The first signs of cancer of the uterus: what is happening and why. How quickly does cervical cancer develop from a precancerous condition? Uterine Cancer Diagnosis Symptoms

Overview

Uterine cancer is a common malignant neoplasm of the uterus in women. It is also called endometrial cancer.

Uterine cancer - takes 1 place in the structure of female oncological diseases of the reproductive system, cervical cancer is in 2nd place. Among all female malignant tumors, endometrial cancer is second only to breast cancer.

Uterine cancer often affects women after menopause (older than 50 years), the peak incidence is observed in women aged 65-69 years. Approximately 5-6% of cases of cancer in women are uterine cancer. The most common symptom of endometrial cancer is the appearance of spotting from the vagina outside the menstrual period, which should always be a reason to contact a gynecologist.

In most cases, uterine cancer begins in the cells that make up the internal mucous membrane of the uterus - the endometrium, so uterine cancer is often called endometrial cancer. Less commonly, a malignant tumor is formed from the muscle tissue of the uterus. Such a neoplasm is called uterine sarcoma, and its treatment may differ from the treatment of endometrial cancer. This article mainly describes endometrial cancer.

The exact cause of uterine cancer is unclear, but factors are known that can increase the risk of developing this disease. One of them is hormonal imbalance. In particular, the risk of developing uterine cancer increases with increasing levels of the estrogen hormone in the body. Hormonal imbalance can be caused by a number of reasons, including menopause, obesity, diabetes, and hormone replacement therapy. Also, the risk of developing uterine cancer increases slightly with prolonged use of a breast cancer medicine called tamoxifen.

Symptoms of Uterine Cancer

The first signs of uterine cancer are watery whites and spotting from the vagina outside of menstruation. Gradually, the discharge becomes more profuse, more reminiscent of uterine bleeding. As a rule, any spotting from the vagina in menopausal women is suspicious of cancerous changes.

The likely signs of uterine cancer in women of reproductive age are:

• more abundant menstruation compared to normal;
• vaginal bleeding between periods.

More rare symptoms of endometrial cancer can be lower abdominal pain and discomfort during intercourse.

If the cancer reaches a late stage, it can manifest itself:

• back, leg, or pelvic pain;
• lack of appetite;
• fatigue
• nausea and general malaise.

Vaginal leucorrhoea and especially spotting not associated with menstruation should be a reason for compulsory treatment. These symptoms are characteristic of many diseases: polyps or uterine fibroids, genital infections, uterine cancer and other parts of the female reproductive system.

Causes and risk factors for uterine cancer

The body is made up of millions of different cells. Cancer develops when some of them begin to multiply indefinitely, forming a volumetric neoplasm - a tumor. A malignant tumor can affect any part of the body where a malfunction occurs in the system of regulation of cell division and growth.

Cancer of the body of the uterus is prone to rapid growth and spread to neighboring organs and tissues. Typically, cancer cells are carried through the body through the lymphatic or circulatory system. The lymphatic system is a collection of nodes and channels distributed throughout the body and interconnected like a circulatory system. Through lymphatic and blood vessels, tumor cells can spread to any part of the body, including bones, blood, and organs. This is called metastasis.

Factors that increase the risk of developing uterine cancer:

• Age.The risk of developing uterine cancer increases with age, in most cases the disease is diagnosed in women older than 50 years.
• Estrogen.The risk of developing uterine cancer is related to the level of estrogen in the body. This is one of the hormones that regulate the female reproductive system. Estrogen stimulates the release of an egg from the ovary, division and growth of endometrial cells. Progesterone prepares the uterine membrane for receiving an egg from the ovary. Usually estrogen levels are inhibited by progesterone. But the hormonal balance in the body can be disturbed. For example, after menopause, the body stops producing progesterone, but still synthesizes a small amount of estrogen. This estrogen causes endometrial cell division, which may increase the risk of developing uterine cancer.
• Hormone replacement therapy.Due to the connection between estrogen and uterine cancer, hormone replacement therapy with estrogens should be prescribed only to women who have removed the uterus. In other cases, a combination of estrogen and progesterone should be given to reduce the risk of uterine cancer.
• Overweight or obesity.Since estrogen can be produced by adipose tissue, being overweight or obese can increase estrogen levels in the body. This significantly increases the risk of developing uterine cancer. The risk of developing uterine cancer in overweight women is 3 times higher than in women with normal weight. In obesity, it is 6 times higher than in women with normal weight. Therefore, it is important to know how to calculate body mass index.
• Lack of childbirth.Nulliparous women have a higher risk of developing uterine cancer. This may be due to the fact that an increase in progesterone and a decrease in estrogen during pregnancy protects the uterine mucosa.
• Tamoxifen.Women taking tamoxifen (a hormone for breast cancer) may have an increased risk of developing uterine cancer. However, the benefits of tamoxifen treatment exceed this risk.
• Diabetes.Women with diabetes are twice as likely to develop uterine cancer as others. Diabetes raises insulin levels in the body, which, in turn, can stimulate estrogen production.
• Polycystic ovary (PCJ).Women with polycystic ovary syndrome (PCOS) are more prone to developing uterine cancer, as they have an increased estrogen content in the body. In women with PCA, cysts form in the ovaries, which can cause symptoms such as irregular or scanty periods, amenorrhea, as well as problems with conception, obesity, acne and excessive hair growth (hirsutism).
• Endometrial hyperplasia.Endometrial hyperplasia is a thickening of the uterine mucosa. Women with this disease have an increased risk of developing uterine cancer.

Diagnosis of uterine cancer

The primary diagnosis of uterine cancer is a gynecologist. He performs a gynecological examination and can, if necessary, perform a number of other studies. If you suspect cancer of the uterine body, the gynecologist will refer you to a consultation with an oncologist-gynecologist, who can be selected by clicking on the link. In addition, additional tests and examinations will be required.

Blood on tumor markers.

A blood test is sometimes performed to diagnose cancer of the uterus, as a cancerous tumor releases certain chemicals into the blood, the so-called tumor markers.

However, the results of a blood test for tumor markers are not always accurate and reliable. The presence of tumor markers in the blood does not mean that you have uterine cancer, and in some women with uterine cancer, these substances are not found in the blood.

Transvaginal ultrasound

You may also be prescribed transvaginal ultrasound (ultrasound). This is a type of diagnostics that uses a small scanning device in the form of a probe. It is inserted into the vagina to obtain a detailed image of the internal structure of the uterus. This procedure can be a bit unpleasant, but usually does not hurt.

Transvaginal ultrasound reveals a compaction of the uterine mucosa, which may indicate the presence of a cancerous tumor.

Uterus Biopsy

If a transvaginal ultrasound scan shows a uterine wall is denser, you will likely be given a biopsy to confirm your diagnosis. A biopsy consists of taking a small sample of the cells of the uterine mucosa (endometrium). This sample is then tested in the laboratory for cancer cells.

A biopsy is performed in various ways:

• aspiration biopsy - a small flexible tube is inserted into the uterus through the vagina, which absorbs endometrial cells;
• hysteroscopy with biopsy - a small optical device is inserted into the uterus through the vagina, with the help of which the doctor can examine the uterine mucosa and use a special surgical instrument to take a tissue sample from a suspicious area of \u200b\u200bthe mucosa.

As a rule, if there is a suspicion of cancer of the uterus in the process of hysteroscopy, a complete removal of the endometrium is performed - curettage. This is a simple surgical procedure performed under general anesthesia. Then removed tissue is sent to the laboratory for analysis.

Additional studies for uterine cancer

To determine the stage of cancer, the size of the tumor, the presence of metastases (daughter tumors) and the development of optimal treatment tactics, additional studies are prescribed:

• chest x-ray to check if the cancer has spread to the lungs;
• magnetic resonance imaging (MRI) to detect metastases and determine the size of the tumor;
• computed tomography (CT) scan, when using a series of X-ray images, a detailed image of the internal structure of the body is created to check if the cancer has spread to other organs;
• additional blood tests to check the general condition of the body and the work of some organs.

Uterine Cancer Stages

The following stages of endometrial cancer are:

• stage 1  - a tumor within the uterus;
• stage 2  - cancer has spread to the cervix;
• stage 3  - the neoplasm has gone beyond the uterus, damages the surrounding tissue or to the lymph nodes;
• stage 4 - the cancer has spread to the soft tissues of the abdominal cavity or to other organs, such as the bladder, intestines, liver or lungs.

The chances of a cure for uterine cancer depend on the stage at which the disease is diagnosed. If uterine cancer is diagnosed in stages 1 or 2, the chances of you living another five years are 70–80%. Many women with cancer in the first stage are completely cured.

If the disease is diagnosed at stage 3, the chances that you will live another five years are 40-50%. In approximately 25% of cases, uterine cancer is diagnosed in the fourth stage. By this time, the chances of living at least another five years are only 20-30%.

Uterine Cancer Treatment

The main method of endometrial cancer is removal of the uterus, ovaries and fallopian tubes. Sometimes, depending on the stage and extent of the spread of cancer, combined treatment is used: after the operation, a course of radiation or chemotherapy is prescribed to kill the remaining cancer cells, if any.

In rare cases, in young women who have not yet reached menopause, the uterus is left to maintain reproductive function. Then uterine cancer is treated with hormone therapy.

In the late, incurable stages of the tumor, chemotherapy is usually used. In this case, the goal of treatment is to achieve remission, when the cancerous tumor decreases in size, which improves well-being and quality of life. But even in advanced cases of cancer, surgical treatment is sometimes performed to remove as many tumor cells as possible. In addition, radiation, hormone or chemotherapy is prescribed to relieve pain, reduce the size of the remaining tumor and slow its growth.

Uterine Cancer Surgery

The main treatment for stage 1 uterine cancer is hysterectomy with appendages  - complete removal of the uterus, cervix, ovaries and fallopian tubes. The surgeon can also take cell samples from the lymph nodes in the pelvic and abdominal regions, as well as other adjacent tissues. If cancer cells are found in them, the operation is supplemented by the removal of lymph nodes.

Most often, during extirpation, one large incision is made on the abdomen, so that the surgeon can access the uterus and remove it. This is called a laparotomy. Sometimes it is possible to carry out the removal of the uterus with appendages through small point incisions - laparoscopic access. During laparoscopic extirpation of the uterus with appendages, several small incisions are made through which a special optical device (laparoscope) and other surgical instruments are inserted. Thanks to this, the surgeon can see what is happening inside the abdomen and remove the uterus through the vagina.

Recovery after laparoscopic surgery is much faster, since the intervention is less traumatic for the body.

After surgery, even while in bed, it is recommended to start moving as soon as possible. This is important for improving blood circulation and preventing blood clots in blood vessels. The attending physician in the hospital should show you exercises that will help you avoid complications.

Another possible treatment   fromthe earliest stage of uterine cancer is endoscopic endometrial ablation. This is the most sparing method of surgical treatment of a malignant tumor of the uterus. Ablation is used in women of pre and postmenopausal age, when removal of the uterus is contraindicated for health reasons, and the woman does not plan the birth of children. The operation is performed without incisions. Special tools are introduced through the vagina and cervix, which, using the energy of an electric current or laser, destroy the entire endometrium along with cancer cells.

With cancer of the uterus, stages 2 and 3 carry out an extended extirpation of the uterus, that is, the uterus, cervix, upper vagina, fallopian tubes, ovaries and fatty tissue with lymph nodes surrounding these organs are removed. After surgery, radiation or chemotherapy is often required to reduce the risk of tumor re-development.

If the tumor has reached a large size and cannot be removed, a cytoreductive surgery is performed completely - removal of the maximum possible volume of cancer cells. The purpose of such an operation is to alleviate symptoms, prolong life and improve its quality.

Radiation therapy for uterine cancer

Radiation therapy is used in combination with surgical treatment to reduce the size of the tumor before surgery or to prevent recurrence of cancer after removal of the uterus. Sometimes irradiation is used in cases where surgery is not possible.

Two types of radiation therapy are used to treat uterine cancer:

• contact radiation therapy (brachytherapy)when a plastic applicator with a radioactive source is introduced into the uterus and a large dose of directly affected tissues is irradiated, with minimal impact on healthy organs;
• remote radiation therapywhen the pelvic area is irradiated with a special device that focuses the rays at the location of the tumor, the effect extends to the surrounding tissue.

You will need to come to the hospital for remote radiation therapy sessions five days a week, with a break for the weekend. The session lasts a few minutes. The course of radiation therapy lasts about four weeks, depending on the stage of the cancer and the location of the tumor in the uterus.

In addition to remote radiation therapy, some women also undergo contact (brachytherapy). There are various types of brachytherapy with a low, medium or high dose of radiation. At a low dosage, irradiation is slower, so the device may be in the uterus longer. Contact radiation therapy is usually performed in a hospital. Discuss this with your doctor.

Radiation therapy has side effects: irritation and redness of the skin, hair loss, severe fatigue. Radiation therapy to the pelvic area can affect bowel function, cause nausea and diarrhea. Most side effects will disappear at the end of treatment, but approximately 5% of women will develop chronic side effects such as diarrhea and anus bleeding.

Chemotherapy for endometrial cancer

Chemotherapy is used more often after surgery to minimize the risk of cancer recurring. Chemotherapy also treats advanced stages of cancer, when it is not possible to completely remove the tumor to the end. Then this treatment method helps to slow down the growth of the tumor, reduce the severity of symptoms, prolong life and improve its quality.

Typically, chemotherapy is carried out in cycles, treatment periods - courses of chemistry, alternate with periods of rest, so that the body can recover. Medicines are often administered intravenously. Treatment is usually carried out in a hospital, but sometimes chemotherapy at home is allowed. This should be discussed with your doctor.

Side effects of chemotherapy:

• nausea;
• vomiting
• hair loss;
• fatigue.

Also, the risk of blood poisoning (sepsis) is increased, since chemotherapy weakens the body's ability to fight infections. Side effects should go away when you complete the treatment.

Hormone therapy for uterine cancer

Since the development of endometrial cancer may be associated with the influence of estrogen, in some cases hormone therapy is used for treatment. Usually, synthetic progesterone or hormones that affect the function of the reproductive system are prescribed for these purposes. Medications are more often administered intramuscularly with a different frequency, depending on the treatment regimen. Sometimes they switch to tablet forms of hormones.

Hormone therapy is mainly used to treat initial uterine cancer in young women who need to maintain reproductive function. If the treatment is successful and the tumor disappears, women are prescribed another hormone therapy regimen to restore the menstrual cycle. It takes about 6 months.

Sometimes hormone therapy is used as a preparatory step for surgery to reduce the size of the tumor. Less commonly, this type of treatment is prescribed at a late stage or in case of repeated growth of cancer.

Treatment can have side effects, including mild nausea, mild muscle cramps, and weight gain. During therapy, menstruation ceases, artificial menopause develops. Discuss this with your doctor.

Clinical trials

Great progress has been made in the treatment of uterine cancer. Every year, the life expectancy of women diagnosed with cancer of the body of the uterus increases. It was possible to reduce the number of side effects from treatment. This was partly made possible by clinical trials when new treatments and combinations of treatments are compared to standard ones.

For some patients with cancer, participation in clinical trials becomes a chance for cure, as the study uses new drugs that can be very effective in treating cancer. As a rule, these drugs are expensive, but with participation in the study are prescribed for free.

If you are offered to participate in a clinical trial, you will need to carefully read the information about the study and issue written consent. You can refuse or interrupt your participation in the trial; this will not affect your treatment.

There is a single database of clinical trials that are currently being conducted or are planned to be conducted in Russia according to the Oncology profile. With this information you can.

Life with uterine cancer

Surgery for cancer of the uterus and other methods of treatment are difficult to tolerate. During the recovery period, which can take from one and a half to three months, you can not lift weights (for example, children or heavy bags) and perform housework associated with heavy physical exertion. It is recommended to refuse to drive a car for 3-8 weeks after removal of the uterus.

At the end of the course of treatment, you need to regularly undergo scheduled examinations. All women treated for cancer of the uterine body are registered with an oncologist. During scheduled visits to the doctor, the woman passes the necessary tests and sometimes undergoes instrumental studies (ultrasound, MRI, etc.) to monitor the tumor.

Sex and social adaptation after removal of the uterus

Uterine cancer and its treatment can affect sex life as follows:

• Premature onset of menopause: removal of the ovaries can cause premature extinction of a woman's reproductive function and a malfunction in the production of sex hormones. Symptoms of menopause include vaginal dryness and loss of sex drive.
• Vaginal changes: after radiation therapy for uterine cancer, the vagina can narrow and lose elasticity. Sometimes this is an obstacle to intimacy. The use of vaginal dilators - special plastic cones that need to be inserted into the vagina to stretch its walls can help. You can stretch the vagina while having sex, either with your fingers or a vibrator.
• Decreased libido: After treating uterine cancer, many women lose interest in sex. Treatment can cause severe fatigue, a diagnosis of nervous shock, and the inability to have children can lead to confusion and depression.

Therefore, a temporary loss of interest in sexuality is quite natural. Try to discuss your feelings with your partner. If you notice that problems in sexual life do not go away over time,. Your doctor may prescribe a course of antidepressants or suggest psychotherapy sessions. There are support groups for people with cancer where you can get advice from someone who has gone through the same thing as you.

To get advice, moral support, help in resolving legal and even medical issues, you can visit the “Movement Against Cancer” portal or the “CO-Action Project”, which provides comprehensive support for people with cancer. All-Russian round-the-clock hotline for psychological assistance to cancer patients and their families 8-800-100-01-91 and 8-800-200-2-200   from 9 to 21 hours.

Benefits for Cancer Patients

For the entire period of treatment and rehabilitation, a paid sick leave is issued. If after treatment there are restrictions on working capacity or a woman can no longer do her previous job (for example, related to harmful working conditions), she is sent to a medical examination for registration of disability. In the future, a disability cash allowance is due.

Cash benefits are also paid to unemployed citizens caring for a seriously ill person. Your doctor should familiarize you with more details.

Cancer patients are entitled to receive free medicines from the list of preferential medicines. To do this, you need a prescription from your doctor. Sometimes a prescription is issued by a medical board.

Uterine Cancer Prevention

Unfortunately, reliable methods for sure to protect yourself from uterine cancer do not yet exist. However, many factors are known, avoiding which can significantly reduce the risk of endometrial cancer.

The most effective way to prevent uterine cancer is to maintain normal weight. The best way to prevent overweight or obesity is to eat right and exercise regularly.

A diet low in fat and high in fiber, including whole grains and at least five servings of fruits and vegetables per day (a total of about 400-500 grams per day), is recommended. Some studies suggest that a soy-rich diet may help prevent uterine cancer. Soy contains isoflavonoids that protect the uterine mucosa. Besides soy, you can eat tofu cheese. At the same time, reliable evidence of this hypothesis is still insufficient.

Most people are advised to have at least 150 minutes (two and a half hours) of moderate-intensity aerobic exercise per week (for example, cycling or brisk walking). It is best to distribute this load for at least five separate workouts during the week. If you have never been involved in sports or have not been involved in them for a long time, undergo a medical examination before starting training.

Research has shown that prolonged use of an oral contraceptive can reduce the risk of developing uterine cancer. Other types of birth control, such as a contraceptive implant and an intrauterine system, release a progestogen (synthetic progesterone). It can also reduce the risk of developing uterine cancer.

Which doctor should I contact for uterine cancer?

Using the NaPravka service, you can find a gynecologist-oncologist or. If necessary, you can call an oncologist at home. On our website you can choose an oncology clinic or oncology center, having read reviews and other information about them.

Localization and translation prepared by site. NHS Choices provided the original content for free. It is available from www.nhs.uk. NHS Choices has not reviewed, and takes no responsibility for, the localization or translation of its original content

Copyright notice: “Department of Health original content 2019”

All materials on the site were checked by doctors. However, even the most reliable article does not allow to take into account all the features of the disease in a particular person. Therefore, the information posted on our website cannot replace a visit to a doctor, but only supplements it. Articles are prepared for informational purposes and are advisory in nature.

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 in women after breast, skin and gastrointestinal tract cancer. 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, hormone therapy or chemotherapy are those treatments that are used individually or in combination with each other in order to heal the female sex from this cancer of the uterus.

Causes of Uterine Cancer

This form of malignant tumors is usually observed between the ages of 40 and 60 years. Uterine Cancer Risk Factors:

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

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

These are erosions, ulcers, scars after birth trauma, the growth of the epithelium (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 cervical cancer 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 (highly differentiated, moderately differentiated and undifferentiated).

Uterine Cancer Stages

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

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

Symptoms of Uterine Cancer

Early symptoms of uterine cancer

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

The main symptoms of uterine cancer

The clinical symptoms of uterine cancer are composed of complaints of leucorrhoea, bleeding and pain. However, all these three symptoms occur already in the period of tumor decay, and the time of their appearance depends on the period of onset of ulceration. Therefore, in some cases for a long period, uterine cancer may not give any symptoms. There are various types of leucorrhoea: watery, mucous, stained with blood, odorless and fetid. An admixture of blood makes the whites look like meat slops. Delayed secretions in the vagina and the joining infection leads to the appearance of purulent whites with a smell. With stage III and IV cancer, excretions from the genital tract are putrefactive. Bleeding can be in the nature of small spotting, as well as single or multiple heavy.

For cervical cancer, so-called contact bleeding is very typical (during sexual intercourse, during douching, vaginal examination, or after lifting). 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. Pain is a late symptom of uterine cancer, indicating involvement in the cancer process of the lymph nodes and fiber of the pelvis with the formation of infiltrates, compressing the nerve trunks and plexuses. General symptoms and, in particular, cachexia (weight loss) occur very late, in very advanced stages, and usually women suffering from uterine cancer retain an outwardly flowering, healthy appearance.

Diagnosis of uterine cancer

Recognition of uterine cancer begins with a study of the patient's complaints and the course of the disease. In all cases of a history of suspicion, 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 vaginal two-handed examination, a rectal two-handed examination and examination with a mirror. With a vaginal examination, in cases of a sufficiently pronounced tumor process, it is possible to determine certain changes in the neck depending on the type of tumor growth (exophytic, endophytic and mixed).

As a rule, the study is accompanied by bleeding as a result of trauma to the tumor with the examining finger. With common uterine cancer, an additional study is performed through the rectum to clarify the transition of the tumor to the walls of the pelvis and sacro-uterine ligaments. Recently, ultrasound imaging (ultrasound) has become widespread and of great importance, allowing to detect changes in the uterus that are inaccessible to other research methods and has become an indispensable method of research in cases of suspected any benign and malignant tumors in the uterus.

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

• chest x-ray,
• intravenous pyelography,
• irrigography
• cystoscopy
• sigmoidoscopy.

It is possible to carry out CT, MRI, lymphangiography, and biopsy of the tumor with a thin needle. These studies are very important for uterine cancer to develop a radiation or combination treatment plan.

Uterine Cancer Treatment

The tactics for treating uterine cancer depend on the age of the patient, the general condition and the clinical stage of the cancer. The treatment is mainly surgical (hysterectomy with appendages and sometimes removal of the pelvic lymph nodes). Perhaps a combined treatment - an operation, and then remote radiation to the area of \u200b\u200bthe vaginal stump, intracavitary gamma therapy. Preoperative radiation therapy is also carried out mainly in stage III. Radiation therapy as an independent method of treating uterine cancer is used in the local spread of the tumor process, with contraindications for surgery.

Antitumor drugs are effective in 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. Studies also include chest x-ray, ultrasound, and intravenous pyelography. During the first year of visiting a doctor every 3 months, then for 5 years - every 6 months. After 5 years, control is carried out annually. In relapses, if the process is localized, partial or total pelvic exentation is performed (removal with a single block of the uterus, cervix, vagina, parametria, 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 give metastases to the pelvic lymph nodes, less often to the inguinal. Distant metastases more often in the kidneys, liver, lungs, have a poor prognosis. With uterine cancer, 5-year survival after surgical treatment is from 84 to 45%, depending on the stage of the disease. With relapses, 25% of patients who have undergone surgical treatment initially can be relieved of relapse with radiation therapy of the 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, 5-year survival 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 such a serious disease? Any gynecologist will tell you that no. Folk remedies for uterine cancer can help at a time when the disease is in its initial stage. If it seems to you that after applying this or that folk remedy it has become easier - do not rejoice very much right away, because this effect is most likely not for long and the disease will continue to spread.

Common means of traditional medicine for cancer of the uterus are: boron uterus, 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, as in most cases, these herbs can be taken as an adjunct to treatment, or generally not recommended.

Uterine Cancer Prevention

Early diagnosis and prevention of uterine cancer is possible only through systematic preventive examinations of all women older than 30 years (at least 2 times a year). Regular examinations are advisable to begin with the onset of sexual activity. Regular examinations, ultrasound tomography and cytological examination (once every 2 years) contribute to the detection of precancerous diseases, and their treatment - to the prevention of cancer. Equally important is the timely and proper treatment of precancerous diseases of the cervix. There are no particularly characteristic signs inherent only to precancerous diseases of the cervix, they occur as ordinary inflammatory diseases.

Symptoms common to precancerous diseases are a long chronic course, persistence of symptoms, and most importantly, the lack of effect from conservative (anti-inflammatory) treatment. Treatment of precancerous diseases of the cervix uteri should be radical and consists in electroexcision, electrocoagulation of the affected areas, or even amputation of the cervix. They also resort to the radiation method of 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 uterine cancer

Question:  My mother (67 years old) has cervical cancer. Radiation therapy was performed. The defeat of the sigmoid colon is now revealed. Doctors told the operation to be done posture. Ascis as a result of damage to the peritoneum. Hydrosclerosis of the right kidney. What can be taken.

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

Question:  Hello, a 60-year-old woman has a preliminary diagnosis of endometrial adenocarcinoma, T4№ M1 class 4, sprouting in the bladder, metastasis in the vagina, tumor necrosis, intermittent uterine bleeding, increasing cancer intoxication. Accompanied by type 1 diabetes. At the bottom of the conclusion is written AH II, Article 2, risk 4. Please write down what is possible to do to treat it and how likely is it to recover? Thank.

Answer:  Sometimes, even with such a prevalence of the 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 she kept a high temperature. She was discharged home to lower the temperature without prescribing any medication. I would like to know why the temperature is kept and how you can bring it back to normal at home. Thank you in advance.

Answer:  Elevated body temperature may be due to the so-called. paracancrotic process (inflammatory changes in the tissues around the tumor).

Question:  And I am only 27 years old, and I already have uterine cancer, I have no children, it turns out and I won’t, I agreed to remove the uterus, I don’t know what to do and how to continue.

Answer:  Hello. It is possible to preserve your eggs, which in the future can be connected with the sperm of your husband (or partner) and implanted into the uterus of a surrogate mother. This is an expensive procedure, but it gives a chance to have your own baby. Also consider adopting. There are no hopeless situations. For you now, the most important thing is to defeat the disease.

Question:  My sister is 35, she was operated on and sewn up, they told us the tumor spread to the entire abdominal cavity. They can do nothing more. As the seams heal, they will let go home, and then, as God wills. Tell me, can something else be done?

Answer:  Hello. You need to follow the advice of your doctor. He will probably recommend drugs that can help eliminate some of the symptoms of cancer and pain (if any).

Question: Hello! A patient with stage 2 cancer of the uterus, 75 years old, has cardiovascular disease, speech and movement coordination are impaired, lives in the city of Rybinsk. Oncologist sent to Yaroslavl to obtain a commission opinion on treatment methods. He cannot move outside the city on his own and with the help of relatives - when traveling in a car, epileptic seizures begin. Droppers and pills do not help. The head of the department of the hospital of the city of Yaroslavl, to which the referral to the commission was received, requires the therapist's conclusion about the patient’s condition and advises relatives to think carefully about what to do with the patient. As a result, assistance is not provided in Rybinsk, it is impossible to deliver the patient to Yaroslavl, time is wasted. Question: what should relatives be guided by without medical education when deciding on further treatment for a cancer patient, and what measures can be taken by relatives in this situation?

Answer:  Hello. In general, in this state, special antitumor treatment is not indicated. Only symptomatic therapy in the community.

Unfortunately, the number of oncological diseases is only growing every year. In women, one of the leading places is cancer of the uterus. Now it has increased, in the female half of the population a longer period of menopause, it is with this that doctors attribute the increase in incidence. The risk group most often includes women 40-60 years old.

What is uterine cancer?

The uterus in women, like any other organ, has a three-layer structure. Internal - epithelial tissue, middle - smooth muscle and external - connective. In the process of the development of the disease, a tumor forms on the walls of the uterus, and then, if no treatment is taken, it will begin to spread throughout the body.

Due to the multilayer structure of the uterus, the tumor is of various types and differs in the location.

Causes of the disease

Doctors concluded that, to a greater extent, cancer of the uterine body begins to develop if this organ has been repeatedly exposed to many factors, among which I especially want to highlight the following:

1. Frequent abortions and breaks during childbirth.
2. Inflammatory processes, especially of a chronic nature.
3. Dystrophic and degenerative changes in the epithelial tissue that can occur as a result of hormonal exposure.
4. Hereditary predisposition.
5. The presence in the body of the human papillomavirus or genital herpes.
6. Long-term use of hormonal contraceptives.
7. The early onset of sexual activity, that is, up to 18 years.
8. The presence of a large number of sexual partners.
9. The presence of bad habits, especially smoking.
10. Non-observance of personal hygiene.

Despite the fact that there are many reasons that can provoke uterine cancer, life expectancy with such a diagnosis will depend on many factors. If you see a doctor in time, then this disease can be completely dealt with.

Diagnosis of the disease

Making any diagnosis begins with a conversation between the doctor and the patient. A woman must be examined by a gynecologist, without a thorough examination, there can be no talk of any treatment and diagnosis.

The examination begins with an examination of the vagina, cervix using gynecological mirrors. If there is a disease, it is usually possible to detect changes in the tissues. Often, a small bleeding may begin during the examination, as the tumor is injured.

If required, a rectal examination may be prescribed to determine how much the pelvic walls are affected.

All these manipulations can be carried out with all the necessary equipment. It often happens that cancer at the initial stage is not recognized due to incomplete examination. With the development of ultrasound diagnostics, this method was also used to detect cancerous tumors.

Since damage to the lymph nodes occurs with the development of cancer, an X-ray examination is also prescribed. In some cases, an MRI, CT scan is prescribed.

All examinations are very important for establishing the correct diagnosis and prescribing adequate treatment, because if a woman has uterine cancer, life expectancy will depend on the effectiveness of therapy.

A timely visit to the doctor will help to identify the disease at an early stage. This guarantees a high percentage of cure.

Uterine cancer: symptoms and signs

Throughout their entire lives, women need to monitor their health more carefully, and after 40, even more so, because it is at this age that the risk of developing cancer increases. Eae and all diseases, there are symptoms and signs of uterine cancer, so you need to pay attention to all deviations from the norm in the body. The trouble is that we are not in a hurry to run to the hospital as soon as we notice suspicious symptoms. It is a pity, not only the quality of our life, but also its duration completely depends on this.

Most oncological diseases are dangerous because they begin to show their symptoms only at later stages, so it often happens that when a person seeks help, nothing can help him.

It turns out that cancer of the uterine body manifests itself differently in different periods of a woman's life. We will try to figure this out.

Signs Before Menopause

If a woman is not yet at the stage of menopause, then the following manifestations of this disease can be diagnosed:

• Periodic spotting from the vagina.
• Menstruation is becoming more rare and scarce, it can, on the contrary, come more often and plentifully.
• Pain in the lower abdomen.

• Drawing pains in the lower back.
• Pain during sexual intercourse.
• Purulent vaginal discharge.
• Frequent urination.

Symptoms during menopause

When a woman is in the period of menopause, then her periods completely stop. At this time, the following symptoms should alert you:

• Any spotting.
• Sudden bleeding from the vagina.
• Drawing pain in the perineum.
• Fast fatiguability.
• Weight loss for no apparent reason.

If you find yourself with any of these symptoms, then you should not hope that everything will go away by itself. This is a rather insidious disease - uterine cancer, photos confirm this.

Cancer of the uterus is also found in pregnant women, but this is rare. This is quite dangerous for a woman's life. In this case, if the diagnosis of uterine cancer is confirmed, surgery is inevitable. Have to terminate the pregnancy and do the treatment.

Uterine Cancer Stages

Most often, any disease goes through certain stages, this can be said about a malignant tumor in the uterus. Oncologists distinguish such stages of uterine cancer:

1. Zero At this time, it is already possible to diagnose endometrial hyperplasia, which will necessarily lead to the development of a malignant formation. It is only a matter of time how quickly this will happen.
2. First stage. A tumor develops only in the body of the uterus itself, but localization can be different:

• Cancer cells affect only the epithelial layer of cells.
• The tumor begins to penetrate the muscle layer.
• Carcinoma germinates half the myometrium.

3. The second stage. Cancer begins to affect the cervix, but does not go beyond the organ. But there are also varieties:

• Only the cervical glands are involved in the process.
• The tumor affects the stroma of the cervix.

4. The third stage of the disease. The cancer of the uterus already goes beyond the limits of the organ, the photos confirm this, but again there are their units:

• A carcinoma damages the serous membrane of the uterus and can pass to the ovaries.
• There are metastases in the vagina.
• Metastases occur in nearby lymph nodes.

5. The fourth stage is the most serious. The tumor already affects the bladder, the rectum. Metastases appear outside the pelvic area.

With a diagnosis of uterine cancer, the degrees are also different. This affects the prognosis of the course of the disease:

1. High degree of differentiation.
2. Moderate.
3. Low

Doctors say that the greater the degree of differentiation, the better the prognosis. Tumors with a low degree quickly metastasize and are characterized by enhanced growth.

If you are diagnosed with uterine cancer, life expectancy will depend on the stage and degree of development of the disease.

Cervical cancer

A malignant tumor can begin to develop not only in the uterine cavity, but also in the cervix, then they talk about cervical cancer. This disease also has its stages of development:

1. First stage. A tumor develops only in the cervix.
2. The second one. It has its own development options:

• Penetration into the parametrium without transition to the walls of the pelvis.
• The vaginal variant, when a tumor affects its walls.
• The tumor develops endocervical. It can even affect the body of the uterus.

3. The third stage is also characterized by the presence of three options:

• There is an infiltration of the wall of the pelvis from one or two sides.
• With the vaginal version, the tumor passes into the lower part of the vagina.
• Pelvic metastases appear.

4. The fourth stage. The following development options can be distinguished:

• The tumor passes to the bladder.
• Cancer cells affect the rectum.
• The tumor extends beyond the pelvis.

Different types of stages and tumor development options help doctors give a clear idea of \u200b\u200bthe treatment methods and its effectiveness.

Uterine Cancer Treatment

Currently, taking into account the level of development of medicine, we can say that most oncological diseases are not a death sentence for a patient. But this is only if a person promptly seeks medical help.

The treatment of malignant tumors is carried out taking into account the stage of the disease, its localization. Most often, the main methods are:

If treatment is started on time, then it is more likely that you will succeed in the cervix, photos well demonstrate the full life of women after surgery.

In the case when a woman seeks medical help too late, the percentage of treatment success is significantly reduced.

Disease prevention

Only if you systematically visit a gynecologist and undergo an annual physical examination, then you can be sure that the cancer will be detected at an early stage.

As soon as a woman begins to live sexually, she should make it a rule to visit a gynecologist every year. Regular examination, smear examination, ultrasound of the pelvic organs allow you to identify precancerous conditions. If you treat them on time, then you can prevent the development of tumors.

So you can prevent. Photos confirm that it is very easy to identify such pathologies if you regularly undergo an examination. It is impossible to independently recognize the disease and correctly prescribe medications for yourself, only a doctor should do this.

Most often, if inflammatory diseases of the pelvic organs are not treated, then over time they can easily develop into oncological ones. Our health is only in our hands, and no one but ourselves will take care of it.

Treatment effectiveness

The effectiveness of the treatment of cancerous tumors can be judged by repeated cases of the disease. Relapse usually occurs in the first three years after therapy. Many with a diagnosis of cervical cancer after surgery normalize the vital activity of the body, the woman recovers and returns to her usual way of life.

If more than three years have passed after the operation, and everything is fine with you, then you can guarantee with great confidence that your relapse is unlikely.

Uterine Cancer Prognosis

Give a 100% guarantee that after the treatment, the tumor will no longer bother you, unfortunately, it is impossible. If the disease is detected at the first stages of its development, then about 90% of patients recover almost completely.

Considering that the quality of medical examinations has now improved, a lot of work is being done on the early detection of the disease, we can guarantee that the survival rate for cancer detection will increase further.

Even if you have uterine cancer of the third and fourth stage, life expectancy with the right treatment is significantly increased. Survival can be enhanced by combining radiation with chemotherapy.

If a woman seeks medical help when metastases capture not only the uterus or cervix, but also neighboring organs, then the prognosis is not very comforting. In this case, it is much more difficult to affect cancer cells.

We can conclude that the quality and duration of our lives depend only on ourselves. Do not be afraid to visit polyclinics, the detected disease in time is treated much faster and more efficiently.

The uterus is one of the most important organs of the female reproductive system. And, like other female organs, the uterus can be affected by a malignant neoplasm. This pathology takes first place among all cases of cancer of the female genital organs. And therefore, it is important for any woman to know the main signs of this formidable and life-threatening disease.

Description of the disease

The uterus is a muscle bag designed for fetal development. Body dimensions - 8/4/3 cm (length / width / thickness). The lower part of the uterus, facing the vagina, is called the cervix. The rest forms the body of the uterus. The upper body of the uterus, adjacent to the peritoneum, is called the bottom of the uterus.

The walls of this organ have several layers. The inner layer is called endometrium, a fertilized egg is attached to this layer. This layer is necessary to supply the embryo with everything necessary. The middle layer of the uterus is relatively thick. It consists of muscle tissue and is called myometrium. The outer layer is thin and is called parametria.

According to histological parameters, uterine cancer is divided into the following varieties:

• adenocarcinoma
• clear cell
• squamous,
• serous,
• glandular squamous,
• mucinous
• undifferentiated.

In most cases, the tumor is localized in the uterine fundus, less often in the lower part of the uterus.

Practice shows that malignant tumors can develop both in the endometrium and in the myometrium, as well as in the cervical region. Nevertheless, cervical cancer has its own characteristics and therefore is distinguished as a separate disease in oncogynecology. In this article, we will not dwell on it, but consider only cancer of the uterus.

Who is most likely to get uterine cancer?

Every year in Russia, many women (approximately 16,000) have this terrible diagnosis - uterine cancer. It can affect both older women who have reached menopause, and young women of childbearing age. Although the proportion of elderly patients over 45 years old still prevails. In addition, the incidence of the disease is increased in those women who entered the menopause period late.

Causes of the disease

There are two main types of disease. This is uterine cancer, associated with the level of female hormones, and uterine cancer, arising regardless of this factor. Doctors have long noticed that women with an increased level of estrogen in the body and with insufficient levels of progesterone are at increased risk of the disease. Uterine cancer caused by these abnormalities is called hormone-dependent. It accounts for 70% of all cases of uterine cancer. This type of disease begins, as a rule, with excessive proliferation of the endometrium. At the same time, processes occur in the woman’s endometrium, which most likely lead to the appearance of a tumor.

What other factors influence the occurrence of uterine cancer:

• prolonged use of estrogen,
• hypertonic disease,
• taking certain medications for breast tumors,
• heredity (cases of cancer of the uterus, breast or ovary in the immediate family),
• immune disorders
• lack of pregnancy
• ovarian tumors
• endometritis
• scars after birth injury,
• multiple abortions
• irradiation of the pelvic organs,
• diseases of the liver and adrenal glands.

As can be seen from this list, many of these factors also indicate that the incidence of uterine cancer is often associated with imbalances in hormones in the female body. For example, adipose tissue also plays the role of a kind of endocrine organ that produces female hormones. According to studies, exceeding the norm of body weight in women by 10-25 kg increases the risk of malignant tumors of the uterus three times, more than 25 kg - 9 times.

Many drugs for treating breast tumors also contain estrogens. With ovarian tumors, an increased release of estrogen often also occurs. Diseases such as adenoma or adrenal hyperplasia, hepatitis, cirrhosis also affect hormones in the body.

However, many tumors occur regardless of the level of hormones in the body of a woman. This cancer is called autonomous, and, as a rule, it is much more difficult than hormone-dependent. Most often, this type of cancer is found in older women. Risk factors here are impaired immunity, cases of uterine bleeding after menopause.

Uterine Cancer Stages

The success of the treatment of the disease depends on the stage at which it was started. The more the disease has developed, the less likely it is to defeat it. Uterine cancer, like most types of malignant tumors, is dangerous because in the later stages it damages surrounding organs and everywhere spreads its metastases, including to distant organs. In such cases, doctors, despite all their efforts to treat the disease, may not save the patient's life.

There are two types of classification of uterine cancer stages. One of them was proposed by the FIGO International Association of Obstetricians and Gynecologists. Another - the so-called TNM classification, takes into account not only the size of the tumor itself, but also the degree of damage to the lymph nodes, as well as the spread of metastases to distant organs.

Consider first the FIGO staging system, which is suitable for describing endometrial cancer. The following steps are present in this classification:

• IIIA,
• IIIB
• IIIC

What do these stages mean? It is customary to designate the zero stage as the stage when there is no cancer as such, however, atypical endometrial hyperplasia is observed, which with a high, almost 100% probability, passes into cancer.

In stage I, the tumor is located exclusively within the uterus. In stage IA, the tumor does not extend beyond the endometrium. At stage IB, the tumor begins to penetrate into the muscle layer; at stage IC, it approaches close to the outer shell of the uterus.

At stage II, a tumor spreads to the cervix. At stage IIA, a tumor is observed only in the region of the neck glands, and at stage IIB, it also spreads to stromal cells.

Stage III is diagnosed when the tumor leaves the uterus, however, the pathological process does not leave the limits of the small pelvis. At stage IIIA, the tumor affects the appendages; at stage IIIA, the vagina; at stage IIIC, metastases are found in the nearest lymph nodes. Stage IVA indicates tumor invasion into the bladder or rectum. Stage IVB is the last, with it metastases form outside the pelvic area.

Consider now the TNM staging system. It takes into account three parameters - T (tumor size), N (metastatic lymph nodes), M (metastases).

Here are the phenomena that correspond to various values \u200b\u200bon the T scale:

• T_IS - precancer;
• T1A - the tumor is within the uterus, less than 8 cm in diameter;
• T1B - tumor within the uterus, more than 8 cm in diameter;
• T2 - a tumor is found in the cervix;
• T3 - the tumor extends beyond the uterus, but does not leave the pelvic area;
• T4 - a tumor spreads to the rectum or bladder, or extends beyond the boundaries of the small pelvis.

Parameters N and M can take the following values:

• N0 - there are no signs of damage to the lymph nodes,
• N1 - lymph nodes are affected,
• M0 - there is no evidence of distant metastases,
• M1 - distant metastases.

G index is also sometimes used to indicate the degree of differentiation of tumor cells. An index value of 1 means a high degree of differentiation, 2 - medium, 3 - low.

Symptoms

Accurate diagnosis in case of uterine cancer is not an easy task. This is due to the fact that the signs of this disease may resemble the symptoms of other pathologies of the female genital organs. And in order to establish the correct diagnosis, it often takes precious time, during which the tumor develops unhindered.

The main symptom that occurs in many women with uterine cancer is vaginal bleeding that is not associated with menstruation. Such phenomena should be alarming, although, of course, they do not always mean the presence of a malignant tumor. However, they must be an occasion to consult a doctor.

The second symptom is abundant vaginal discharge, often of an unusual appearance. They can be purulent and watery, have an unpleasant odor.

The first signs of uterine cancer usually do not include severe pain. Pain in the early stages of uterine cancer is usually mild or not observed at all. A woman may be bothered except by pulling pains in the lower abdomen. Severe and disturbing pains can appear only after the spread of the pathological process in the pelvic area. Also, if the tumor develops and squeezes the ureter, then pain may appear during urination, frequent urination. Symptoms such as pain during bowel movements and false urge to defecate may appear. Sexual intimacy also usually causes discomfort.

In adult women after menopause, when menstruation stops, there should normally be no spotting from the vagina. A similar phenomenon very often indicates a malignant tumor.

It should be remembered that in 8% of cases, cancer of the uterus at an early stage develops completely asymptomatically.

Diagnostics

If during a gynecological examination a doctor suspects uterine cancer, the doctor directs the patient to a number of additional diagnostic procedures. First of all, this is an ultrasound. With ultrasound diagnostics, it is easy to determine the thickness of the endometrium, and its increased thickness is cause for concern. In older women, after menopause, it should not exceed 4 mm, in older women during menopause - 7 mm, in women of childbearing age - 12 mm. Ultrasound also allows you to determine in which direction the tumor grows - inside the uterine cavity or beyond. The disadvantage of the ultrasound procedure is the impossibility of examining nearby lymph nodes for their damage.

There are more informative research methods - MRI and computed tomography. However, the biopsy method is most accurate. If a suspicious formation is found, then a tissue sample is taken from it using a special needle for analysis. A biopsy of nearby lymph nodes may also be performed. An endoscopic research method is also carried out - hysteroscopy. This method can be combined with taking tissue samples for analysis by biopsy. In addition, with hysteroscopy, a sampling of diagnostic material can also be carried out by scraping the surface of the endometrium.

Another common method is to analyze the contents of the uterus (aspiration biopsy). Content sampling for analysis can be performed in women and on an outpatient basis. Unfortunately, in the early stages of cancer, the method is uninformative. In any case, a suitable method is selected by a specialist.

In addition, the following diagnostic tests may be prescribed by a doctor:

• general blood analysis,
• blood chemistry,
• analysis of urine,
• coagulogram.

When diagnosing, it is important to differentiate malignant neoplasm of the uterus from other diseases of the genital organs - fibroids, endometriosis, polyps, adenomatosis, tumors of the vagina and cervix. Only after the diagnosis has been accurately established, you can proceed to the treatment of the disease.

Statistics say that in most cases, cancer of the uterus is diagnosed in the first stage of the disease (72% of cases). The stages 2, 3 and 4 account for 13%, 12% and 3%, respectively.

Treatment

Therapy of any malignant formation is not an easy and lengthy process. Uterine cancer is no exception to this rule. The choice of treatment methods largely depends on the location of the tumor, the type of cancer cells (differentiated or not), the stage of the disease. In addition, the patient's age and its concomitant diseases are taken into account. The latter factor is also important, because uterine cancer is rarely diagnosed in completely healthy women in other respects. As noted above, diabetes, obesity, and hormonal imbalance in the body often contribute to the development of the disease.

In most cases, the main treatment is performed surgically. Usually, complete removal of the uterus (total hysterectomy) is practiced. Often it is carried out together with appendages, especially in those cases when a woman is in menopause. The extent of the spread of the tumor is also taken into account. There are two types of uterine removal surgery - amputation and extirpation. During amputation, the uterus is separated from the cervix, and during extirpation it is removed along with the cervix. Practice shows that amputation is more tolerated by patients than extirpation. In addition, it leads to fewer complications. However, it is also necessary to consider how much the tumor has grown, whether it affects the neck of the organ.

Usually, during this operation, the appendages, the ovaries with fallopian tubes, are also removed. Of course, after the operation, the amount of female hormones produced by the body decreases, but not much, because partly the function of hormone synthesis is taken over by other organs of internal secretion, for example, the adrenal glands.

The operation to remove the organ can be carried out both by the classical, abdominal method (using an incision in the abdomen), and by the vaginal, in which the uterus is removed through an incision in the posterior wall of the vagina. A similar procedure today is usually performed using laparoscopic technology.

In some cases, instead of removing the entire organ, an ablation (removal) of the endometrium may be performed. This operation is carried out only if the tumor is small - no more than 3 mm. After this operation, as well as after organ removal, a woman loses the ability to bear children.

Treatment may also include chemotherapy and radiation therapy. These treatments are commonly used as adjunctive to surgical. With their help, it is possible to achieve a significant reduction in the tumor, which makes it easier to remove it. In those cases when surgery for one reason or another, for example, due to the patient’s health condition, is impossible, radiation therapy and chemotherapy become the main methods of treatment.

Cytostatics are used to treat a tumor as part of chemotherapy. The principle of their action is based on blocking the processes of reproduction of pathological tumor cells. The most commonly used drugs are cisplatin, doxorubicin, cyclophosphamide.

Often they treat the disease with the help of radiation therapy. In this case, two methods are possible. In one case, the radiation source is introduced inside the organ, and in the second it is outside.

If the cancer has a hormone-dependent nature, then treatment with hormones - antiestrogens and gestagens - is often used. In the initial stages of cancer, hormone therapy can stop the progression of the disease, and with atypical endometrial hyperplasia, even achieve complete cure.

Forecast

The prognosis of the development of the disease depends on such factors as the stage of the disease, the type of tumor, the age of the patient, her state of health. It has been observed that hormone-dependent cancer is usually less severe and easier to treat than hormone-independent (autonomous).

In addition, in the elderly, the disease is more severe than in the young.

The degree of differentiation of cancer cells also matters. If it is low, then such a disease usually develops faster and is difficult to treat.

The prognosis for the disease largely depends on such a factor as the formation of metastases. This factor is affected by the woman’s age, the degree of differentiation of tumor cells, its location, and the type of cancer - hormone-dependent or autonomous. With an autonomous type of cancer, the probability of metastasis is 13%, with hormone-dependent - 9%. With highly differentiated cancer, metastases form in 4% of cases, with low-grade cancer in 26% of cases. In patients under the age of 30 years, metastases are extremely rare, in patients aged 30-60 years - in 6% of cases, in patients over 60 years of age - in 15% of cases.

After the treatment is completed, relapse of the disease cannot be ruled out. In the first three years, relapse occurs in every fourth patient, and in subsequent years, relapse is observed only in every tenth patient.

On average, for all categories of patients, the five-year survival rate is 86-98% for those who started treatment at the first stage of the disease, 70% at the second, 30% at the third, and 5% at the fourth.

Prevention

One hundred percent guarantee that uterine cancer does not occur, of course, does not exist. However, it is worth remembering that a number of factors contribute to the onset of this disease. This is overweight, uncontrolled intake of hormonal drugs, diabetes. In addition, a woman needs to visit a gynecologist regularly, at least once a year. This is especially true for those women who entered the menopause. If feminizing benign tumors are detected, they must be removed in a timely manner. Any suspicious phenomena occurring with the genitals, especially bleeding from them, can be harbingers of malignant tumors. This should be remembered. You should also eat right, eat more plant fiber, which reduces the risk of getting any kind of cancer, and avoid bad habits - smoking and drinking alcohol.

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

In recent decades, there has been a steady increase in the incidence of cancer of the female genital area, including such common as cancer of the uterus.

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

Cancer of the uterus can develop at any age, but mostly women over 45 years old are ill (the average age of patients who first went to the doctor for symptoms of endometrial cancer is 60 years).

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

Anatomy and physiology of the uterus

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

The bladder is located in front of the uterus located deep in the pelvic pelvis, and the rectum is in the back. Such a neighborhood causes the occurrence of disorders of urination and defecation with severe pathological processes in the uterus.

The dimensions of the non-pregnant uterus are normally relatively small (length about 8 cm, with a width of 4 cm and a thickness of up to 3 cm). The reproductive organ has a pear-shaped shape; in its structure, the bottom, body and neck are distinguished.

From the top, in the area of \u200b\u200bthe enlarged fundus of the uterus, the fallopian tubes fall into the right and left tubes, through which the egg enters the organ cavity from the ovary (as a rule, the process of fertilization takes place even in the fallopian tube).
  Downward, the body of the uterus narrows and passes into a narrow channel - the cervix.

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

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

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

Growth, flowering and rejection of the functional layer of the endometrium are associated with a cyclical change in the level of female hormones in the blood, which are secreted by the female sex glands - the ovaries.

The production of hormones is controlled by a complex neuro-endocrine system of regulation, therefore, any nervous or endocrine disorders in the female body adversely affect the vital activity of the endometrium and can cause serious diseases, including cancer of the uterus.

What factors increase the risk of developing uterine cancer?

  Factors that increase the risk of developing cancer of the uterus include:

• adverse heredity (the presence of endometrial cancer, ovarian cancer, breast or colon cancer in immediate families);
• late menopause;
• no history of pregnancy;
• ovarian tumors producing estrogen;
• treatment of breast cancer with tamoxifen;
• prolonged oral contraception using dimethisterone;
• estrogen replacement therapy;
• irradiation of the pelvic organs.

Causes and mechanisms of development of cancer of the uterus

  There are two most common types of cancer of the uterus: hormone-dependent and autonomous. It is proved that the factor of genetic predisposition plays a significant role in the development of both variants.

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

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

Clinically, hyperestrogenism is manifested by the following symptoms:

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

  It should be noted that estrogen levels can also increase in severe liver diseases, when the metabolism of sex hormones (chronic hepatitis, cirrhosis) is impaired.

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

As a rule, hormone-dependent malignant tumors of the endometrium have a high differentiation, therefore, they are characterized by slow growth and a relatively low tendency to metastasis. Often there is primarily multiple development of malignant tumors (in the ovaries, in the mammary gland, in the rectum).
  In the development of hormone-dependent endometrial cancer, several stages can be distinguished:

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

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

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

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

How is uterine cancer stage determined?

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

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

The first stage (IA-C) is said to be when the tumor is limited to the uterine body. In such cases, they distinguish:

• ІА stage - the tumor does not grow deep into the myometrium, being limited to the epithelial layer;
• IV stage - the tumor penetrates the muscle layer of the uterus, but does not reach the middle of its thickness;
• ІС stage - a carcinoma grows half of the muscle layer and more, but does not reach the serous membrane.

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

• Stage II, when only the glands of the cervix are involved in the process;
• Stage III, when the stroma of the cervix is \u200b\u200baffected.

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

• Stage III, when a carcinoma sprouts the external serous membrane of the uterus and / or affects the uterine appendages;
• Stage III, when there are metastases in the vagina;
• Stage III, when metastases occurred in the nearby lymph nodes.

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

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

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

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

  The tumor lesion of the lymph nodes (N) and the presence of distant metastases (M) is determined by the indices:

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

  So, for example, a diagnosis of T 1a

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

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

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

  The higher the degree of differentiation, the better the prognosis. Low-grade tumors are characterized by rapid growth and an increased tendency to metastasis. Such carcinomas are usually diagnosed already in the late stages of development.

How does uterine cancer metastasize?

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

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

Thus, the lymph nodes are a barrier to the spread of the tumor. However, with significant contamination of the “filter”, tumor cells settled in the lymph nodes begin to multiply, forming metastasis.
  In the future, the spread of malignant cells from the affected lymph node to more distant parts of the lymphatic system (inguinal lymph nodes, lymph nodes near the aorta, etc.).

The cancer of the uterine body begins to spread hematogenously when the tumor grows into the blood vessels of the organ. In such cases, individual malignant cells are transferred with blood flow to distant organs and tissues.

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

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

What factors affect the ability of cancer of the uterus to metastasize?

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

• tumor localization in the uterine cavity (the risk of developing metastases ranges from 2% with localization in the upper posterior part of the uterus to 20% with localization in the lower posterior part);
• the patient’s age (in patients under 30 years of age, metastases are almost never met, at the age of 40-50, the probability of developing metastases is about 6%, and in women over 70 years of age - 15.4%);
• pathogenetic variant of cancer of the uterus (with a hormone-dependent tumor - less than 9%, with an autonomic one - more than 13%);
• the degree of differentiation of the malignant tumor (with highly differentiated tumors - about 4%, with low-grade tumors - up to 26%).

What are the symptoms of cancer of the uterus?

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

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

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

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

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

Whites
  These discharge characterize another characteristic symptom of cancer of the body of the uterus, which most often appears even with significant sizes of the primary tumor. In some cases, discharge may be profuse (leukorrhea). The accumulation of whites in the uterine cavity causes pulling pains in the lower abdomen, reminiscent of pain during menstruation.

Purulent discharge
  With stenosis of the cervix, suppuration of whites may occur with the formation of pyometers (accumulation of pus in the uterine cavity). In such cases, a characteristic picture develops (bursting pains, fever with chills, deterioration of the general condition of the patient).

Watery discharge
  Abundant watery whites are most specific for cancer of the uterus, however, as clinical experience shows, a malignant tumor can also manifest as bloody, bloody-purulent or purulent discharge, which usually indicates secondary infection. With the decay of the tumor, leucorrhoea takes the form of meat slops and an unpleasant smell. Unrelated to bleeding and leukorrhea pain appear already in the late stages of development of cancer of the uterus. When a tumor invades the serous membrane of the genital organ, a gnawing pain syndrome occurs, in such cases, as a rule, pain is more often disturbed by patients at night.

Pain
  Often, pain occurs even with a common process with multiple infiltrates in the pelvis. If the tumor compresses the ureter, lower back pain appears, the development of attacks of renal colic is possible.

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

• pain when urinating or defecating;
• frequent painful urges to urinate, which are often of an imperative nature;
• tenesmus (painful urge to defecate, as a rule, not ending with the release of feces).

What diagnostic procedures should be performed if cancer of the uterus is suspected?

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

• diagnosis of malignant neoplasm;
• determination of the exact location of the primary tumor;
• assessment of the stage of development of the disease (the prevalence of the tumor process, the presence of lymph nodes affected by the tumor and distant metastases);
• elucidation of the degree of differentiation of tumor tissue;
• study of the general condition of the body (the presence of complications and concomitant diseases, which may be contraindications to a particular type of treatment).

Characteristic complaints
  Diagnosis of cancer of the uterine body begins with a traditional survey, during which the nature of complaints is clarified, the history of the disease is examined, and the presence of risk factors for the development of a malignant tumor of the endometrium is established.

Gynecological examination
  Then the doctor examines the gynecological chair using mirrors. Such an examination eliminates the presence of malignant neoplasms of the cervix and vagina, which often have similar symptoms (spotting, whitening, aching pains in the lower abdomen).

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

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

In women of reproductive age, manipulation is performed on the 25-26th day of the menstrual cycle, and in women in postmenopause, on any day. Aspiration is carried out without expansion of the uterine canal. This is a minimally invasive (less traumatic) and completely painless technique.

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

Unfortunately, the method is not sensitive enough to the early stages of cancer of the uterus (it reveals pathology only in 37% of cases), while in common processes this indicator is much higher (more than 90%).

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

• exact localization of the neoplasm in the uterine cavity;
• type of tumor growth (exophytic - in the uterine cavity or endophytic - germination in the wall of the organ);
• the depth of tumor growth into the muscle layer of the uterus;
• the prevalence of the process on the cervix and surrounding fiber;
• damage to the tumor process of the uterus.

  Unfortunately, with ultrasound, it is not always possible to examine the lymph nodes of the pelvis, which are targets for early metastasis of cancer of the uterus.

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

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

In the early stages of the disease, a new promising method of endoscopic diagnosis is often used as fluorescence study  using tumorotropic photosensitizers or their metabolites (aminolevulinic acid, etc.). This method allows you to determine microscopic neoplasms up to 1 mm in size using the preliminary introduction of photosensitizers that accumulate in tumor cells.

Hysteroscopy is usually accompanied by separate gynecological curettage of the uterus.First, scraping of the cervical canal epithelium is performed, and then fractional curettage of the uterine cavity is performed. Such a study allows to obtain data on the state of the epithelium of various parts of the uterine cavity and cervical canal and has a sufficiently high diagnostic accuracy.

All patients with suspected uterine cancer pass general body study, to obtain information about contraindications to the conduct of a particular method of treatment of a malignant tumor. The examination plan is compiled individually and depends on the presence of concomitant pathologies.

If there is a suspicion of the presence of distant metastases, additional studies are performed (ultrasound of the kidneys, chest x-ray, etc.).

When is surgical treatment for cancer of the uterus indicated?

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

The surgical method is the main one in the treatment of cancer of the uterus in the early stages of development, with the exception of cases of severe comorbidity, when such an intervention is contraindicated. According to statistics, about 13% of patients with cancer of the uterine body have contraindications for surgery.

The volume and method of surgery for uterine cancer is determined by the following main factors:

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

Do organ-preserving operations for cancer of the uterus?

  Organ-preserving operations for cancer of the uterus are less frequent than, for example, for breast cancer. This is due to the fact that most patients are postmenopausal women.

In young women with atypical endometrial aplasia (stage zero according to the FIGO classification) can be performed endometrial ablation.

In addition, this manipulation can be shown in individual cases of stage 1A of the disease (endometrial tumor that does not extend beyond the mucous membrane) and in elderly patients with severe concomitant diseases that prevent a more traumatic intervention.
  Endometrial ablation is the total removal of the uterine mucosa, together with its basal germ layer and the adjacent surface of the muscle membrane (3-4 mm myometrium), using controlled thermal, electrical or laser exposure.

The removed mucous membrane of the uterus does not recover, therefore, after ablation of the endometrium, secondary amenorrhea (absence of menstrual bleeding) is observed, and the woman loses the ability to bear children.

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

What is uterine extirpation surgery and how does it differ from uterine amputation?

Uterine Amputation
Subvaginal amputation of the uterus (literally, uterine dissection) or subtotal hysterectomy is the removal of the body of the genital organ while preserving the cervix. Such an operation has a number of advantages:

• the operation is easier for patients;
• ligamentous material is preserved, which prevents the omission of the internal organs of the small pelvis;
• less likely to develop complications from the urinary system;
• violations in the sexual sphere are less common.

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

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

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

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

Operation Technique
  Classical or open abdominal hysterectomy is said in cases where the surgeon gets access to the uterus by opening the abdominal cavity in the lower abdomen. This operation is performed under general anesthesia, so that the patient is unconscious.

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

Vaginal hysterectomy is the removal of the uterus through the posterior wall of the vagina. Such access is possible in women giving birth with small tumor sizes.

Vaginal hysterectomy is much more easily tolerated by the patient, however, a significant drawback of the method is that the surgeon is forced to act almost blindly.

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

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

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

When is radiation therapy for uterine body cancer indicated?

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

Indications for the appointment of radiation therapy may be the following conditions:

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

  In addition, radiation therapy can be prescribed in the complex treatment of inoperable stages of the disease, as well as in patients with severe concomitant pathologies, when surgical intervention is contraindicated.
  In such cases, this treatment method allows to limit tumor growth and reduce the symptoms of cancer intoxication, and, therefore, extend the patient's life and improve its quality.

How is radiation therapy performed for cancer of the uterus?

  With cancer of the uterus, external and internal radiation is used. External irradiation is carried out, as a rule, in a clinic using a special apparatus that directs a beam of high-frequency rays to the tumor.

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

According to indications, a combination of internal and external exposure is possible.

What are the side effects of radiation therapy for uterine cancer?

Propagating cells are most sensitive to radioactive radiation, which is why radiation therapy destroys, first of all, intensively multiplying cancer cells. In addition, in order to avoid complications, a directed effect on the tumor is carried out.

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

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

  The patient should inform the attending physician about the appearance of these symptoms.
  In addition, in the first weeks after radiation therapy, women are advised to abstain from sexual life, since during this period often increased hypersensitivity and soreness of the genital organs.

When is hormone therapy for uterine cancer shown?

  Hormone therapy is used in the hormone-dependent variant of cancer of the uterus. In this case, the degree of differentiation of tumor cells is preliminarily assessed and, with the help of special laboratory tests, the sensitivity of the malignant tumor to changes in the hormonal background is determined.

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

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

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

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

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

  Unlike other conservative treatments for cancer of the uterus, hormone therapy is generally well tolerated.

Hormonal changes can cause dysfunction of the central nervous system, in particular sleep disturbances, headache, increased fatigue, and a decrease in the emotional background. For this reason, this type of treatment is prescribed with great care to patients who are prone to depressive conditions.

Sometimes with hormone therapy there are signs of pathology of the digestive tract (nausea, vomiting). In addition, metabolic disturbances (sensation of hot flashes, swelling, blackheads) are possible.

Unpleasant symptoms of the cardiovascular system appear less often, such as an increase in blood pressure, the occurrence of heart attacks and shortness of breath.

It should be noted that high blood pressure is not a contraindication to the appointment of hormone therapy, however, it should be remembered that some drugs (for example, hydroxyprogesterone capronate) enhance the effect of antihypertensive drugs.

The appearance of any side effects should be reported to the attending physician, tactics to combat unpleasant symptoms are selected individually.

When is uterine cancer chemotherapy indicated?

  Chemotherapy for cancer of the uterus is used exclusively as a component of complex treatment for common stages of the disease.

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

What complications can develop with chemotherapy for uterine cancer?

  For chemotherapy, drugs that inhibit dividing cells are used. Since antitumor agents have a systemic effect, in addition to intensively proliferating tumor tissue cells, all regularly updated tissues fall under the blow.

The most dangerous complication of chemotherapy is the inhibition of proliferation of cellular blood elements in the bone marrow. Therefore, this method of treating cancer is always carried out under laboratory control of the blood condition.

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

These symptoms are reversible and completely disappear some time after drug withdrawal.
  In addition, each medication from the antitumor group has its own side effects, which are reported to patients by the doctor when prescribing a course of treatment.

How effective is the treatment of cancer of the uterus?

The effectiveness of treatment for cancer of the uterine body is evaluated by the frequency of relapses. Most often, the tumor recurs within the first three years after the end of the initial treatment (in every fourth patient). In later terms, the relapse rate is significantly reduced (up to 10%).

The cancer of the uterine body recurs mainly in the vagina (more than 40% of all relapses) and in the pelvic lymph nodes (about 30%). Often there are tumor foci in distant organs and tissues (28%).

What is the prognosis for uterine cancer?

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

Recently, a fairly high five-year survival rate has been achieved in patients with uterine cancer. However, this applies only to women who seek help at the first and second stages of the disease. In such cases, the five-year survival rate is 86-98% and 70-71%, respectively.

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

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

How can I protect myself from cancer of the uterus?

  Prevention of cancer of the uterine body includes combating removable risk factors for the development of pathology (eliminating excess weight, timely treatment of liver diseases and metabolic and endocrine disorders, identifying and treating benign endometrial changes).

In cases where benign endometrial dysplasia is not amenable to conservative treatment, doctors are advised to resort to surgical methods (endometrial ablation or hysterectomy).

Since the prognosis for cancer of the uterus is largely dependent on the stage of the disease, so-called secondary prophylaxis aimed at the timely diagnosis of a malignant tumor and pre-tumor conditions is of great importance.