Removal of the uterus for stage 1 cancer. Uterine cancer: how to recognize the disease at an early stage, methods and effectiveness of treatment

Staging is the process of collecting and analyzing information about a malignancy in order to determine the extent of its spread. The stage and final grade of malignancy (endometrial cancer) are the most important factors in choosing a plan.

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How are cancer stages classified?

The two systems used to stage uterine cancer (the International Federation of Obstetricians and Gynecologists' FIGO system and the American Joint Committee on Cancer's TNM staging system) are virtually identical.

Both approaches classify cancer based on 3 factors:

1. tumor size (T);
2. spread of cancer in The lymph nodes (N);
3. spread of cancer in remote internal organs and structures (M).

The system described below is the latest development of the American Joint Committee on Cancer. It came into force in January 2010. The difference between this system (AJCC) and the FIGO system is that the latter does not distinguish between stage 0 cancer.

On what basis is the stage of the disease determined?

The stage of uterine cancer is determined by examining tissue removed during surgery. This process is called surgical staging. The need for such diagnostics is driven by the fact that doctors often cannot accurately determine the stage of cancer until they receive tissue samples.

Before surgery, your doctor may order imaging tests:

1. Ultrasound;

This is done in order to determine signs of the spread of pathology. Although the accuracy of these methods is inferior to that of surgical staging, the information obtained can be useful in planning surgery and other procedures.

If diagnostic images indicate that the cancer may have spread beyond the uterus, you will be referred to a gynecological oncologist (if you have not already seen one).

What is the extent of tumor spread?

The staging system is based on determining the extent of cancer spread:

• The disease can spread locally, on and other parts of the organ.
• Cancer can also spread regionally and hijacking nearby lymph nodes (bean-sized organs that are part of the immune system). Regional ones are located in the pelvic cavity, slightly further from the uterus and parallel to the aorta (the main artery leading from the heart down the back of the abdomen and pelvis). The lymph nodes located along the aorta are called para-aortic lymph nodes.
• Cancer can spread to distant organs: The lymph nodes, top part abdominal cavity, omentum (a large piece of fatty tissue in the abdominal cavity that covers the stomach, intestines and other organs like an apron) or other internal organs and structures, including the lung, liver, bone and brain.

Tumor size (T)

• T0: There are no signs of tumor in the uterus.
• Tis: Pre-invasive cancer, also called carcinoma in situ. Cancer cells are found only in the superficial layer of the endometrium and do not grow into the lower cellular layers.
• T1: The tumor grows only in the uterine cavity. The pathology can also involve the glands of the cervix, but does not grow into the supporting connective tissue of the cervix.
• T1a: Cancer is found in the endometrium (the lining of the uterus) and may involve less than half of the lower muscle layer (myometrium).
• T1b: Cancer has grown from the endometrium into the myometrium, covering more than half the thickness of the muscle layer. The disease has not spread beyond the boundaries of the uterine body.

• T2: Cancer has spread beyond the uterine body and is growing into the uterine support. connective tissue cervix (cervical stroma). Pathology is limited to the uterus.
• T3: The cancer has spread outside the uterus but has not reached the lining of the rectum or bladder.
• T3a: The disease has taken over outer surface uterus (serous membrane) and/or fallopian tubes or ovaries (appendages).
• T3b: Cancer has spread to the vagina or tissue surrounding the uterus (parametrium).
• T4: The disease has affected the inner (mucous) lining of the rectum or bladder.

Spread to lymph nodes (N)

• NX: Extent of spread to lymph nodes cannot be determined.
• N0: Cancer has not invaded nearby lymph nodes.
• N1: Cancer has invaded the lymph nodes in the pelvic cavity.
• N2: The pathology has spread to the lymph nodes along the aorta (periaortic lymph nodes).

Distant metastases (M)

• M0: The cancer has not spread to distant lymph nodes, organs or tissues.
• M1: Cancer has spread to distant lymph nodes, the upper abdomen, omentum, or other internal organs (such as the lungs or liver).

Cancer stages according to the AJCC system and the FIGO system

To determine the stage of a disease, doctors combine data about the tumor, lymph nodes, and secondary cancer sites, grouping individual stages together to derive an overall measure. The stages are designated by the Arabic numeral 0 and the Roman numerals I to IV. Some stages are divided into substages with corresponding letters and numbers.

Stage 0

• Tis, N0, M0: This period of cancer development is also called carcinoma in situ. Malignant cells are found only in the superficial layer of the endometrium and do not grow into the lower cellular layers. The cancer has not spread to nearby lymph nodes or distant internal organs and structures. This is a precancerous condition. This stage is absent in the FIGO system.

Stage I

Stage II

• T2, N0, M0: Cancer has spread beyond the uterine body and into the supporting connective tissue of the cervix, called the cervical stroma. The pathology did not go beyond the boundaries of the organ. The cancer has not spread to lymph nodes or distant structures.

Stage III

• T3, N0, M0: Cancer has spread either outside the uterus or into nearby tissue in the pelvis.
• Stage IIIA (T3a, N0, M0): The disease has spread to the outer surface of the uterus (the serosa) and/or the fallopian tubes or ovaries (appendages). The cancer did not invade the lymph nodes and did not form distant metastases.
• Stage IIIB (T3b, N0, M0): The cancer has affected the vagina or the tissue surrounding the uterus (parametrium). The disease has not spread to lymph nodes or distant structures.
• Stage IIIC1 (T1-T3, N1, M0): The tumor grows in the body of the uterus. It may involve some of the nearby tissue, but the cancer does not grow into the bladder or rectum. The pathology has spread to the lymph nodes, but has not affected the lymph nodes along the aorta or distant internal organs.
• Stage IIIC2 (T1-T3, N2, M0): The tumor grows in the body of the uterus. It may involve some of the nearby tissue, but the cancer does not grow into the bladder or rectum. The pathology has spread to the lymph nodes around the aorta (periaortic lymph nodes), but has not formed.

Stage IV

The disease affects the inside of the bladder or rectum (lower segment of the large intestine), lymph nodes in the groin, and/or distant structures including the bones, omentum, or lungs.

• Stage IVA (T4, any N, M0): The cancer has invaded the inner (mucous) lining of the rectum or bladder. Possible spread to lymph nodes. There are no distant metastases.
• Stage IVB (any T, any N, M1): The cancer has spread to distant lymph nodes, the upper abdomen, the omentum, or structures away from the uterus, including the lungs or bones. The tumor can reach any size. The disease may spread to the lymph nodes.

Cost of treatment for uterine cancer in Israel

The table below will show the prices of some diagnostic and therapeutic procedures prescribed for uterine cancer in.

You need to contact medical Center by calling +7-495-777-6953 or +972-3-376-03-58, and also by sending the completed form on the website. After this, our representative will contact you. Next, a treatment plan for uterine cancer is drawn up, indicating the price of services. Receiving the document does not impose any obligations on you, and all consultations are free.

We also guarantee full compliance with medical etiquette in terms of non-disclosure of information.

Every day, almost one and a half thousand women around the world learn that they have cervical cancer. Because symptoms appear too late, the chances of cure are lower and life expectancy is shortened. This can be avoided if cervical cancer is diagnosed at stage 1.

Characteristic symptoms of this stage

Most cases of detection of cervical cancer (CC) occur when a woman’s disease is already in an advanced form. The main reason why early diagnosis is difficult is the absence or mild severity of symptoms.

The first stage of cancer is the initial stage, during which epithelial cells just begin to rapidly divide. It is impossible to notice this with the naked eye. If the patient has no complaints, the gynecologist will not be able to detect this disease during the examination.

Detection of cancer at the very beginning contributes to a favorable treatment outcome in more than 90% of cases, therefore oncologists and gynecologists recommend paying close attention to the following symptoms:

Although these symptoms may also appear due to other, less serious illnesses, it is worth visiting a doctor if they appear.

Diagnostics

If a girl or woman has complaints characteristic of cervical cancer, or were identified during an appointment with a gynecologist, then a more thorough diagnosis is carried out.

First of all, a smear is done for cytology. Thanks to a special brush, epithelial cells from the suspected focus of the disease on the cervix are transferred to a special glass, after which it is examined under a microscope. This way you can detect cells that are evidence of a precancerous condition or cancer.

If the PAP test shows the presence of atypical cells, then an additional colposcopy or biopsy is performed. The method chosen will depend on the number of cells and the nature of the changes present.

A cytological smear is a screening method for cervical cancer, i.e. performed on a regular basis for early diagnosis of cancer. This approach is the best for identifying pathologies and improves treatment results.

Detected changes in the epithelium do not always lead to the development of cancer; despite this, treatment is prescribed that affects the changed cells mechanically or thermally. In the future, this can lead to complications during pregnancy, and also increases the risk of premature birth and death of the newborn. Therefore, it is recommended from 25-30 years old.

If during the study there is every reason to diagnose cancer, then additional examinations to clarify the size of the tumor and the stage of the disease, because cancer cells could already have spread and there may be more affected organs. The following methods can be used for this:

• CT scan;
• Magnetic resonance imaging;
• X-ray;
• cystoscopy;
• positron emission tomography.

At the first stage of cervical cancer, changes in the epithelium affect only the cervix, without spreading to other organs. This stage is divided into 2 substages:

1. At this stage the quantity cancer cells so small that they can only be seen with a microscope. The affected area does not exceed 7 mm in width and 5 mm in depth.
2. In the second substage, changes in the epithelium can be seen without using a microscope, but they do not exceed 4 cm in width.

Treatment methods

If cancer was detected at the initial stage, when the affected area is small and does not affect the uterus, vagina and adjacent tissues, then low-traumatic methods can be used. This can be electrocoagulation and laser cauterization. They only affect the tumor itself. During this procedure it is used local anesthesia, the patient is conscious.

If the epithelium affected by cancer cells spreads to the uterus or, then surgery may be required to completely remove the uterus, and in some cases, the fallopian tubes and ovaries. Radiation therapy is often given to increase the chances of a full recovery and prevent the cancer from recurring. The use of radiation in combination with chemotherapy is also acceptable. The need to use a particular treatment method is determined by the doctor based on the results of the examination.

After surgery, it will take some time to recover. If methods were used without completely removing the uterus, the process takes no more than 2 weeks. After a hysterectomy, it takes 2-3 months to recover.

Possible complications

Thanks to the treatment of stage 1 cervical cancer, it is possible complete cure, but complications may arise as a result. The most common side effect of treatment is a narrowing of the vagina. Because of this intimate relationships with a partner become difficult, because during sex there are unpleasant sensations and even pain. In order to cope with this problem, the doctor may prescribe a special hormone-containing cream that will increase the elasticity of the walls and increase the amount of lubrication.

Another method in this case would be to use special vaginal dilators in the form of tubes. They are different sizes, and their use helps to stretch the vagina and make it more flexible.

Due to the removal of the ovaries or after exposure to radiation therapy, an early onset of menopause and impossibility are possible. Early menopause may be accompanied by the following symptoms:

• vaginal dryness;
• tides;
• decreased interest in sex;
• urinary incontinence when sneezing or coughing;
• thinning of bone tissue, which can lead to osteoporosis in the future.

To make symptoms less pronounced, prescribe hormonal drugs, replenishing the lack of those hormones that were produced in the ovaries before.

If lymph nodes are removed during the treatment of cervical cancer, then in the future this may lead to impaired drainage of fluid from the body, especially from the legs. As a result, large swelling may occur. Massage and special compression clothing will help cope with this problem.

A common consequence of cancer is deterioration emotional state, which increases the risk of depression several times. Such patients benefit greatly from cognitive behavioral therapy and a course of antidepressants.

Prevention

Preventive measures are aimed at reducing the risks that lead to cervical cancer. They are treated as general recommendations, for example, maintaining healthy image life, exercise, changing eating habits and giving up bad habits, especially from smoking, and narrowly targeted ones, such as vaccination.

Women who are infected with the human papillomavirus (HPV) are at risk, so getting vaccinated against this infection can help prevent the tumor.

For this purpose, special vaccines are used that effectively protect the body from infection with oncogenic types of HPV. This method will only be effective if this virus is not yet in the patient’s body. Therefore, the best age to get vaccinated is from 10 to 26 years or before the start of sexual activity.

Forecast

At the first stage, the prognosis is the highest due to the fact that the cancer does not metastasize to other organs. The rates are based on a five-year period from diagnosis and are 95-99% for the first substage and 80-90% for the second. Patients who have coped with cancer in the future need to undergo regular examinations by a gynecologist and attend consultations with an oncologist to prevent relapse.

Cervical cancer is the fourth most common cancer oncological diseases among women. What is it? (the disease may be referred to as the abbreviation “CC”) is a malignant tumor of the female genital organs.

Most often it affects the female population after 45 years. But throughout recent years this disease has become somewhat younger.

In most cases, this terrible disease is gaining momentum unnoticed and with virtually no signs, and treatment for stage 1 cervical cancer is not prescribed on time. It can only be identified at an appointment with a gynecologist.

Causes of cancer

• a large number of abortions;
• inflammatory genital infections;
• venereal diseases;
• long-term use of hormone-based medications;
• a large number of partners, both for the woman and her man;
• intimate life that began early;
• pregnancy at too early an age;
• bad habits (mainly smoking);
• violation of sexual hygiene.

Malignant formations can appear if you do not get rid of chronic erosion, endorcevicosis, dysplasia, adenomatosis, and endorcervitis.

Signs of stage 1 cervical cancer are almost invisible. The patient does not have any anxiety or concern, and therefore she does not go to the doctor.

As a rule, a cancerous tumor is discovered by chance, but then it is no longer stage 1 of development, but already the second, if not worse. That is why girls need to be regularly observed by a gynecologist as much as possible, so that the initial stage is missed.

Over the past 30 years, incidence rates have decreased. Awareness and screening help reduce mortality from a diagnosis of cervical carcinoma, but its occurrence is still striking.

In 2014, there were approximately 13,000 new cases of invasive cervical cancer.

Some symptoms of stage 1 cancer

Here are the signs of cervical cancer, which will most often help to recognize the symptoms in the early stages of the disease and reduce the risk of mortality from this disease:

1. Leg pain.
   This indicator can often go unnoticed, but is one of the first physical signs of a problem. When attacked by cancer cells, the organ will swell and blood flow to the organ will decrease. lower limbs, causing your feet to ache and swell.
2. Painful urination.
   The cervix and urinary tract are more interconnected than you might think. Urinary tract infections can be the result of bacterial contamination from the vaginal walls and therefore, metastatic cervical cancer will cause irritation and inflammation of the muscles around the bladder and make urination very painful. As a rule, this will be a sure sign of the spread of the disease, which will metastasize to surrounding tissues, and must be immediately diagnosed by a doctor in order to begin treatment.
3. Abnormal discharge.
   Vaginal discharge should be relatively odorless and without any particular color. One of the first signs of a problem in the vagina is discharge, which has an unpleasant color and odor. Fungal infections should not be left without treatment, as they can become a barrier to further control of the disease.
4. Unusual bleeding.
   One of the most common and alarming symptoms is heavy and unscheduled bleeding. When fighting abnormal cells, female organ will make attempts to form a protective coating, and as a result, unscheduled menstruation.
5. Uncomfortable sensations.
   Uncomfortable or unpleasant sensations in the vagina during sexual intercourse may be a sign of other diseases; this should never be ignored.
6. Irregularity of menstruation.
   For most women there is a level of normality or consistency in their menstrual cycle, as well as any sudden changes or missed periods may be a sign of poor health or malignant in nature. If the irregularity persists, then you should take note of any daily diet or medication changes and talk to your doctor so that therapy can be prescribed.
7. Irregular urination.
   Similar to the menstrual cycle, the urinary tract must function in a cycle and irregular urination or incontinence, or a very small amount, is one of the early symptoms of the disease. Even more significant is the appearance of blood in the urine, which may indicate a severe stage of the disease.
8. Pelvic pain.
   Aching in the pelvic area is not uncommon for many women, but is severe or sharp pain in the pelvic area outside of menstruation may indicate a cancer syndrome.
9. Lower back pain.
   Sometimes pelvic pain can affect the supporting muscles of the lower back, causing them to tighten. It is important that you pay attention to the cause of any lower back discomfort, as this is often the most undiagnosed symptom of this terrible disease.
10. Radical weight loss and fatigue.
    Cervical cancer stage 1, stage 2, 3 and 4, no different from other types of this disease, reduces the production of healthy red blood cells, as a result the number of white blood cells can make the body weak and tired, as well as lack of appetite are all symptoms early stage cervical cancer.

Of course, every patient with such a diagnosis has the question: “How long do they live?” Normal life with cancerous tumor possible before the onset of metastasis.

And this happens differently for every woman. You can live with such a diagnosis as the first stage of cervical cancer for a very long time. It all depends on how quickly it begins to develop.

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.

Basic pathogenetic species diseases:

• 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. She is sensitive to progestogens and has 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;
• incorrect treatment estrogens, 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 along lymphatic vessels.

Exists genetic theory cancer, according to which cell mutations are programmed into DNA.

The main stages of the formation of a malignant tumor of the 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 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 likelihood of recovery is quite high.

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

Cancer is localized in the area of ​​the fundus and body of the uterus, in its lower segment the tumor is found less often.

Symptoms

Often, a patient consults a doctor when she experiences the first signs of uterine cancer in the early stages. First of all, these are irregular bloody issues in young women that do 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. This may cause difficulties in early diagnosis of the disease, especially in young women. They can be observed for a long time about.

Other symptoms of uterine cancer appear over late stages. When blood accumulates in the organ cavity, pain appears in the lower abdomen. Long pain syndrome occurs when a 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 oncopathologies - 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 a high rate of 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. By blood vessels tumor cells enter 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. He is considered additional method to assess 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 dilation of the 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 – the most important method diagnostics, allowing 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?

A modern method for detecting the early stages of endometrial cancer is 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 opportunities 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 likelihood of incomplete removal of 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 should 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 healthy.

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 cancer of the 1st degree (stage) it is used complete removal uterus and appendages (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 injection is prescribed after surgery. radiation therapy.

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 surgery and radiation treatment. 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 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.

In the event that a young woman has completed the full course of treatment with good effect, she may become pregnant in the future. To restore fertility, doctors prescribe courses of hormonal therapy that restore 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.

The female reproductive system is one of the most vulnerable areas of the body. The cervix acts as a protective barrier between pathogens and the uterine body. Under the influence of certain factors, a malignant neoplasm can form in the tissues of an organ. Cervical cancer is one of the most dangerous diseases. For a long time, the oncological process is asymptomatic. The first characteristic sign appears at stages 3-4, when the possibility of recovery decreases. The disease mainly affects women after 40-45 years of age, but in the last 5-10 years, cancer has been diagnosed in girls 20-35 years old.

Cervical cancer is a malignant neoplasm formed from the genomes of stratified squamous epithelium. A tumor can form on the surface layer of the cervix or in the tissues of the cervical canal.

ICD-10 code for pathology:

• C53.0 “Cancer of the cervix (internal part)”;
• C53.1 “Cancer of the cervix (external part).”

The area where two different tissue fibers connect is considered extremely vulnerable to the development of cancer. Malignant tumors are most often diagnosed here.

Depending on the type of cells involved in the formation of the tumor, two types of cancer are distinguished:

• Squamous cell carcinoma is a neoplasm with the presence of squamous epithelial genomes. It occurs most often - up to 90% of cases. It can be keratinizing and non-keratinizing.
• The glandular type, or adenocarcinoma, is characterized by a predominance of columnar epithelial pathogens. Diagnosed quite rarely - up to 18% of total number sick.

Mixed formations are known when both types of epithelium are present. Depending on differentiation, three types of pathology are distinguished: highly differentiated, moderately differentiated and poorly differentiated type. The most dangerous is considered to be poorly differentiated due to aggressive growth into distant areas of the body. Pathology is difficult to treat medical procedures, the prognosis for the patient is usually sad.

The squamous cell type is considered more favorable, because develops slowly and responds positively to therapeutic manipulations.

A woman of reproductive age – after 30 years – is at risk. Examples are given in medical practice, when cancer was diagnosed in girls under 25 years of age.

Reasons for the development of pathology

Doctors do not yet know the exact reasons for the development of the disease. There are a number of factors that are prerequisites for the formation of a malignant tumor. A person with papilloma virus type 16 or 18 is at risk. Today doctors consider this factor to be the main cause of cancer formation.

The virus in epithelial cells causes transformation of normal genomes, which leads to degeneration into cancer and the formation of dysplasia. After some time, the precancerous process in the tissues of the cervix develops into a malignant one. If the HPV virus is in the body, a woman is recommended to undergo cancer screening once a year. This will help identify the tumor in the early stages of formation.

The main causes of the disease are:

• Sexual contact without using contraception (condom).
• Early intimate life - up to 16 years.
• A large number of sexual partners.
• The presence of viral diseases.
• Frequent childbirth.
• Termination of pregnancy more than 3 times.
• Abuse of alcoholic beverages and smoking.
• Injury to cervical tissue.
• Living in an environmentally unfavorable area.
• Unbalanced diet - deficiency of plant fiber, excess of animal fats and carbohydrates.
• Reproductive age.

The disease usually occurs when a number of factors combine simultaneously. Don't try to preventive measures exclude the only one dangerous factor– this will not help prevent the development of cancer. An integrated approach will be required.

Classification of the first stage of cervical cancer

Stage 1 cervical cancer is divided into two main substages:

• microinvasive type or stage 1A (T1A);
• macroinvasive type or stage 1B (T1B).

Microinvasive cervical cancer forms predominantly in the basal layer of the epithelium in small quantities; the tumor can be detected using powerful high-resolution equipment. The preliminary diagnosis will be confirmed by histology of the obtained biological material.

Microinvasive cancer stages 1A1 and 1A2 cannot be detected visually - the size of the tumor does not exceed 3 mm. A grade 1A1 neoplasm is the preclinical stage of cervical cancer, i.e. the disease is on the border between the formation of a severe stage of dysplasia and a visually detectable neoplasm. There are no symptoms at this stage. Only foreign vaginal discharge is noted, but the first diagnosis shows the pathologies present reproductive system– inflammatory processes, erosion or dysplasia. Detection of grade 1A disease increases the patient’s chance of full recovery after the course of therapy.

Macroinvasive cancer corresponds to substage 1B of stage 1 cervical cancer. The stage refers to clinical form malignant pathology. The size of the tumor does not yet exceed 10 mm and is located in the cervical area, but during colposcopy with visual examination a suspicious lump is detected. After surgery to excise diseased tissue, a woman has a chance for a complete cure.

There are substages of stage 1 pathology with characteristic features:

• The tumor of the first degree is located within the boundaries of the cervix, without going beyond its limits.
• Stage 1A or T1A is microinvasive cancer.
• The cancerous process at substage 1A1 (T1A1) grows into the stroma of the cervix up to 3 mm; its width can reach 7 mm.
• Stage 1A2 or T1A2 is characterized by penetration into the stroma up to 5 mm, but the size of the neoplasm does not exceed 7 mm.
• A tumor of grade 1B (T1B) is defined as macroscopic, difficult to determine visually, but the depth of germination does not correspond to stage 1A.
• Cancer at stage 1B1 (T1B1) can be detected during a routine examination by a gynecologist; the size ranges from 10-40 mm.
• A grade 1B2 (T1B2) induration extends beyond 40 mm and is considered a visible tumor.

Signs characterizing the first stage of cervical cancer

High mortality from cervical cancer is associated with asymptomatic disease during long period time. The disease usually appears at stages 3-4, when treatment is complicated by the presence of metastatic growths. Therefore, for a woman, detection of a tumor at stage 1 guarantees a complete recovery.

The precancerous process does not have characteristic signs by which the disease can be identified. But there are several symptoms that help detect foreign compaction in the tissues of the cervix.

The following are distinguished: characteristic symptoms 1st degree pathology:

• Stage 1A disease is characterized by the presence of liquid discharge from the vaginal cavity of a transparent shade - this symptom is considered the beginning of the formation of invasive cancer. As the tumor enlarges and grows into the stroma, the capillaries with lymph are damaged, which leads to the development of lymphorrhea.
• At stage 1B, the cancerous lump continues to spread abnormal cells deep into the cervical epithelium, which is accompanied by extraneous vaginal discharge mixed with blood. Sometimes blood may appear after sexual intercourse.

Minor discharge from the uterus is considered normal or a symptom of mild inflammatory process. Blood impurities may be present in the presence of other diseases - cervical erosion, polyps or dysplasia, fibroids and endometriosis. These pathological formations make it difficult to detect cervical cancer at the initial stage. Only a highly qualified doctor can determine the disease after a series of diagnostic procedures or by chance when examining a woman for another gynecological disease.

Diagnosis of the disease

The diagnosis can be confirmed using different types diagnostics The course of therapy used will depend on the test results, which will help the doctor assess the patient’s condition. If a woman is suspected of having an oncological lump in the tissues of the cervical canal, she is sent for an extensive examination, where tissue from the problem area and blood are examined for the presence of a specific antigen.

To confirm the diagnosis, diagnostic procedures are used:

• The doctor examines the cervix using a speculum and a rectovaginal examination.
• A smear is taken from the cervical canal to perform an oncocytology procedure, a PAP test, and to check for the presence of malignant cells.
• Colposcopy is done together with a biopsy of the problem area with scraping of the surface layer in the area of ​​the cervical canal; if necessary, scraping of the mucous surface in the uterus is performed.
• A woman is recommended to undergo a wedge biopsy - electrosurgical excision is used using the LEEP method or conization of the mucous membrane of the problem area is performed (the resulting samples are sent to the laboratory for histological examination).
• The diseased organ is studied using ultrasound examination: check the pelvic area and abdominal cavity (prescribed if there is a compaction of more than 40 mm).
• Computed and magnetic resonance imaging of the genitourinary system is performed using a contrast agent - this improves the quality of the resulting images; the problem area is examined layer by layer, which allows you to obtain detailed information about the tumor.
• Positron emission tomography is required to determine possible metastatic growths in the tissue of the lymph nodes and in other organs.

The biological material obtained during the biopsy is sent to the laboratory for histological and histoimmunochemical examination. The following tumor parameters are determined here:

• Type malignant neoplasm– adenocarcinoma, squamous cell carcinoma and so on.
• The compaction differentiation parameter (G) is determined.
• The degree of germination of atypical cells into the stroma and other layers of the cervix.
• The presence of atypical cells in vessels with lymph or blood is detected: when marked on the diagnostic sheet, LVSI+ indicates that the cancerous tumor has grown in the vascular tissue (considered an unfavorable prognosis for the patient), the value LVSI- characterizes the absence pathological process in the area of ​​blood flow (for a woman this is a favorable sign).
• The presence of an oncological process in the adjacent tissues of the area is revealed after the tumor excision procedure.
• Specific histoimmunochemical parameters are determined.

The degree of differentiation characterizes the similarity of cancer cells to normal ones. The closer the abnormal cells are to the structure of normal ones, the more favorable the prognosis for the patient. In this case, the compaction grows slowly, is easily amenable to therapeutic manipulation, and metastases are observed in isolated situations.

Cervical cancer has 3 degrees of differentiation:

• G1 is a highly differentiated cancer with a favorable course of the disease: there are no metastases, growth is slow.
• G2 moderately differentiated tumor type is less aggressive form pathology.
• G3 is a low-grade tumor of high malignancy with an unfavorable prognosis for women.
• Gх means that it was not possible to determine the degree of differentiation.

Treatment of stage 1 cervical cancer

It is possible to determine the type of oncological neoplasm by conducting a histological examination and conization of the suspicious area. If there are abnormal cells in the tissues of the operated area, repeat histology is performed. Sometimes a hysterectomy is prescribed using the Wertheim method - radical resection of the tumor. During excision, the uterine body, ligamentous apparatus of the uterus, regional lymph nodes are removed and 20 mm of the vaginal cuff is captured. After the excision procedure, the diseased tissue is again sent to the laboratory for histological examination.

Features of treatment for stage 1A cervical cancer

Treatment of microinvasive cervical cancer demonstrates the following features:

• When LVSI pathology is detected in a girl at a young age, it is necessary to preserve fertility, and extensive conization of the organ is performed.
• Diagnosed with an LVSI+ tumor at a young age with the need to preserve fertility, wide conization of the cervix with bilateral pelvic lymphadenectomy and extended trachelectomy is prescribed (the cervix with adjacent tissue and the upper third of the vagina is removed, an anastomosis is performed between the uterine body and the vagina).
• A diagnosis of LVSI cancer has been made and there is no goal of preserving fertility - a standard hysterectomy is performed with removal of the appendages and uterine body.
• The disease was detected in a woman in adulthood with other concomitant diseases - radical hysterectomy with removal of the uterine body and appendages is used.

Irradiation with radioactive substances is used in conjunction with surgical intervention or as monotherapy. Radiotherapy courses are carried out remotely, intracavitarily, or combine both methods. In the case of diagnosing microinvasive cervical cancer of the cervical uterus of 1A degree, gamma ray irradiation is often used instead of surgery if there are certain contraindications or the patient refuses surgery. Chemotherapy courses are usually not used at this stage due to the small size of the tumor and insignificant growth into the stroma of the organ.

Therapeutic manipulations in the fight against neoplasm stage 1B

There are no specific methods for treating pathology at stage 1B. The doctor determines the course of treatment individually. This takes into account the woman’s age, medical indications, the patient’s well-being and the medical equipment of the clinic. The disease can be treated with surgery, the combined use of chemotherapy and radiation with radioactive substances, and using all three methods.

The surgical intervention consists of radical extirpation of the uterine body according to Meigs - the uterus is removed along with the appendages, the third of the vagina that is located on top, the adjacent tissue, lymph nodes and the cardinal, cross-uterine ligaments of the pelvic walls. The obtained samples of atypical tissue are sent to the laboratory for histological examination to determine postoperative manipulations.

After surgery, adjuvant treatment is used, depending on the histological results obtained regarding disease progression. Dangerous symptoms after analysis the following are considered:

• there are metastatic sprouts in the area of ​​the lymph nodes;
• the degree of differentiation is defined as G3, which complicates the patient’s situation;
• the diagnosis was established with the mark LVSI+;
• the neoplasm exceeds 30 mm in size;
• endophytic growth of an atypical compaction was diagnosed - a barrel-shaped cervix was identified;
• the operation was carried out with partial resection of the diseased organ;
• The results obtained do not reflect the entire picture of the pathology.

If after histology no relapse of the pathology is detected, the woman is simply under the close supervision of a doctor. There is no treatment after surgery. When identifying high risk Further progression of the pathology after radical resection, the patient is prescribed courses of radiotherapy with chemotherapy. Typically, Cisplatin is used once every 7 days during the entire period of exposure to radioactive substances. The postoperative method lasts up to 6 weeks.

Sometimes used conservative treatment without surgical intervention. Here they use radiation therapy or treat the tumor with medicines from the group of cytostatics. Indications for such treatment are the following symptoms:

• surgical intervention cannot be used for various objective reasons;
• the patient refused the operation;
• the neoplasm is at stage 1B2 - in this case, individual indicators are taken into account.

If a compaction of more than 40 mm is detected (corresponding to stage 1B2 of the cervical canal), courses of chemotherapy are prescribed before surgery. This allows you to stop the further growth of the atypical formation, which will help reduce the size of the tumor. Courses of therapy are selected individually. This is influenced by a lot of factors - age, health, type of pathology and medical indications.

Postoperative period

After a treatment course in the fight against cancer, the patient must be under medical supervision for the rest of her life. 2 years after therapy or surgery, a woman should undergo the following procedures every 3 months:

• blood is taken to study SCC antigen cells;
• physical examination by a gynecologist and oncologist;
• make a smear for cytological examination;
• ultrasound examination of the pelvic organs, abdominal cavity and retroperitoneal space.

During the period of 3-5 years, diagnostic procedures are carried out every 6 months. After 6 years of therapy, a woman undergoes diagnostics once a year. The sternum area is examined using x-rays annually. If suspicious symptoms appear, the patient is sent for computed tomography and magnetic resonance imaging.

Nutrition for cervical cancer

During illness and after a course of therapy, nutrition is important for a woman. A proper and balanced diet will help restore the deficiency of microelements and vitamins that are required for recovery. There is a list of harmful and healthy foods.

For stage 1 cervical cancer, the following must be excluded:

• alcoholic drinks;
• limit consumption of table salt;
• salted, pickled and canned foods must be removed from the diet;
• chocolate and products based on this ingredient;
• sweet pastries made from white flour;
• Sweet carbonated drinks should not be consumed;
• It is strictly forbidden to consume fast food;
• sausage from different types of meat and other offal should be removed from the diet;
• consumption of animal fats should be limited;
• margarine and butter are prohibited.

After surgery and during illness, you must adhere to proper nutrition– cook food only by steaming, boiling or in the oven. Vegetables are best eaten raw. It is necessary to increase the amount of greens, fruits and berries. Useful products are considered:

• lean meat - chicken, turkey, rabbit;
• You should also choose low-fat fish - pollock, chum salmon, etc.;
• you need to take 1% fermented milk products;
• meat can be replaced with legumes - they are easier to digest and do not require large energy costs;
• Drinks allowed include green tea, decoctions and infusions of medicinal herbs.

During the recovery period, it is recommended to monitor your body weight - weigh yourself regularly. Smoking should not be done or reduced to a minimum during this time. Useful to practice physical therapy, perform light exercises independently physical exercise. Required to do every day hiking in the fresh air.

Disease survival prognosis

After a radical hysterectomy, a woman is guaranteed a full recovery and can live long life. If treatment is carried out while preserving the organs of the reproductive system, in the future a woman can give birth to a child naturally or through in vitro fertilization.

Survival for cervical cancer depends on the degree of growth of atypical cells into the stroma. In some cases, stage 1 invasive cancer can develop quickly, which is dangerous because it spreads aggressively to nearby tissues and complicates the course of therapy. There are types of pathology when the tumor penetrates the bloodstream and the malignant process extends beyond the uterine body and cervix in the first stage.

The development of the disease is greatly influenced by the patient's age. During a long-term pathology study, it was found that in women aged 20-38 years, the disease is characterized by aggressive spread in the first stage. This is often observed during a course of therapy.

In women over 40 years of age the disease long time develops without pronounced symptoms, so the tumor can be detected only at stages 3-4. Cancer forms slowly, metastases occur at a later stage.

Depending on the location of the oncological process, forecasts are distinguished:

• Localization in the vaginal area of ​​the cervix is ​​considered positive for survival prognosis. Exophytic growth characterizes a favorable course of the disease. In this case, the tumor grows on the outside of the vagina, which reduces germination into adjacent tissues. In this situation, the operation to excise the problem area takes place without complications.
• A tumor located in the endocervix and growing inside the uterus has an unfavorable prognosis. Surgical intervention in this situation often has unpleasant consequences.

On average, women live with stage 1 cervical cancer for up to 5 years or more. After therapeutic manipulations, the patient’s life expectancy increases. If no recurrent neoplasm is detected during the first 5 years, then life expectancy increases to 10, 15, 25 or more years. Gradually, the woman can return to her usual rhythm of life.

The positive effect of therapeutic procedures depends on the type of pathology and the location of the atypical tissue. In general, stage 1 cervical cancer is easily treatable and progression is possible. full recovery. The tumor does not have time to grow into the deep layers of the organ and spread to neighboring tissues, which provides a small area for surgical intervention. This helps minimize side effects from radiotherapy, chemotherapy and surgery.

Doctors advise women to undergo regular examinations with a gynecologist every 6 months. At the first suspicious symptoms, you should immediately consult a doctor and undergo an extensive examination. Stage 1 cancer is considered curable, so treatment at this stage guarantees a complete recovery.