Uterine cancer occurs. Uterine cancer: symptoms at an early stage. Stages of development and treatment of endometrial tumor

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How quickly cervical cancer (CC) develops worries many women. This is not surprising, given that this type of oncopathology occupies second or third place (data from different sources vary) among tumor diseases representatives of the fair half of humanity.

We can immediately make a reservation: cervical cancer is not an acutely developing pathology. Several years pass from its initial stage, when the disease responds well to treatment, to the invasive state, when the prognosis becomes not very good. In addition, it is possible to identify a precancerous condition, which can be diagnosed using simple and inexpensive tests. Any clinic can handle them, so there is a chance to start taking the first steps towards recovery when the cancer has not yet reached a severe stage.

Despite the fact that medical science has reached great heights, no one can say with one hundred percent certainty why people get cancer. But in the case of cervical cancer, scientists have determined that it is virus-dependent. Without exception, all patients with this disease were diagnosed with human papillomavirus (HPV) or in Latin human papillomavirus (HPV).

This pathogen has a variety of species - more than eight dozen. About a third of them hit reproductive system person. Half of this group cause cancer. But only four serotypes are “responsible” for malignant tumors of the cervix - 16, 18, 31 and 45. The first two of them are the most aggressive and manifest themselves in almost 80% of detected cervical cancer.

Human papillomavirus is perhaps the leader among the causative agents of sexually transmitted diseases. But, fortunately, not all people who have contracted this “charm” are future cancer patients. The clinical development of cervical cancer manifests itself only in a negligible percentage of those infected with HPV. In the vast majority of cases, the human immune system itself copes with the uninvited guest and the hostess of the body is not even aware that a battle has taken place inside it to free itself from the papilloma virus.

But there is a percentage of women (from 5 to 10%) in whom law enforcement officers cannot cope with the infection and the virus begins its “subversive” activity. It’s hard to say how long it will last, maybe several months, maybe a couple of years. But in this group of patients, the clinic of a precancerous condition begins to manifest itself - cervical dysplasia (cervical intraepithelial neoplasia, or abbreviated as CIN).

If this disease is ignored and left to chance, then there is a possibility that in 10-15 years an invasive form of cancer will grow from dysplasia. The good news is that the probability of this process is not so high - about 0.3%, but the statistics are upsetting that the number of women with cervical cancer in the world is increasing every year.

It should be noted that in the achievements medical science There are vaccines against HPV. Therefore, it is possible to protect against cervical cancer through vaccination. After all, if you increase immunity against the virus that causes cancer, then there is every chance of avoiding the disease.

Factors contributing to the disease

Who should be concerned about possible development this oncology?

First of all, those who:

• Leads a mess sex life. Under such conditions, the risk of contracting papillomavirus is enormous. You can also sympathize with ladies whose men had contact with a woman infected with HPV;
• Has a weakened immune system due to the presence chronic diseases, including the reproductive system, or other reasons;
• Smokes. Harmful substances contained in tobacco smoke, several times increase the likelihood of developing cancer and not only of the cervix;
• Excess body weight. The statement that graceful ladies are healthier than plump ones is justified in this case as well.

If we talk about the age structure of patients with cervical cancer, then most of them are 40+. In girls over 30, cancer is usually not diagnosed because it takes years to develop.

In this category, cervical dysplasia of varying degrees of development is predominantly found. Whether these conditions will develop into oncology depends on the state of the woman’s immunity, her attitude towards her health and the attentiveness of the attending physician.

Precancerous condition – cervical dysplasia

Cervical dysplasia is a disease in which mutated cells appear in the mucous membrane of this organ. Causes one or more already familiar types of human papillomavirus. If atypical cells are distributed over a third of the mucosa, then they speak of the first stage of CIN1 dysplasia. If the changes affect 2/3 of the cell layer, the second stage of CIN2 is noted, but if the changes affected the entire depth of the mucosa, then this is a severe, third stage of CIN3, which experts regard as stage zero of cancer. It is also called carcinoma in situ.

The time interval between CIN1 and in situ carcinoma averages a couple of decades. In this condition there appear cancer cells, but there are not many of them.

The patient may not know for years that preparations for cancer are taking place in her genital area, because the first and second stages of dysplasia are asymptomatic. Only when the erosive process on the cervix becomes extensive and large does the clinical picture of the disease consist of bloody discharge that occurs after sexual intercourse.

The symptom is quite nonspecific and is characteristic of many diseases of the reproductive system. But the good news is that even in the absence of any signs, dysplasia can be seen with the naked eye during a routine examination by a gynecologist.

True, if there is a first stage of pathology, then it is simply so difficult to see. But don’t despair, because doctors have enough effective and low-cost ways to determine cancer. First of all, this is a smear from the cervical area on cytological examination. IN developed countries This test is called a Pap smear or PAP test. In most Russian medical institutions This analysis is done a little differently - the difference is in the method of staining the cells. The PAP test is more sensitive. Therefore, if a clinic offers patients this particular type of examination, feel free to trust local doctors. The absence of a medical examination for several years allows the development of a dangerous disease.

Cytoanalysis and preventive examination by a gynecologist are part of screening of the female population.

They can be used to diagnose precancerous conditions and in situ carcinoma.

If the doctor sees visual changes on the cervix, and a cytological examination shows the presence of cancer cells, then additional research methods are performed:

• Colposcopy. Helps to see small accumulations of modified tissue;
• Blood test for tumor markers. The presence of the SCC marker is indicative. Its concentration in the blood can show the extent of the disaster, as well as assess the success of treatment;
• Cervical biopsy. Allows you to analyze the condition of tissues at the very site of the suspected disease.

Based on the totality of test results, the attending physician will determine the therapy for the identified disease.

If a woman does not rush to the gynecologist for a preventive examination and does not undergo a smear for cytological examination for several years, then after several years of inactivity she may live to develop a cancerous tumor.

The oncopathology discussed has several classifications.

For example, depending on the location of the disease and the type of epithelium affected, the following are distinguished:

• Squamous cell carcinoma. Develops on the vaginal side of the cervix (ectocervix). Its epithelium consists of flat cells, which gives the tumor its name. It accounts for more than 80% of cases of cervical cancer;
• Glandular or adenocarcinoma. Grows in cylindrical cells in the cervical canal (endocervix);
• Mixed cancer or adenosquamous carcinoma. It occurs most rarely - no more than 3% of the total disease.

Tumors are also distinguished according to the direction of growth:

• If cancer tumor stands out towards the vagina, on the surface of the cervix, then they speak of an exophytic tumor. This visible appearance cancer that can be diagnosed in its early stages.
• If the cancer spreads into the wall of the uterus. Requires special diagnostics because it is not visually visible. It accounts for about 20% of diseases.

As the cancer grows, it affects not only the uterus, but also neighboring organs. Cancer cells through the blood and lymph can spread far beyond the reproductive system. Thus, on last stage Disease metastases can be diagnosed in the lungs, liver, kidneys.

Different countries classify the degrees of development of cervical cancer slightly differently.

In Russia and the CIS countries there are four stages:

1. Stage zero or carcinoma in situ. In fact, this is still a precancer, and not oncology itself, that is, third-degree dysplasia CIN. You can prevent the growth of such a condition into real cancer by removing the affected area. Characterized by 100% cure.
2. First stage. The disease does not spread beyond the cervix. May not be detected visually due to the small size of the tumor. This degree has its own stages: 1A, divided into subgroups 1A1 (tumor less than 7 mm and no deeper than 3 mm) and 1A2 (size > 7 mm and depth of growth > 3 mm), and 1B, in which the size of the affected area is larger than stage 1A. 1B is also divided into two subgroups: 1B1 (tumor diameter< 4 см) и 1В2 (>4 cm). The chance of recovery depends on the size of the tumor and the depth of germination. At stage 1A1 it is 98-99%, 1A2 – 95-98%, 1B1 – 90-95%, 1B2 – 80%.
3. Second stage. Oncology affects not only the cervix, but also nearby organs. This stage also has two degrees: 2A – the cancer spreads downwards and 2B – around the neck. The first degree is further divided into two, depending on the size of the tumor: 2A1 (< 4 см) и 2А2 (>4 cm). The cure rate is already lower than in the previous stage: for stage 2A - 70-90%, 2B - 60-70%.
4. Third stage. The cancer has advanced to the pelvic organs. Grade 3A – the tumor grows to the end of the vagina. At stage 3B, the tumor begins to affect the urinary system, in particular the ureters. From 30 to 50% of patients have a chance of recovery at this stage.
5. Fourth stage. Development occurs over many years and metastases have spread to other organ systems. It also has several stages. Survival rate is approximately 20%.

The figures given are statistical averages and the main condition is treatment of the disease.

Cervical cancer is a disease that develops over several years. No one can say for sure how long it will take. But a woman has every chance to protect herself from papillomavirus, which causes cancer, in time and begin symptomatic treatment diseases.

The interest of patients about how to treat uterine cancer is very important, and the answer to it will be visible only after full diagnostics, during which the type of disease and stage will be determined. The main types of treatment for this disease are:

Surgical intervention

Usually you have to resort to this type of treatment in the initial stages. The most common procedure is a hysterectomy - removal of the uterus and ovaries, as well as its appendages.

Women are often concerned about hysterectomy, how painful it is and how large a suture remains in the peritoneum after hysterectomy.

Depending on the extent of the cancer, the surgeon will perform either a simple hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, upper part of the vagina, and nearby tissue).

For postmenopausal patients, the surgeon will also perform a bilateral salpingo-oophorectomy, which involves removing both the fallopian tubes and the ovaries.

A hysterectomy can be performed as a traditional surgery with 1 large incision or laparoscopy, which uses several smaller incisions.

A hysterectomy, when there is a possibility of cancer, is usually performed by a gynecological surgeon, who is a surgeon who specializes in surgery reproductive system women.

Hyperectomy, the removal of the uterus using robotic technology through small holes, can also be used to treat cancer.

At the same time, along with the removal of the uterus, the surgeon can remove The lymph nodes near the tumor to determine whether the cancer has spread beyond the uterus.

Chemotherapy

Chemotherapy is the use medical supplies, promoting the death of cancer cells, usually by stopping the ability of cancer cells to grow and divide.

Chemotherapy is administered by an oncologist or gynecologic oncologist - a doctor who specializes in treating cancers of the female reproductive system with drugs.

When treating endometrial cancer, chemotherapy is usually given after surgery, either together with or instead of radiation therapy. Chemotherapy is also given if endometrial cancer comes back after initial treatment.

Systemic chemotherapy enters the bloodstream to reach cancer cells throughout the body. Common methods of administering chemotherapy include an intravenous tube placed into a vein using a needle, or a tablet or capsule that is swallowed by patients.

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific period of time. The patient can simultaneously take 1 drug or combinations of different drugs.

The goal of chemotherapy is to destroy the cancer left after surgery or to shrink the cancer and slow the growth of the tumor if it returns or has spread to other parts of the body.

Side effects of chemotherapy depend on the person, the type of chemotherapy and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite and diarrhea. These side effects usually disappear after treatment is completed.

Advances in chemotherapy over the past 10 years include the development of new drugs to prevent and treat side effects, such as antiemetics for nausea and vomiting and hormones to prevent low indicators leukocytes, if necessary.

Other potential side effects of chemotherapy for uterine cancer include inability to become pregnant and early menopause if the patient has not already had a hysterectomy (see Surgery above). Rarely, some medications cause hearing loss. Others may cause kidney damage. Patients may be prescribed additional intravenous injection to protect the kidneys.

Radiation therapy

There is both a remote method of treatment and a contact (internal) method. This is a fairly effective method and is often used in cases where surgical method impossible or in cases where the disease occurs a second time (relapse).

Radiation therapy is the use of high-energy X-rays or other particles to kill cancer cells. A doctor who specializes in providing radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a given period of time. The most common type of radiation therapy is called external beam radiation therapy, which is radiation received from a machine outside the body.

Some women with uterine cancer need both radiation therapy and surgery. Radiation therapy is most often given after surgery to destroy any cancer cells remaining in the area. Radiation therapy is rarely given before surgical intervention to reduce swelling. If a woman is unable to undergo surgery, the doctor may recommend radiation therapy as an alternative option.

Radiation therapy options for endometrial cancer may include radiation therapy directed to the entire pelvis or applied only to the vaginal cavity, often called intravaginal radiation therapy (IVRT) or vaginal brachytherapy.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements and will depend on the extent of radiation therapy administered. Most side effects usually disappear soon after treatment is completed, but long-term side effects may occur. causing symptoms bowel or vaginal condition.

Doctors sometimes advise their patients not to have sexual intercourse during radiation therapy. Women can resume normal sexual activity within a few weeks after treatment if they feel ready to do so.

In most cases, it is used after the later stages of the disease, when the spread extends beyond the initial localization.

Hormone therapy is used to slow the growth of certain types of uterine cancer cells that have hormone receptors on them. These tumors are usually adenocarcinoma and are grade 1 or 2 tumors.

Hormone therapy for uterine cancer often involves a high dose of the sex hormone progesterone in pill form. Other hormonal therapies include aromatase inhibitors often used to treat women with breast cancer, such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasine).

Aromatase inhibitors are medications that reduce the amount of the hormone estrogen in a woman's body, stopping tissues and organs other than the ovaries from producing it.

Hormone therapy may also be used for women who do not have surgery or radiation therapy, or in combination with other treatments.

Side effects of hormone therapy in some patients include fluid retention, increased appetite, insomnia, muscle pain and weight gain. They do not pose any danger to the body.

You should also change your diet if you have uterine cancer: alcohol and foods that provoke cancer should be excluded from your diet. You need to eat more garlic, vegetables, broccoli, and fruits.

This is a malignant tumor that develops from the tissues of the uterus and can spread throughout the body. Uterine cancer is very common, currently occupying fourth place among women after breast, skin and gastrointestinal tract. Every year this tumor is detected in several hundred thousand women around the world.

Uterine bleeding after menopause - bleeding from the genital tract that occurs six months after menopause - is the most characteristic symptom of this type of cancer. Surgery, radiotherapy, hormonal therapy or chemotherapy are those treatment methods that are used alone or in combination with each other in order to heal the female sex from this uterine cancer.

Causes of uterine cancer

This form of malignant tumors is usually observed between the ages of 40 and 60 years. Risk factors for uterine cancer:

• diabetes,
• hypertonic disease,
• smoking,
• infection with human papillomavirus,
• early onset of sexual activity,
• late menopause,
• menstrual irregularities,
• infertility,
• a large number of sexual partners,
• early first birth,
• venereal diseases,
• reception per oral contraceptives.

One of the significant risk factors is obesity: in women with a body weight exceeding the norm by 10-25 kg, the risk of developing endometrial cancer is 3 times greater than with normal body weight, and in women with a body weight exceeding the norm by more than 25 kg, the risk diseases are 9 times higher. Precancerous conditions are widely known and play a significant role in the occurrence of uterine cancer.

These are erosions, ulcers, scars after birth trauma, epithelial proliferation (condylomas, polyps) and leukoplakia, as well as chronic inflammatory processes- endocervicitis and endometritis. According to the nature of the epithelium of various parts of the uterus, squamous cell carcinoma of the cervix and glandular cancer (adenocarcinoma) of the cervical canal and uterine cavity are distinguished. Adenocarcinoma is the main morphological variant (up to 70%). It should be noted that a relatively rare tumor affecting the uterus is sarcoma. There are three degrees of tumor differentiation (well differentiated, moderately differentiated and undifferentiated).

Stages of uterine cancer

For uterine cancer, there are 4 stages of its development:

• Stage I - location of the tumor in the body of the uterus,
• Stage II - damage to the body and cervix,
• Stage III - spread to parametrial tissue or metastases in the vagina,
• Stage IV - spread beyond the pelvis, invasion of the bladder or rectum.

Symptoms of uterine cancer

Early symptoms of uterine cancer

Many women who experience, for example, pain in the lower abdomen, are interested in what is the main symptom of uterine cancer. As mentioned above, uterine cancer is diagnosed in the early stages, most common symptom This pathology is uterine bleeding (observed in approximately 90% of cases). Another obvious sign of uterine cancer is a firm, palpable tumor in the lower abdomen.

Main symptoms of uterine cancer

Clinical symptoms of uterine cancer consist of complaints of leucorrhoea, bleeding and pain. However, all three of these symptoms occur already during the period of tumor disintegration, and the time of their appearance depends on the date of onset of ulceration. Therefore, in some cases, uterine cancer may not produce any symptoms for a long period. Leucorrhoea can be of various types: watery, mucous, blood-stained, odorless and foul-smelling. The admixture of blood gives the leucorrhoea the appearance of meat slop. Retention of vaginal discharge and associated infection leads to the appearance of purulent leucorrhoea with an odor. In cancer stages III and IV, discharge from the genital tract is putrid in nature. Bleeding can be in the form of small spotting, as well as single or multiple heavy discharges.

For cervical cancer, so-called contact bleeding is very typical (during sexual intercourse, during douching, vaginal examination or after lifting heavy objects). If a woman has already stopped menstruating, then the appearance of bloody discharge from the vagina in most cases is a sign of a malignant tumor. The pains are late symptom uterine cancer, indicating the involvement of the lymph nodes and pelvic tissue in the cancer process with the formation of infiltrates that compress the nerve trunks and plexuses. General symptoms and, in particular, cachexia (loss of body weight) occurs extremely late, in very advanced stages, and usually women suffering from uterine cancer retain an outwardly blooming, healthy appearance.

Diagnosis of uterine cancer

Recognition of uterine cancer begins with studying the patient’s complaints and the course of the disease. In all cases suspicious based on anamnesis, patients are subject to immediate examination by a gynecologist. It is completely unacceptable to prescribe any treatment for such patients without a detailed examination. The examination includes a bimanual vaginal examination, a bimanual rectal examination, and a speculum examination. During vaginal examination in cases of sufficiently pronounced tumor process it is possible to determine certain changes in the cervix depending on the type of tumor growth (exophytic, endophytic and mixed).

As a rule, the examination is accompanied by bleeding as a result of trauma to the tumor with the examining finger. In case of advanced uterine cancer, an additional examination is carried out through the rectum to clarify the transition of the tumor to the pelvic walls and uterosacral ligaments. IN Lately widespread and great importance acquired ultrasound tomography (ultrasound), which makes it possible to detect changes in the uterus that are inaccessible to other research methods and has become a mandatory research method if any benign or malignant formations in the uterus are suspected.

To establish damage to the lymph nodes and metastases, which very often accompanies cervical cancer, they resort to x-ray methods - lymphography and ileocavagraphy. For the same purpose they carry out:

• radiography of organs chest,
• intravenous pyelography,
• irrigography,
• cystoscopy,
• sigmoidoscopy.

It is possible to perform CT, MRI, lymphangiography, and fine needle tumor biopsy. These studies are very important for uterine cancer to develop a plan for radiation or combined treatment.

Treatment of uterine cancer

Treatment tactics for uterine cancer depend on the patient’s age, general condition and clinical stage of the cancer. Treatment is mainly surgical (extirpation of the uterus and appendages and sometimes removal of pelvic lymph nodes). Combined treatment is possible - surgery, and then external irradiation to the area of ​​the vaginal stump, intracavitary gamma therapy. Preoperative radiation therapy is also carried out mainly for Stage III. Radiation therapy as independent method Treatment of uterine cancer is used in cases of local spread of the tumor process and when surgery is contraindicated.

Antitumor drugs are effective for highly differentiated tumors, in stages III and IV of the disease. After treatment, periodic visits to the doctor are required to examine the pelvic organs and take a smear. Tests also include chest x-ray, ultrasound, and intravenous pyelography. During the first year, visit the doctor every 3 months, then every 6 months for 5 years. After 5 years, monitoring is carried out annually. In case of relapses, if the process is localized, partial or total pelvic exenteration is performed (removal in a single block of the uterus, cervix, vagina, parametrium, bladder and rectum).

In the presence of distant metastases, patients usually receive chemotherapy. Radiation therapy can be used for palliative treatment of painful metastases. Most often, tumors metastasize to the pelvic lymph nodes, less often to the inguinal ones. Distant metastases, most often to the kidneys, liver, lungs, have a poor prognosis. For uterine cancer, the 5-year survival rate after surgical treatment is from 84 to 45%, depending on the stage of the disease. In case of relapses, 25% of patients initially treated surgically can be spared from relapse of the disease using radiation therapy pelvic organs. With metastatic relapses, cases of cure for uterine cancer are extremely rare, and the therapeutic effect is individual and short-lived. In stage IV of the disease, the 5-year survival rate is up to 9%.

Treatment of uterine cancer with folk remedies

Treatment of uterine cancer with folk remedies is a common request today, but can only herbs cure this? serious illness? Any gynecologist will tell you that no. Folk remedies for uterine cancer can help for a time when the disease is in its early stages. If you feel that after using this or that folk remedy it has become easier - you shouldn’t be too happy right away, because this effect most likely will not last long and the disease will continue to spread.

Common means traditional medicine for cancer of the uterine body are: hog queen, red brush. These herbs have an anti-inflammatory effect and will help cope with the disease. But before using them, be sure to consult a doctor, because... in most cases, these herbs can be taken as an addition to treatment, or are not recommended at all.

Prevention of uterine cancer

Early diagnosis and prevention of uterine cancer is possible only through systematic preventive examinations of all women over 30 years of age (at least 2 times a year). Regular examinations It is advisable to start with the onset of sexual activity. Regular examinations, ultrasound tomography and cytological examination (once every 2 years) help identify precancerous diseases, and their treatment helps prevent cancer. Equally important is the timely and correct treatment precancerous diseases of the cervix. There are no particularly characteristic signs unique to precancerous diseases of the cervix; they proceed like ordinary inflammatory diseases.

Common signs of precancerous diseases are prolonged chronic course, persistence of symptoms, and most importantly, lack of effect from conservative (anti-inflammatory) treatment. Treatment of precancerous diseases of the cervix must be radical and consist of electroexcision, electrocoagulation of the affected areas, or even amputation of the cervix. They also resort to radiation method treatment in the form of application radium therapy. Among patients radically treated for various precancerous lesions, mortality from cervical cancer decreased by 6 times.

Group of diseases:

Questions and answers on the topic "Uterine cancer"

Question:My mother (67 years old) has cervical cancer. Radiation therapy was performed. Now a lesion of the sygnoid colon has been discovered. The doctors told me to do the operation late. Ascis as a result of damage to the peritoneum. Hydrosclerosis right kidney. What can be done.

Answer: If there really is already ascites, radical treatment impossible, only symptomatic and palliative.

Question:Hello, a 60-year-old woman has been given a preliminary diagnosis of endometrial adenocarcioma, T4 No. M1 class 4, invasion into bladder, metastasis to the vagina, tumor necrosis, intermittent uterine bleeding, increasing cancer intoxication. Accompanied diabetes mellitus 1 type. At the bottom of the report it says AG II, art. 2, risk 4. Please write what can be done to treat it and how high is the likelihood of recovery? Thank you.

Answer: Sometimes, even with such a widespread tumor, surgical treatment is possible. Tumor removal, gynecological oncology.

Question:My mother has stage III cervical cancer. She underwent a radiation therapy session, but the treatment did not end, as it persists heat. She was discharged home to lower her temperature without prescribing any medications. I would like to know why the temperature persists and how you can bring it back to normal at home. Thank you in advance.

Answer: Increased body temperature can be caused by the so-called. paracancrosis process (inflammatory changes in the tissue around the tumor).

Question:And I’m only 27 years old, and I already have uterine cancer, I don’t have children, it turns out that I won’t have them, I agreed to have my uterus removed, I don’t know what to do and what to do next.

Answer: Hello. It is possible to save your eggs, which in the future can be combined with the sperm of your husband (or partner) and implanted in the uterus of a surrogate mother. This is an expensive procedure, but it gives you the chance to have your own child. Also consider adoption. Can not be hopeless situations. The most important thing for you now is to defeat the disease.

Question:My sister is 35, she was operated on and stitched up, we were told that the tumor had spread to the entire abdominal cavity. There is nothing more they can do. Once the stitches heal, they will be sent home, and then as God wills. Tell me, is there anything else I can do?

Answer: Hello. You need to listen to the advice of your doctor. He or she will likely recommend medications to help relieve some of the cancer symptoms and pain (if any).

Question:Hello! Patient with stage 2 uterine cancer, 75 years old, available cardiovascular diseases, speech and coordination of movements are impaired, lives in the city of Rybinsk. The oncologist sent her to Yaroslavl to obtain a commission’s conclusion on treatment methods. He cannot move outside the city on his own or with the help of relatives - when traveling in a car, epileptic-type seizures begin. Droppers and pills don't help. The head of the department of the hospital in Yaroslavl, to which a referral for a commission was received, requires a physician’s opinion on the patient’s condition and advises the relatives to think carefully about what to do with the patient. As a result, no help is provided in Rybinsk, it is impossible to deliver the patient to Yaroslavl, and time is wasted. Question: what should relatives without medical education be guided by when making decisions about further treatment of a cancer patient and what measures can relatives take in this situation?

Answer: Hello. In general, in this condition it is special antitumor treatment not shown. Only symptomatic therapy at the place of residence.

Oncological pathologies of the female reproductive system are quite common. One of the common diseases of this kind is uterine cancer.

This disease is called differently - endometrial cancer, cancer of the uterine body, cancer of the uterine mucosa, etc. All these oncological processes are uterine cancer.

Disease concept and statistics

Uterine cancer is a malignant tumor process that develops from the inner epithelial layer - the endometrium.

On average, this disease is found in 2-3% of the female population. Endometrial cancer can occur in every woman, however, women over 45 are most susceptible to this type of cancer.

Classification

Oncologists classify uterine cancer into two types: autonomic and hormonal.

Autonomous cancer accounts for 1/3 of all cases of uterine oncology. This form of the disease occurs suddenly without any prerequisites or reasons.

Experts believe that such oncology is of hereditary etiology or occurs under the influence of traumatic injuries.

The picture shows a uterine cancer cell under a microscope

The hormonal type of uterine cancer develops due to hormonal changes in female body. This type of cancer accounts for 2/3 of all cases of endometrial cancer. It is characterized by pronounced disturbances of endocrine-metabolic origin.

According to histological data, cancer of the uterine body can be:

• Leiomyosarkinoma;
• Glandular squamous cell oncology, etc.

Depending on the degree of differentiation of cellular structures, cancer can be highly differentiated, poorly differentiated or moderately differentiated.

Causes

As mentioned above, endometrial cancer can be hormone-dependent or autonomous in nature. Based on this, we can identify several characteristic causes of uterine body cancer:

• Increased stimulation of the epithelial uterine layer by estrogen hormones;
• Metabolic disorders such as obesity, diabetes, hypertension;
• Hormone-producing ovarian tumors;
• Adenoma of the adrenal cortex;
• Treatment with hormone-containing drugs;
• The presence of severe liver pathologies accompanied by disturbances in metabolic sex-hormonal processes (hepatitis, etc.);
• Negative heredity, such as the presence in blood relatives of oncological formations in the intestines, mammary gland, ovaries or in the body of the uterus;
• Late onset of menopause;
• Lack of pregnancies with natural births;
• Long-term use of oral contraceptives like Dimethisterone;
• Irradiation of pelvic organs, etc.

Symptoms of uterine cancer in women

Signs of oncological formations of the uterine body are very diverse, however, in the early stages of the development of the cancer process, any symptoms are usually absent.

First signs

Among the first alarming symptoms Uterine cancer is particularly characterized by uterine bleeding not associated with menstruation.

A similar sign, according to oncologists, is observed in almost 7-9 out of ten patients.

Such bleeding may vary in nature:

• Abundant;
• Scarce;
• Multiple;
• Breakthrough;
• One-time;
• Intermittent, etc.

Contact bleeding that occurs as a result of sexual intercourse is very typical for uterine cancer. gynecological examination, lifting heavy objects, douching, etc.

In addition to discharge, when uterine cancer reaches advanced stages of development, it can be recognized by the following symptoms:

1. Hyperthermia with low-grade fever;
2. Nagging pain in the lumbar area, perineum, abdomen;
3. A noticeable reduction in performance, excessive and fast fatiguability, to the point of exhaustion;
4. Sexual intercourse is accompanied by pain, which can also appear after it;
5. Refusal to eat;
6. Problems with bowel movements such as constipation or diarrhea;
7. Severe weight loss.

How to identify uterine cancer by symptoms before menopause?

In women who are premenopausal, it is considered quite normal to have uterine bleeding, which gradually becomes scarce and bothers you less and less.

If an oncological process begins to develop in the uterine body, then the typical reduction in symptoms does not occur, and it often happens that uterine discharge, on the contrary, becomes more abundant and frequent.

What manifestations can be observed in postmenopause?

IN menopause Women generally do not menstruate. Therefore, if sudden vaginal discharge occurs, you should always suspect the presence of a uterine cancer process.

Moreover, the frequency of such bleeding, its duration, intensity and abundance at this age no longer matter.

Stages and their lifespan

Oncologists distinguish several sequential degrees of uterine cancer:

• At the first stage Oncological formation is located directly in the uterine body. The probability of recovery is about 80-90%;
• At the second stage oncological process tumor formation penetrates beyond the boundaries of the uterine body, affecting cervical canal(cervix), however, nearby organs are not affected. Recovery occurs in approximately ¾ of cases;
• On third stage of cancer, the oncological process spreads to the appendages and vagina. Survival rate is about 40% of patients;
• On fourth stage of cancer of the uterine body, tumor processes spread beyond the pelvic region, the formation grows into the intestinal and bladder tissues. Survival rate – no more than 15%.

Consequences

Cancer of the uterine body is a very dangerous pathological condition. If there is no adequate therapy, then uterine cancer will certainly lead to the death of the patient.

Often, cancer of the uterus requires its removal along with the appendages, part of the vagina and the cervix. However, this factor usually does not play a significant role, because cancer is found mainly in women aged 45-60 years with adult children.

Pathways of metastasis

In case of cancer in the body of the uterus, the main routes of metastasis are vessels and nodes, and on terminal stage The circulatory system is also involved in distribution.

First, the lesion spreads to the lymph node structures in the iliac region and hypogastric zone. Much less often, the lesion affects other groups of pelvic lymph nodes.

Metastasis extends to the cervical canal and beyond the uterine body. In a hematogenous manner, metastases penetrate from the upper uterine region into the appendages; in addition, the vagina, and sometimes even the kidney or liver or bone tissues are affected.

Diagnostics

The diagnostic process for uterine cancer begins with a gynecological examination using speculum. The patient is then sent to ultrasonography, which allows us to identify the true size and structure of the uterus, as well as the structure and thickness of the endometrium.

The photo shows what uterine cancer looks like on ultrasound diagnostics

The resulting biomaterial is often scraped. This procedure is performed using general anesthesia in a hospital setting.

When analyzing for the detection of tumor markers for uterine cancer, the following markers are used:

• Carcinoembryonic antigen;
• HCG or human chorionic gonadotropin.

Thanks to its introduction into gynecological oncology practice, it was possible to save the lives of many patients.

How quickly does the disease develop?

The rate of development of the oncological process in the uterine body is determined by the histological type of formation, concomitant pathologies, the strength and intensity of the body's anticancer resistance, the adequacy of therapy, the age of the patient and other similar factors.

Therefore, it is impossible to say for sure how long it will take for the final development of the cancer process in the uterine body.

The difference between pathology and fibroids

They call the process of hyperplastic enlargement of uterine tissue that occurs as a result of traumatic factors, frequent abortions, curettage, a large number of sexual partners, genitourinary inflammation, lack of orgasms in women, etc.

Cancer of the uterine body and fibroids have absolutely nothing to do with each other. This is absolutely various pathologies, so fibroids never degenerate into cancer.

Benign uterine hyperplasia is formed in the muscular layer of the organ, and oncology - in the epithelial layer. When fibroids are detected, observation tactics are usually chosen to determine whether the fibroids are growing or not.

For this purpose, the patient undergoes every six months gynecological examination. As for direct scientific evidence of the relationship between cancer and fibroids, there is no evidence.

Treatment and prevention

In general, it depends on individual prognostic results:

1. The basis of treatment is surgery, which involves removing the uterine body along with the ovaries.
2. Sometimes before and after surgical intervention radio irradiation is performed to reduce the risk of cancer recurrence, but such treatment has absolutely no effect on survival rates;
3. In addition to surgery, chemotherapy is used. Such an approach to treatment is justified when the tumor process is widespread, as well as when the tumor is autonomous, has active metastasis, and relapses. Platinum drugs such as Cisplatin, Carboplatin, Adriamycin, as well as Doxorubicin, Taxol, Epirubicin, etc. are used. For hormonal-dependent oncology of the uterine body, chemotherapy treatment is ineffective;
4. Hormone therapy provides good therapeutic results. For similar treatment Progestagen drugs are usually used: Megeys, Depostat, Provera, 17-OPK, Farlugal, Depo-Provera, etc. These drugs can be combined with Tamoxifen or prescribed without it. If active metastasis occurs and treatment with progestogens is ineffective, Zoladec is prescribed. Sometimes hormonal treatment I combine it with chemotherapy.

When determining the appropriate therapeutic method, the oncologist takes into account several decisive factors such as the physiological state of the patient, the presence of endocrine disorders, histological parameters, tumor size and extent, etc.

Preventive measures are the most effective anti-cancer measure. Primary preventive actions involve avoiding factors that provoke such cancer, such as obesity, diabetes and infertility.

In other words, you need to strictly control your weight, treat reproductive functions and diabetes.

There are also secondary preventive measures, which involve timely detection and treatment of inflammatory pathologies and precancerous conditions.

Women over 40 are recommended to undergo annual screening examination using transvaginal ultrasound. This procedure makes it possible to detect cancer of the uterine body in its infancy, which significantly increases the chances of recovery and long life.

If a precancerous disease is discovered in the patient, then it must be treated.

Patient survival prognosis

Every year the number of cancer patients with cancer of the uterine body increases, every year this pathology found in half a million patients. But timely diagnosis and an adequate approach to healing process allow to achieve a high and favorable survival prognosis.

In general, the prognosis for the survival of cancer patients is determined by the stage of initiation of therapy, the degree of cell differentiation, etc.

For example, with a highly differentiated formation with the first degree of development, the survival rate will be 96%, and with a low degree of cell differentiation and 4 degrees of development, the survival rate does not exceed 18%.

The following video will tell you how to recognize and treat uterine cancer:

Uterine cancer is a malignant tumor caused by the uncontrolled growth of endometrial cells in the uterus. This disease is also called uterine cancer or endometrial cancer because tumor growth begins in the tissue lining the uterus from the inside, i.e. in the endometrium. This type of cancer is considered the most common among tumor diseases of the female reproductive system.

Another type of uterine cancer is uterine sarcoma. It occurs when a tumor affects muscle or connective tissues. Sarcoma is rare, accounting for about 8% of all uterine tumors.

Cancer of the uterus in women

Endometrial cancer mainly affects postmenopausal women, that is, from 45 to 74 years old. Before age 45, this disease is extremely rare, occurring in less than 1% of women. Uterine cancer ranks 4th among all cancers in women. Fortunately, it is often detected in the early stages, when treatment is possible.

Cancer of the uterus in ICD-10

By international classification diseases, pathology is classified in section C54 - “ Malignant formation body of the uterus. There are cancers of the uterine isthmus - C54.0, endometrium - C54.1, myometrium - C54.2, fundus of the uterus - C54.3, lesions extending beyond one localization - C54.8, and unspecified C54.9.

Causes of uterine cancer

The causes of uterine cancer are still not completely clear. However, risk factors have been identified.

Hormone imbalance. Disruption of hormone production plays a major role in the occurrence of the disease. Before menopause, estrogen and progesterone levels are in a balanced state. After menopause, a woman's body stops producing progesterone, but small amounts of estrogen continue to be produced. Estrogen stimulates the proliferation of endometrial cells, the restraining influence of progesterone disappears, which increases the risk of developing cancer.

Another reason hormonal disorders occurs if a woman receives replacement hormone therapy only estrogens, without a progesterone component.

Overweight. The risk of uterine cancer increases with excess body weight, since adipose tissue can produce estrogens. Overweight women are three times more likely to develop endometrial cancer than women of normal weight. In women with severe obesity, the risk of developing the disease increases 6 times.

History of the reproductive period.

Taking tamoxifen. The risk of illness will arise if a woman takes tamoxifen. This medicine is used to treat breast cancer.

Diabetes. The disease doubles the risk of uterine cancer. This is due to an increase in insulin levels in the body, which in turn increases estrogen levels. Diabetes is often associated with obesity, which makes the situation worse.

Diseases of the genital organs. PCOS (polycystic ovary syndrome) also predisposes to the disease because estrogen levels are elevated in this condition. Precancerous condition consider endometrial hyperplasia, i.e. thickening of the uterine mucosa.

Family history. Women whose relatives (mother, sister, daughter) have uterine cancer are at risk. Also, the chances of getting sick increase when there is a hereditary type in the family history colorectal cancer(Lynch syndrome).

Uterine cancer and pregnancy

Women who have not given birth are more likely to have uterine cancer. During pregnancy, progesterone levels increase and estrogen levels decrease. This hormonal balance has a protective effect on the endometrium.

Also at risk are women who began menstruating before age 12 and/or menopause occurred after age 55.

What happens with uterine cancer

The process begins with a mutation in the DNA structure of endometrial cells. As a result, cells begin to multiply and grow uncontrollably, causing the tumor itself to appear. Without treatment, the tumor can extend beyond the inner lining of the uterus and grow into the muscle layer and further into the pelvic organs. In addition, cancer cells can spread throughout the body through the blood or lymph. This is called metastasis.

Symptoms and signs of uterine cancer

The most common manifestation of endometrial cancer is considered bloody issues from the vagina. The discharge can be either scanty, in the form of streaks of blood, or in the form of heavy uterine bleeding.

There are also less specific signs:

• discomfort when urinating
• pain or discomfort during sex
• lower abdominal pain.

If the disease has caused damage to organs near the uterus, then you may experience pain in the legs and back, and general weakness.

Signs before menopause

Before the onset of menopause, the disease can be suspected if menstruation becomes heavier than usual, or if there is bleeding during the intermenstrual period.

Manifestations in postmenopause

After menopause, any bleeding from the genital tract is considered pathological. Regardless of the amount of bleeding, if present, you should visit a gynecologist.

Stages

There are several stages of uterine cancer. At stage zero, atypical cells are found only on the surface of the inner lining of the uterus. This stage is determined very rarely.

Stage 1. Cancer cells grow through the thickness of the endometrium.

Stage 2. The tumor grows and invades the cervix.

Stage 3. The cancer grows into nearby organs, such as the vagina or lymph nodes.

Stage 4. The tumor affects the bladder and/or intestines. Or cancer cells, forming metastases, affect organs located outside the pelvis - the liver, lungs or bones.

Diagnosis of uterine cancer

During a routine gynecological examination, the doctor can determine changes in the shape, density, size of the uterus, and suspect a disease.

Ultrasound examination (ultrasound) of the pelvic organs performed through vaginal access is considered more accurate: the doctor inserts a sensor into the vagina and examines the endometrium in detail. If there is a change in its thickness, the next stage of diagnosis is a biopsy - a small fragment of the uterine mucosa is studied in the laboratory. There are two ways to perform a biopsy:

· Aspiration biopsy, when a piece of the mucous membrane is taken using a thin flexible probe inserted through the vagina.

· Hysteroscopy, in which a flexible optical system (hysteroscope) is inserted into the uterine cavity, which allows you to examine the entire surface of the uterus from the inside. The doctor can then do diagnostic curettage, after which a fragment of the endometrium is also sent for research. The procedure is performed under general anesthesia.

If cancer cells are detected during the biopsy, then additional examination is carried out to understand how much the cancer has spread. For this use:

• X-rays of light
• Magnetic resonance imaging (MRI), which provides a detailed image of the pelvic organs
• computed tomography(CT), which can also detect metastases outside the uterus.

Analyzes

The study of tumor markers in blood serum is not considered a reliable way to diagnose uterine cancer, although the level of the CA-125 marker may be elevated during the disease.

A test used to diagnose cervical cancer (Pap test or cytological smear) will not help detect endometrial cancer in the early stages. However, if the cancer has spread from the uterus to the cervix, the test may be positive.

Treatment of uterine cancer

A gynecologist-oncologist, a chemotherapist, and a radiologist may be involved in helping the patient. For effective treatment doctors take into account:

• stage of the disease
• general state health
• the possibility of pregnancy is relatively rare, since this type of cancer is typical for older women.

The treatment plan may involve using several methods at the same time.

Surgical treatment of uterine cancer

At stage 1 of the process, a hysterectomy is performed, i.e. removal of the uterus along with the ovaries and fallopian tubes. If necessary, nearby lymph nodes are removed. The operation is performed through a wide incision in the abdomen or laparoscopically. At stages 2-3, a radical hysterectomy is performed, additionally removing the cervix and top part vagina. At stage 4, as much of the affected tissue as possible is removed. Sometimes, when cancer has extensively spread to other organs, it is impossible to remove the tumor completely. In this case, surgery is done to relieve symptoms.

Radiation therapy for uterine cancer

This method is used to prevent relapse of the disease. It is carried out in two ways: internal (brachytherapy) and external. During internal surgery, a special plastic tube containing a radioactive substance is inserted into the uterus. For external treatment, irradiation is used using radiation therapy devices. In rare cases, both options are used: internal and external irradiation at the same time.

Chemotherapyuterine cancer

It can complement surgical treatment in stages 3-4 of the disease, or can be used independently. The drugs are usually administered intravenously.

Medicines and drugs

Most often used

• carboplatin
• cisplatin
• doxyrubicin
• paclitaxel.

Hormone therapy uterine cancer

Some types of uterine cancer are hormone dependent, i.e. the tumor depends on the level of hormones. This type of formation in the uterus has receptors for estrogen, progesterone, or both hormones. In this case, the introduction of hormones or hormone-blocking substances suppresses tumor growth. Typically used:

• gestagens (medroxyprogesterone acetate, megestrol acetate)
• tamoxifen
• gonadotropin releasing hormone analogues (goserelin, leuprolide)
• aromatase inhibitors (letrozole, anastrozole, exemestane).

Complications

During radiation therapy, ulcerations, redness, and pain may occur at the site of irradiation. There is also diarrhea and damage to the colon with bleeding from it.

During chemotherapy, hair loss, nausea, vomiting, and weakness are not excluded.

Hormone treatment may cause nausea, muscle cramps, and weight gain.

In 5% of women, fatigue and malaise persist even after treatment.

Recurrence of uterine cancer

If the disease returns (relapse), the tactics will depend on the state of health and the treatment already performed. A combination of surgery, radiation and chemotherapy, as well as targeted and immune therapy in different combinations.

After the treatment has been carried out for the first time, the patient is monitored.

Urgent consultation with a doctor is needed if:

• bleeding from the uterus or rectum occurs
• the size of the abdomen has increased sharply or swelling of the legs has appeared
• there was pain in any part of the abdomen
• cough or shortness of breath bothers you
• Appetite disappears for no reason and weight loss occurs.

Rehabilitation after treatment

Uterine cancer, both at the stage of diagnosis and at the stage of treatment, disrupts the usual way of life. To combat the disease more effectively, you should try to communicate with women who have the same disease, ask relatives for support, try to learn as much as possible about your condition and, if necessary, get a second opinion on treatment methods.

Food must provide sufficient quantity calories and protein in order to avoid weight loss. Chemotherapy can cause nausea, vomiting, and weakness, in which case a nutritionist can help.

After successful treatment, follow-up visits to the doctor and examinations are necessary to ensure that the disease has not returned.

Patient survival prognosis

With stage 1, 95% of women recover and live five years or more.

At stage 2, the five-year survival rate is 75%.

In stage 3, 40 out of 100 women live more than 5 years.

At stage 4, the 5-year survival rate is 15%. The outcome depends on how quickly the tumor spreads to other organs.

Prevention of uterine cancer

Since the exact cause has not been identified, it is impossible to carry out complete prevention uterine cancer. However, to reduce the risk you need to:

• maintain normal weight. It is important to know your body mass index (BMI). Its value between 25 and 30 indicates overweight, and above 30 indicates obesity. It is recommended to keep your BMI below 25.
• do not use hormone replacement therapy containing only an estrogen component. This type of HRT is only safe in women who have already had a hysterectomy, i.e. the uterus was removed.
• use oral contraceptives as recommended by your doctor.
• Visit your doctor immediately if you experience spotting after menopause or during treatment with hormones for breast cancer.