsen the prognosis, but also limit the choice of methods for comprehensive comprehensive treatment.

With the third stage of endometrial cancer, about a third of patients survive, with the fourth - only about 5%, so it is very important to diagnose the tumor in time and not waste time.

All women treated for endometrial cancer are subject to constant dynamic monitoring by gynecological oncologists. In the first year, to prevent the possibility of relapse, it is necessary to examine the patient every four months, in the second year - once every 6 months, then - once every year. Not only a gynecological examination, ultrasound, but also an X-ray of the lungs are required to exclude the appearance of tumor metastases.

Prevention of uterine cancer is extremely important and should be aimed at maintaining normal hormonal levels and the ovulatory menstrual cycle, normalization of body weight, timely detection and treatment of background and precancerous changes in the uterine mucosa. Annual visit required antenatal clinic, examination and ultrasound of the pelvic organs. If any symptoms appear, you should consult a doctor as soon as possible. Any disease, including uterine cancer, is easier to prevent than to treat.

Video: uterine cancer in the “Live Healthy” program

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.

Oncological diseases are quite a pressing problem today. There are many recorded cases of citizens turning to the oncology center for help and diagnosis of such a disease.

Oncology, unfortunately, can spread to any organs in the human body. Tumors arise in various places and can begin to grow anywhere.

Uterine cancer occurs quite often in women today, and according to statistics, this type of oncology is one of the most common.

What is uterine cancer?

This type of tumor is a neoplasm. As is known, neoplasms can be malignant or benign.

A tumor such as uterine cancer can be classified as a malignant tumor.

The formation of such a neoplasm originates, first of all, from tissues located in the uterus, which can spread to all parts of the body.

Cancer is one of the most common diseases and ranks fourth after breast cancer. skin and gastrointestinal tract.

Morbidity statistics

In order to talk about any cancer disease, of course, one cannot fail to note the statistical data on the basis of which appropriate conclusions can be drawn.

As mentioned earlier, uterine cancer is one of the ten most common cancers and ranks fifth among them.

Of course, it should be noted that the emergence of this disease, and the mortality rate for this pathology has decreased significantly in recent years.

Statistics show that this pathology occurs more often in women over 50 years of age. However, according to doctors, young girls are also susceptible to this disease.

Previously, there was an opinion that uterine cancer is one of the main causes of death from malignant tumors. The incidence of such pathology has decreased to 70%.

Types of uterine cancer

There are several morphological types of uterine cancer:

1. Adenocarcinoma;
2. Squamous cell neoplasm;
3. Glandular squamous cell type cancer;
4. Clear cell type adenocarcinoma;
5. Serous type cancer;
6. Mucinous cancer;
7. Undifferentiated cancer.

Causes of uterine cancer

Of course, the formation of uterine cancer is promoted by certain causes and factors that can aggravate the severity of this serious disease.

As such, the exact reason due to which the development and growth of a neoplasm on the uterus begins in modern world not established or studied.

Research has made it clear that the factors contributing to the growth of cancer include the following number of reasons:

One of the most basic and, perhaps, dangerous factors contributing to the formation of cancer is increased body weight.

If a female patient’s body weight exceeds the usual established norm by more than 10-25 kilograms, then the risk of developing a tumor will be tripled.

Some facts also play a very important role in the occurrence of a malignant tumor:

• ulcerative processes
• uterus
• scar formations after childbirth;
• inflammatory processes.

Methods for diagnosing the disease

Diagnostics– a very important stage in any type of cancer. It is very important to diagnose the disease and this process must be organized competently.

Diagnostics includes:

Symptoms of uterine cancer in women

Of course, symptoms play an important role in determining this disease.

A symptom is something that should be paid utmost attention to if the patient feels that something is wrong. It is extremely important for women over forty to pay special attention to their health.

Unfortunately, cancer is one of the diseases whose symptoms appear in the final stages.

Conventionally, symptoms can be divided into several types:

Based on the age category and period of menopause, the following symptoms may appear:

• opening of bleeding;
• pain in the perineum;
• pain in the lumbar region and lower abdomen;
• fatigue and sudden weight loss.

If you have one of the symptoms, you must immediately visit a doctor to eliminate this problem.

Determination of uterine cancer before menopause

As noted earlier, there are symptoms that make it clear that a tumor has appeared before the onset of menopause.

Most often, during such a period, vaginal discharge is already irregular and appears less frequently with each passing month.

It is during this period that symptoms of uterine cancer can include all the discharge with blood from the vagina.

Uterine cancer can be suspected only if the menstrual cycle gradually stops, and then discharge in large quantities begins again.

Manifestation during menopause

At a time when a woman has already begun, namely menopause, symptoms may also arise that need to be given special attention.

As a rule, a woman has not had her period for several months; symptoms of cancer can include bloody discharge, regardless of the frequency with which they appear, for how long and in what volume.

Description of the stages of uterine cancer and life expectancy

There are only four stages of uterine cancer:

1. The first is a tumor that affects only the body of the uterus. The tumor is capable of penetrating in the primary stages to the endometrium, myometrium to half the depth and to more than half the depth of the myometrium.
2. The second type is malignant cells, which are found directly in the cervix. This type of neoplasm can penetrate the body of the uterus and penetrate into the deep layers of the cervix.
3. The third tumor is capable of spreading to the vagina and appendages, as well as to the lymph nodes. This type The tumor can give birth to the external serous layer of the uterus or adjacent appendages, begin to grow in the vagina, and with metastases move to the pelvic lymph nodes.
4. The fourth type of uterine cancer with the spread of metastases manifests itself in bladder or in the rectal area, and also begins to spread to the lungs, liver, bones and distant lymph nodes.

In addition, the degrees of cell differentiation in the neoplasm differ.

There is a fairly high degree of cell existence, as well as a low-differentiated degree. The whole point is that the more differentiation is expressed, the slower the growth process of the neoplasm occurs.

Accordingly, the likelihood of metastases decreases. If the cancer is poorly differentiated, then the prognosis in this situation becomes worse.

Patient life expectancy:

• At the primary stage When the tumor is just forming and begins to populate the uterine body, the patient’s probability of recovery is about 80–90%.
• At the second stage, The cancer begins to penetrate beyond the boundaries of the uterine body itself and then affects the cervix. In such a situation, nearby organs are not affected. Recovery is noted in 3 out of 4 of all cases.
• At the third stage, when the oncological process begins to spread to the appendages and directly to the vaginal area, about 40% can get out of this situation.
• At the fourth stage, when the tumor grows beyond the pelvic area, the formation begins to penetrate the intestines and bladder tissue located in the uterus. The survival rate is no more than 15%.

Development of uterine cancer by stages (photo)

Metastasis

Metastases begin to grow and usually penetrate into lymphatic vessels and nodes.

Being at the terminal stage, the human venous system is also affected.

Initially, the lesion begins to grow in the area of ​​the lymph nodes and its structure. As a rule, this happens in the iliac and hypogastric regions.

It is extremely rare that the lesions involve other organs.

Metastases also grow onto the cervical canal and, as mentioned earlier, beyond the aisles of the uterine body.

With the hemotogenic type method, from which metastases usually begin to penetrate directly into the area of ​​the appendage.

In addition, the vaginal area is also affected, and in some cases the kidneys, liver and bone tissues.

Speed ​​of disease development

The rate of growth and development is determined primarily by the histological type of occurrence. In addition, it is necessary to take into account pathology, the body’s ability to fight, competent treatment and the age category of the patient, the psychological and spiritual mood of the patient.

As such, it will not be possible to get an exact answer and find out over what period of time cancer will develop to the end.

Treatment of uterine cancer

Of course, the basis of competent treatment lies in surgical intervention, namely surgery.

The operation involves the removal of the uterine body in combination with the ovaries.

Very often, doctors prescribe this treatment methodology even after surgery or radio irradiation.

Radiation or radiation therapy can reduce the risk of relapse. However this method treatment has no effect on recovery rates.

Chemotherapy is also used. This method is in demand in oncology therapy.

In addition, good results have been observed with hormone therapy.

It is necessary to determine the appropriate method of therapy, taking into account certain factors. Prevention is the most effective measure to prevent diseases such as uterine cancer.

Methods and techniques of treatment

As noted earlier, treatment is possible in a comprehensive and comprehensive manner.

Very often, doctors force patients to agree to surgical removal of the tumor, radio irradiation, chemotherapy and hormonal therapy.

Surgery

Intervention through surgery is a common type of cancer treatment.

This type of treatment involves surgery, which involves removing the uterine body and ovaries.

Radiotherapy

Radio irradiation is also a popular method of getting rid of cancer. However, this method allows you to get rid of only relapses of cancer.

This type of radiation, unfortunately, does not affect patient survival rates.

Hormone therapy

As is already known, hormones are quite a strong component that helps cure many diseases and can also prolong people’s lives.

Drugs used for this treatment Depostat, Farlugal and others.

If metastases are active, then treatment with progestogen is ineffective.

In this situation, it is prescribed Zoladek.

Very often, treatment with hormones combines chemotherapy to achieve the best effect.

Chemotherapy

Chemotherapy is a fairly common technique that allows, in certain cases, to get rid of cancer.

Quite often, this treatment methodology is used when tumor growth is widespread.

Also, with the autonomous nature of the tumor, if the metastases are in an active position and have begun to spread, chemistry is used.

Consequences of uterine cancer

It is worth immediately noting that uterine cancer is the most dangerous pathological conditions. If there is no therapy as such, which is necessary during cancer treatment, then the consequences of the growth of education will most likely lead to death.

Often, oncologists offer it together with the appendages, with some part of the vagina and cervix.

As a rule, uterine cancer is detected in women whose age ranges from 45 to 60 years.

Differences between uterine cancer and fibroids

- this is a process that represents an increase and growth of uterine tissues, which are formed as a result of some traumatic factors.

Frequent abortions, curettage, inflammatory processes of the genitourinary system and much more can contribute to this.

It is worth noting that uterine cancer and fibroids have nothing to do with each other. These two pathologies are completely different and fibroids cannot develop into cancer in any situation.

It is also worth noting that oncology is formed in the epithelial layer, benign finds itself in the muscle layer.

That is why any patient should visit a gynecologist for examination.

Prevention of uterine cancer

To prevent such a disease, it is necessary to avoid diagnoses such as diabetes, obesity and infertility.

In other words, you need to control your body weight, treat reproductive functions, if there is such a need and get rid of diabetes, if you have it.

IN modern medicine There is another measure to prevent cervical cancer - vaccination.

Vaccination against cervical cancer is a vaccine that prevents infection with the dangerous human papillomavirus. The occurrence of a malignant tumor is provoked by approximately 15 types of HPV, of which types 16 and 18 are the most oncogenic.

By itself, it cannot cause the development of the disease or provoke its exacerbation, but it forms stable immunity to all oncogenic types of HPV.

It should be noted the importance of such a means of prevention, because often even the use of the most innovative techniques treatment of a malignant tumor does not give the desired result, which leads to death.

Therefore, it is better to prevent the disease through vaccination, which prevents infection, which doctors recommend for girls aged 12 years and older.

There is also secondary prevention, which suggests that women over 40 years of age be examined year after year using ultrasound. This type of procedure helps detect cancer even in initial state and increase the chances of successful treatment.

Patient survival prognosis

As noted earlier, the survival rate primarily depends on the factor at what stage the cancer was found.

The sooner a reason arises and the patient visits a doctor and can diagnose cancer, the greater the chance of living long and beating cancer.

This suggests, first of all, that it is necessary to regularly visit a gynecologist and undergo the required tests and examinations.