Uterine cancer: symptoms and signs. How to recognize the first symptoms and signs of uterine cancer at an early stage? How long does it take for uterine cancer to develop

Every year, due to the deterioration of the general ecological state of the planet and cities in particular, the number of sick women is growing. At the moment, this disease ranks first among all oncological sores. Every year in our country, 17 thousand patients with gynecological cancer are diagnosed. And what is most unpleasant - the figure is constantly growing every year.

What is uterine cancer? This is a malignant neoplasm in the uterine cavity, which begins to appear from the soft tissues and later develops into a cancerous tumor that affects the vagina and cervix, as well as nearby lymph nodes. Under normal conditions, the uterus has a pear-shaped shape, and with a disease, there may be severe deviations.

If taken as a whole, then here the pathology occurs mainly in older older women after 60-65 years. Also at risk are those patients who will soon have menopause with menopause. In young girls, the disease appears much less frequently.

The advantage of this disease is that, compared with other malignant tumors, it begins to manifest itself at the earliest stages. The first symptoms are quite pronounced and most women immediately go to the doctor.

Causes of uterine cancer

Scientists and doctors still cannot answer the exact question of the oncology of the uterus. The only thing that can be said for sure is that such diseases appear more and more every year.

Risk factors for uterine cancer

• Genetics and diseases in close relatives: mothers, grandmothers, etc.
• Irregular sex life.
• Numb women.
• Any intervention at the level of antiestrogen (hormonal) drugs. Such drugs include, for example, Tamoxifen. But here it is necessary to clarify that the risk can arise only if the drug itself is used incorrectly, which will lead to a violation of the hormonal background.
• Diabetes mellitus.
• Severe obesity.
• The onset of menopause after 57 years.
• Permanent prolonged anovulation.
• endocrine infertility.

Basically, endometrial cancer occurs in the female half of the population, in which the hormonal balance in the body is disturbed: due to diseases or due to drugs.

Types of pathogenetic disease

harmonically dependent- occurs much more often in women with diabetes and obesity. This is accompanied by increased production of the sex hormone estrogen. The hormones themselves begin to act on the inner layer of the uterus - the endometrium, resulting in hyperplasia, when the cells themselves begin to increase in size, and then multiply rapidly.

Further, the cells themselves can develop first into a benign formation, and then into cancer. Usually, other diseases may appear in combination: Stein-Leventhal syndrome, or as it is also called ovarian sclerocystosis, ovarian and breast tumors. Such a tumor is very sensitive to progestogens, but it grows rather slowly, which is why the disease is quite tolerable.

SIGNS

1. Adrenal adenoma
2. Cirrhosis of the liver
3. Overweight
4. Follicular ovarian cysts and texomatosis
5. late menopause.

Autonomous. When a woman enters postmenopause, the level of estrogen drops dramatically, which causes atrophy of the ovary and endometrium. In this case, female hormones do not affect the tumor. But at the same time, the tumor is very aggressive and growing rapidly. Rapid development is characterized by deep germination of the tumor deep into the tissues.

Stages of occurrence of malignant tissues of the uterus

1. External factors + lack of ovulation and increased estrogen levels.
2. polyps
3. endometrial hyperplasia
4. Atypia
5. Hyperplasia of epithelial cells is one of the precancerous conditions.
6. Preinvasive cancer
7. Penetration into nearby tissues.

Symptoms of uterine cancer

Like any other cancer, the first signs of uterine cancer can indicate the presence of other diseases. A woman can confuse the first symptoms with hormonal fluctuations, various infectious processes, especially if she has already encountered them. But there are several factors that will point to a tumor.

early stages

1. Infertility.
2. Ovarian dysfunction.
3. Bleeding from the uterus. Many young girls can be confused with dysfunctional uterine bleeding, which is why they lose a lot of time.
4. Watery, purulent and clear discharge from the uterus (Lycoria).
5. In women of an earlier age, intermenstrual bleeding, which is accompanied by a large abundance of blood, may indicate cancer of the uterine body.

Late stages

1. Pain in the lower abdomen.
2. Pain in the lower back and sacrum. Occur due to the fact that the tumor touches the nerve endings.
3. Inflammation, purulent discharge from the uterus with a putrid odor.
4. If the uterine and ovarian cancer itself begins to spread to the cervix, then there is a possibility of its closure due to the tumor. Later, the pus itself will accumulate inside because of which intoxication will begin.
5. In the later stages, when the tumor grows to nearby organs, there may be such symptoms: for the intestines, constipation, mucus and blood in the feces, hydronephrosis with compression of the ureteral canal, back pain. If the cancer affects the bladder, then there may be blood in the urine, and the process of urination itself will also become problematic.

How fast does the tumor develop? And what is the differentiation of cancer?

There is a highly differentiated and a low-grade form of cancer. In the first variant, the tumor grows rather slowly up to several years; in this case, if the tumor is detected early, it can be cured quickly and without consequences. In the second variant, tumor growth is very rapid.

Metastases

Where do uterine cancer metastases occur? First, the cancerous tumor itself spreads to the nearest lymph nodes - N of the pelvic organs. It all depends on the stage of the malignant formation itself, as well as on the degree of damage to the uterus. The deeper the cancerous tumor sits, the greater the chance of metastasizing it to the nearest organs and tissues.

When cancer spreads only through the lymphatic pathways, this is called lymphogenous metastasis and occurs at the very first stages - stages 1, 2 of cancer. There is a lesion of the uterine cavity and cervical canal.

In the later stages, hematogenous metastasis occurs, when the cancer cells themselves spread to any organs: lungs, bones, liver. Implantation metastases go to the nearest organs from the uterus.

Stages of uterine cancer

Consider the stages of development of a cancerous tumor according to the FIGO method.

1 stage	1 a- The tumor is located in the endometrium
	1b- half meometrium
	1 c- reaches but does not cross the conjunctiva
2 stage	2a- damage to the intracerebral glands
	2b- damage to the cervical canal
3 stage	3a- ovarian and abdominal involvement
	3b- Metastases in the vagina
	3 c- Damage to para-aortic and pelvic lymph nodes.
4 stage (last stage of cancer)	4 a- Metastases appear in the bladder and rectum.
	4 b- Cancer cells penetrate the bloodstream, and through it already into other organs.

Forms of cancer

• serous
• musical
• undifferentiated
• squamous
• glandular squamous
• adenocarcinoma
• light cell

Diagnosis of uterine cancer

Any other cancer is usually very difficult to recognize in the early stages. Not always even screening diagnostics gives a result. In order not to miss the moment of ignition, it is necessary to undergo a scheduled examination by a gynecologist every year. Diagnostic methods are practically no different from other types of oncology.

They do it quite rarely, since usually the main antigen for uterine cancer is CA-125, but it can also indicate other diseases, since it is not specific to this organ. The only thing is that this analysis is carried out in aggregate to clarify the diagnosis. The antigen can also increase with normal inflammation, menstruation and pregnancy.

Biopsy. An aspiration biopsy is carried out directly, using a special syringe. The procedure itself is performed on an outpatient basis. For a more accurate result, it is best to carry out several procedures at regular intervals.

Ultrasound procedure the same has a large error at the very initial stages of cancer. But you can view the thickness of the endometrium on ultrasound in postmenopausal women. If the figure exceeds 4 mm, there is reason to worry. Uterine cancer on ultrasound is also visible at later stages, you can consider the size of the tumor and the depth of germination.

Biopsy + Hysteroscopy. They take a sample of tissue and conduct microscopic examinations for changes in cells.

MRI gives the most accurate result. Since you can find out not only the size of the tumor, but also the stage and degree of damage.

Color Doppler Imaging makes it possible to see a picture of blood flow inside the uterus and the tumor itself. Later, additional research is carried out in a different way.

Fluorescent Diagnostics is one of the most accurate methods to detect uterine carcinoma at the earliest stages. Special substances are injected into the woman's body, which accumulate in malignant cells. After irradiation, the substances themselves glow, which allows you to see the tumor itself, which can be very small. After that, a tissue biopsy is performed to clarify the diagnosis.

NOTE! The presence of comorbidities may interfere with or mislead some studies.

Treatment of uterine cancer

In the early stages, surgical intervention is possible, when the tumor itself, along with nearby lymph nodes, is simply removed. If the problem is identified before the appearance of metastases, then the percentage of cure increases. In any other case, irradiation and drug treatment are included in addition. They can also remove the entire uterus with appendages. The operation of extirpation of the uterus is performed with metastases in the ovaries, the body of the cervix, and also in the fallopian tubes.

If the tumor is not deeply affected, it is cauterized or ablated in another way. But there is a risk of incomplete removal. Therefore, after the procedure, it is necessary to be constantly examined so that the uterine cancer does not return again.

If the tumor is at stage 3 or 4, then in this case, radiation therapy is performed for cancer of the uterine body. Often they do a combination: surgery to remove the tumor and radiotherapy in order to destroy the remaining cells.

Radiotherapy - IMRT - point irradiation of malignant tissues. The advantage of this method is that the nearest tissues do not suffer so much, and the affected area is reduced. At the same time, the general condition of the patient does not deteriorate much during the procedure.

Brachytherapy- using the device, radioactive substances are injected directly into the tumor. Substances act only on cancer cells.

Hormone therapy. Special hormones are injected that block the effect of estrogen on the tumor itself and thereby reduce its growth and development.

Chemotherapy. Not the most effective remedy and more aimed at reducing the impact of the tumor itself on the woman's body. Usually performed on low-grade uterine cancer.

Diet and daily routine during cancer

• Get more rest and get enough sleep.
• No stress.
• Avoid smoking and alcohol.
• Complete nutrition with vitamins and minerals.
• Sweet, chocolate, animal fat, fried, canned food, spices are completely excluded.
• More dairy products and plant foods.
• Green tea
• Turmeric
• Beet
• Tomatoes

Uterine cancer and pregnancy

It is quite rare during pregnancy, but at the same time, if the tumor itself is in a decent stage, then it can directly affect the fetus and the reproductive reproductive system. Because of what there may be placental abruption, bleeding and, as a result, a miscarriage.

After curing cancer, a woman can give birth if the body of the reproductive organ has not been removed, but before that, the doctor prescribes a course of hormone therapy for her to restore the internal hormonal background of the body. As soon as a woman becomes pregnant, she will additionally have to be examined by an oncologist.

How long do people live with uterine cancer?

Life expectancy is largely affected by the stage of the cancer, as well as the intensity and aggressiveness of the tumor. In the first stage, the recovery rate is quite large - 80-90%. At the second stage 65-75%. When the third stage comes and metastases appear, the percentage drops sharply to 30%. At the last stage, the chance to be cured drops to 5%.

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Uterine cancer affects older women, that is, from 55 to 65 years, but in 40% of cases the disease occurs in young women. Among all malignant neoplasms of the female genital area, uterine cancer is given the first place, and the second place in female oncology (primacy belongs to).

Doctors note that the incidence of this pathology has increased in recent years, and explain this trend by an increase in life expectancy (lengthening of the postmenopausal period) and an increase in the frequency of "modern diseases": chronic and anovulation, and, and others.

note

It is noted that the combination of these diseases with a variety of disruptions in the endocrine system and metabolic disorders (overweight, and others) contributes to the development of dysfunctions in the reproductive, protective, adaptive and metabolic systems of the body and provokes the formation of endometrial cancer.

Classification, stages of uterine cancer

Uterine cancer is a malignant degeneration of the endometrium, which is the inner lining of the uterus. Systematization of uterine cancer in gynecology is carried out according to the following criteria:

The degree of differentiation of a malignant tumor is an important prognostic feature. The more undifferentiated atypical cells are contained in the tumor, the more doubtful the prognosis is. An unfavorable option is low-grade uterine cancer.

Etiology and pathogenesis

Sex hormones that provide phase changes in the endometrium, leading either to the implantation of a fertilized egg and the further development of pregnancy or to its rejection (menstruation), select uterine cancer as their target, since it is a hormone-dependent tumor. Hormonal imbalance, which occurs as a result of changes in the hypothalamus-pituitary-ovaries system, leads to the development of proliferative processes in the endometrium, and then to its hyperplasia, which creates a background for malignant degeneration of the cells of the uterine mucosa. But the cause of the onset of endometrial cancer against this background remains unknown to this day.

Risk factors:

• endocrine and metabolic disorders (, diabetes, overweight);
• hormone-dependent disorders of the reproductive sphere (anovulation, prolonged infertility, hyperestrogenism);
• estrogen active;
• heredity (burdened family history of endometrial cancer, breast and);
• no pregnancy/childbirth;
• late cessation and onset of menstruation;
• hormone treatment (tamoxifen).

The pathogenesis of uterine cancer is explained by three hypotheses:

• Hormonal (estrogen). This hypothesis is based on a combination of excess estrogen, endocrine and metabolic disorders in 70% of confirmed endometrial cancer. Hyperestrogenism is manifested by anovulatory uterine bleeding, infertility and late (55 years or more) menopause, tumors and ovaries and / or uterus. Against the background of excess estrogen, highly differentiated uterine cancer develops, which slowly progresses and metastasizes. The course of this form of the disease is favorable, and the neoplasm is highly sensitive to progestogen therapy.
• Estrogen independent. In 30% of cases of uterine cancer, there are no endocrine and metabolic disruptions, and there are no ovulation disorders. Cancer is formed against the background of atrophied uterine mucosa and is characterized by low differentiation, insensitivity to progestin drugs, and a tendency to rapid metastasis. This variant of the pathology is less favorable in terms of prognosis.
• Genetic. Explains the mechanism of the formation of the disease by genetic moments.

In the process of development, uterine cancer goes through several stages:

• functional disorders (excess estrogen, lack of ovulation);
• the appearance of background morphohistological changes (polyposis or endometrial hyperplasia);
• the occurrence of precancerous changes (atypical and / or dysplasia);
• the formation of malignant neoplasia (degeneration).

Ways of metastasis of uterine cancer:

• lymphogenous - malignant cells spread with the lymph flow and affect the near and far lymph nodes;
• hematogenous - cancer cells are carried with the bloodstream to the internal organs (mainly in the lung and liver tissue and in the bones);
• implantation - the tumor grows into the uterine wall and spreads along the peritoneum, into the periuterine tissue and appendages.

Signs of uterine cancer

The first signs of uterine cancer include the appearance of acyclic bleeding - intermenstrual, before the onset of menstruation or after it ends. can last long enough and be plentiful. This symptom occurs in 90% or more cases of endometrial cancer. However, this symptom also appears in many other gynecological diseases (endometrial hyperplasia, uterine fibromyoma, endometriosis) in women of childbearing age, which often leads to an error in the diagnosis and delays the diagnostic and therapeutic measures of uterine cancer. Bleeding from the uterus is a pathognomic symptom for endometrial cancer only in postmenopausal women. The intensity of bloody discharge in this case may vary - from meager to abundant.

Elderly patients complain of copious watery discharge (tumor decay). During a gynecological examination, there are no characteristic signs of inflammation (,). Watery discharge is considered a specific manifestation of endometrial cancer. When attached to the site of tumor necrosis of a secondary infection, the discharge becomes purulent or takes the form of meat slops with a putrid odor. With the accumulation of purulent discharge in the uterine cavity, a pyometra is formed, which is accompanied by signs of intoxication (fever, chills, weakness and malaise, loss of appetite).

A later sign of uterine cancer is pain syndrome, which manifests itself at stages 3-4 of the disease.. Pain is caused by the germination of the tumor in the periuterine tissue and compression of nerve endings in it, in the walls of the small pelvis, large intestine and bladder. Pain is described by patients as constant, aching, of sufficient intensity. Localized, in the lumbar and sacral regions, may occur during coitus or natural administration. When the rectum and bladder are affected, urination and defecation are disturbed.

note

In 70% of cases, uterine cancer is diagnosed at the first stage, which leads to a favorable prognosis for life and almost never leads to death. Self-healing of endometrial cancer is impossible, and the use of alternative methods is unacceptable, only a timely visit to a doctor is the key to a positive outcome and recovery.

Diagnostics

Diagnosis of uterine cancer consists in taking an anamnesis and complaints, conducting a general and gynecological examination, prescribing additional research methods:

• Gynecological examination. When viewed in the mirrors, there are no signs of damage to the vagina and cervix, bimanual palpation allows you to determine the size of the uterus and its consistency, mobility, palpate the ovaries and fallopian tubes.
• M-echo values ​​(endometrial thickness) of 12 mm or more in women of childbearing age (normally 10 to 16 mm) and 4 mm or more in postmenopausal patients should raise suspicion of a malignant tumor of the uterus. In this case, the patient is necessarily sent for aspiration of the endometrium. Ultrasound also allows you to clarify the size and contours of the uterus, the depth of tumor germination in the uterine wall and its localization, the state of the internal pharynx, regional lymph nodes, appendages and parametria.
• Cytogram. Cytological examination in order to identify atypical cells is subjected to a smear from the cervical canal and material obtained by aspiration of the endometrium.
• Hysteroscopy. Allows you to examine the uterine cavity and cervical canal, make a targeted biopsy of the endometrium and determine the feasibility of separate curettage. If necessary, curettage is performed first of the cervical canal, and then of the uterine cavity. The resulting material is sent for histological examination.

In order to exclude / confirm metastases to distant and nearby organs, chest, cystoscopy, and urinary system and abdominal cavity are prescribed. Comparative diagnosis of uterine cancer is carried out with and endometrial hyperplasia, adenomatosis and submucosal

Treatment of uterine cancer

Treatment of uterine cancer is carried out comprehensively and includes surgery, radiation, hormonal and drug (cytostatics) therapy.. The sequence of treatment methods and their intensity are determined by the stage of the disease, the size and histotype of the tumor, the degree of differentiation and the depth of penetration of the neoplasm into the myometrium. The prevalence of neoplasms outside the uterus, the presence / absence of distant metastases, the age of the patient, and concomitant diseases are also taken into account.

The main direction in the treatment of this pathology is surgical intervention.. The volume of the operation depends on certain prognostic factors. In the presence of favorable factors (stage 1 cancer, highly differentiated, germination of the myometrium by no more than a third), the uterus with appendages is extirpated. In the case of unfavorable factors (stage 3-4 cancer, poorly differentiated, invasion into the myometrium by more than a third, the spread of the tumor to neighboring organs), an extended extirpation of the uterus with appendages is performed (removal of the upper third of the vagina, parametrium and regional lymph nodes). But in the case of severe extragenital diseases (hypertension, diabetes, overweight), they are limited to simple extirpation of the uterus with appendages, combined with pelvic lymphadenectomy.

note

In the case of the first stage of cancer in women of childbearing age, it is possible to perform endometrial ablation using a hysteroresectoscope (complete destruction of the basal layer of the mucosa and 3-4 mm of myometrium).

In the postoperative period, in the case of sprouting of the myometrium and the prevalence of the tumor, the vaginal area, small pelvis and regional lymph nodes are irradiated. Additionally, treatment with cytostatics (cyclophosphamide, doxorubicin) is prescribed, and if cancer is sensitive to hormone therapy, antiestrogen, progestogen, and combined estrogen-gestagen preparations are prescribed.

Prognosis for uterine cancer

Success in the fight against uterine cancer depends on the stage of the process, the age of the patient, the presence of distant and near metastases, cancer differentiation, its prevalence and pathogenetic course. The five-year survival rate for women younger than 50 years of age and with hormone-dependent uterine cancer without metastases is 90%. An unfavorable prognosis is expected in patients older than 70 with an estrogen-dependent variant of uterine cancer, in this case, a five-year survival rate is 60% or less.

Relapse of the disease in 75% of patients is observed during the first 3 years after primary therapy. If cancer has metastasized to the lymph nodes, then the risk of disease progression increases by 6 times. In 42%, the tumor recurs in the vagina, in 30% in the pelvic lymph nodes, in 28% in distant organs.

Sozinova Anna Vladimirovna, obstetrician-gynecologist

Uterine cancer is a malignant tumor of the uterus, which is often manifested by frequent uterine bleeding. Uterine cancer is one of the most common types of malignant tumors in women.

Causes of uterine cancer

The exact causes of uterine cancer are not yet known, but it has been observed that certain factors increase the risk of developing this disease. An increased risk of uterine cancer is observed:

• In overweight women;
• In women with;
• In women with diabetes;
• In menopausal women taking;
• If started before the age of 12;
• If it occurred at the age of more than 55 years;
• If the woman has never been pregnant;
• In older women (the older the woman, the higher the risk of developing uterine cancer);
• In women with;
• In women undergoing treatment for breast cancer and taking Tamoxifen;
• In women who have inherited a particular gene that increases the risk of developing uterine and bowel cancers;
• In women who often drink alcoholic beverages.

Types of uterine cancer

The uterus is a muscular organ, the internal cavity of which is covered with a special type of mucous membrane - the endometrium. There are two main types of uterine cancer depending on the cells from which the malignant tumor has developed:

• Endometrial cancer (adenocarcinoma)

This is a malignant tumor that grows from the mucous layer of the uterus. 75% of cases of malignant tumors of the uterus are endometrial cancer. This article focuses mainly on endometrial cancer.

• Cancer of the muscular layer of the uterus (leiomyosarcoma)

This tumor is less common, accounting for about 15% of uterine cancers.

Symptoms and signs of uterine cancer

The main symptom of uterine cancer are. Uterine bleeding in uterine cancer can appear at different times of the cycle and, as a rule, is quite abundant.

If a woman has already entered menopause (menstruation stopped more than a year ago), then with uterine cancer, uterine bleeding resumes, which can create a false impression of the resumption of the menstrual cycle.

Sometimes uterine cancer can appear scanty, which do not stop for weeks.

In later stages of uterine cancer, the following symptoms may appear:

• Pain in the lower abdomen
• with an unpleasant odor
• Weight loss for no apparent reason
• Fatigue, weakness

Diagnosis of uterine cancer

A gynecologist may notice signs of uterine cancer during a routine pelvic exam. An increase in the size of the uterus and a change in its shape (deformity) can indicate uterine cancer.

To clarify the diagnosis, the doctor may prescribe the following examinations:

• Ultrasound of the uterus

• Hysteroscopy and endometrial biopsy

• Surgery for uterine cancer

In the early stages of uterine cancer, the first step is surgery to remove the uterus (hysterectomy). In order to reduce the risk of recurrence (re-growth of the tumor), doctors usually remove not only the uterus, but also the uterine appendages (fallopian tubes and ovaries), as well as lymph nodes that may have been affected by the tumor. Our site has separate articles on this topic: and.

• Radiotherapy

Radiotherapy for uterine cancer reduces the risk of recurrence (re-growth of the tumor) after surgery, or can be prescribed as an independent treatment, as well as in combination with chemotherapy.

• hormone therapy

Since endometrial cancer is extremely sensitive to hormonal changes in the body, drugs that lower estrogen levels and increase blood levels of progesterone can slow down the rate of tumor growth.

• Chemotherapy

Chemotherapy drugs prevent cancer cells from dividing and tumor growth. These drugs can be prescribed in the form of tablets or droppers. Chemotherapy can use a single drug or a combination of several drugs.

After uterine cancer treatment

After the end of the course of treatment for endometrial cancer, a woman needs careful monitoring by her doctor. Regular examinations and examinations will allow early detection of cancer recurrence if the disease returns. Discuss with your doctor how often you need to see each other.

As a rule, after treatment for stage 1 uterine cancer, a woman is advised to visit a doctor every 6 months in the first year, and then once a year.

After treatment for advanced uterine cancer, visits to the doctor are required every 3 months during the first year, every 3-6 months during the second year, and then once a year.

If uterine cancer is not cured

In some cases, even despite adequate and modern treatment, uterine cancer cannot be cured. In this case, the woman is prescribed supportive treatment, which helps to cope with pain and prolong life for the maximum possible period.

This disease is considered very common at the present time. The most common early signs and symptoms of cervical cancer found in women aged 30 to 55 years(In recent years, this disease has greatly "rejuvenated"). Despite the fact that this pathology is easily diagnosed, unfortunately, in almost half of the patients it is detected already in the later stages. Modern medicine offers several ways to solve the problem, up to complete recovery and restoration of the body. Practice shows that with timely treatment of the disease in the early stages (without removal of the organ), a woman can have healthy offspring in the future.

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

Girls who begin to have sex at an early age (before 16 years of age), when the cervical epithelium contains immature cells that easily degenerate into cancer, can also get sick. Cicatricial changes on the mucous membrane of the organ, hormonal imbalance, smoking, alcohol intake, exposure to radiation - all this significantly increases the risk of occurrence. Every year, this diagnosis is detected in 600,000 women worldwide.

Causes

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

The main reasons are:

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

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

Kinds

Depending on the type of affected epithelium, there are:

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

Squamous cell carcinoma is divided into 3 groups:

• keratinized (the tumor is distinguished by its density, keratinous structure);
• poorly differentiated (the tumor grows rapidly, has a soft texture);
• non-keratinized (considered an intermediate stage between keratinized and poorly differentiated cancer).

Main stages

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

Symptoms of cervical cancer

It is impossible to say exactly what is the first symptom of cervical cancer, since all manifestations of the disease are usually mild. In the early stages, they may not be present at all. As the tumor grows, warning signs and symptoms may occur. But at this point, the lesion can reach neighboring organs. That's why women should have regular check-ups with a gynecologist with mandatory colposcopy (microscopic examination of the state of the cervix).

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

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

When examining the condition of the cervix in cancer, ulcerations are diagnosed, as well as a change in the color of the cervix.

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

Diagnostics

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

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

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

• MRI of the pelvic organs - is performed in cases where the results of ultrasound do not allow us to accurately determine the spread of the disease;
• Ultrasound of the kidneys;
• Ultrasound of the liver;
• ultrasound examination of the bladder;
• X-ray of the lungs - performed to exclude or confirm the presence of distant metastases;
• irrigoscopy - a study of the colon using an x-ray, which allows you to determine the area of ​​\u200b\u200bdistribution of the neoplasm;
• rectoscopy and cystoscopy - an examination of the rectum and bladder, which allows you to determine whether these organs are affected by the tumor;
• intravenous urography is necessary to determine the "performance" of this organ, since cervical cancer often causes compression of the ureters, with further impairment of kidney function.

Treatment

Treatment of cervical cancer involves the following types of therapy:

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

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

Irradiation is the leading method of treatment, it is especially often resorted to if the patient has a 3-4 stage of the disease and surgical removal of the tumor is impossible.

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

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

Complications

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

• compression of the ureters;
• stasis of urine;
• development of hydronephrosis;
• the appearance of a purulent infection of the urinary tract;
• the occurrence of bleeding from a tumor or genital tract;
• the formation of fistulas, peculiar unnatural channels connecting the bladder or intestines with the vagina.

Prevention

In order not to understand what symptoms may be evidence of cervical cancer and look for what is the first sign of such a disease, one should timely preventive maintenance. To this end, the following actions are taken:

• regular examinations at the gynecologist - visual and bimanual (manual);
• colposcopy (at least 1 time per year) - examination of the organ with a magnification of 7.5-40 times, allows you to see precancerous processes;
• passing a PAP test to detect atypical cells;
• timely treatment of sexually transmitted diseases;
• protected sexual intercourse;
• vaccination against cervical cancer with a quadripartite vaccine. (vaccination gives immunity for 3 years, is performed in several stages, is given to girls aged 9 to 12 years (before sexual activity, when infection with the virus has not yet occurred), as well as older girls (from 13 to 26 years old); average the cost of vaccination - from $ 400 per course).

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

Forecast

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

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

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- malignant lesion of the endometrium lining the uterine cavity. Cancer of the body of the uterus is manifested by spotting, watery whites from the genital tract, pain, acyclic or atypical uterine bleeding. Clinical recognition of cancer of the body of the uterus is carried out on the basis of data from a gynecological examination, cytological analysis of aspirates, ultrasound, hysteroscopy with separate diagnostic curettage, and histology results. Treatment of uterine body cancer is combined, including surgical (panhysterectomy), radiation, hormonal, and chemotherapeutic components.

General information

Cancer of the body of the uterus ranks first among malignant neoplasms of the female genital organs, and in the structure of all female oncopathology, it is an intermediate place between breast cancer and cervical cancer. The upward trend in the incidence of endometrial cancer in gynecology is partly due to the increase in the total life expectancy of women and the time they are in postmenopause, as well as the rapid increase in the frequency of pathologies such as chronic hyperestrogenism, anovulation, infertility, uterine fibroids, endometriosis, etc. More often, uterine body cancer develops in women of the perimenopausal and postmenopausal period (average age - 60-63 years).

Causes and stages of development

0 stage(Tis) - preinvasive cancer of the body of the uterus (in situ).

I stage(T1) - the tumor does not spread outside the body of the uterus:

• IA (T1a) - cancer of the body of the uterus infiltrates less than 1/2 of the thickness of the endometrium
• IB (T1b) - cancer of the body of the uterus infiltrates half the thickness of the endometrium
• IC (T1c) - cancer of the body of the uterus infiltrates more than 1/2 of the thickness of the endometrium

II stage(T2) - the tumor extends to the cervix, but does not spread beyond its borders:

• IIA (T2a) - there is involvement of the endocervix
• IIB (T2b) - cancer invades cervical stroma

III stage(T3) - characterized by local or regional spread of the tumor:

• IIIA (T3a) - spread or metastasis of the tumor to the ovary or serosa; presence of atypical cells in ascitic effusion or lavage
• IIIB (T3b) - spread or metastasis of the tumor into the vagina
• IIIC (N1) - metastasis of cancer of the uterine body to the pelvic or para-aortic lymph nodes

IV stage(T4) - tumor spread to the mucosa of the large intestine or bladder.

IVB stage(M1) - tumor metastasis to distant lymph nodes and organs.

Symptoms of uterine cancer

With preserved menstrual function, cancer of the body of the uterus can be manifested by prolonged heavy menstruation, acyclic irregular bleeding, and therefore women can be mistakenly treated for ovarian dysfunction and infertility for a long time. In postmenopausal patients, bloody discharge of a scanty or profuse nature occurs.

In addition to bleeding in cancer of the body of the uterus, leukorrhea is often observed - abundant watery liquid leucorrhoea; in advanced cases, the discharge may have the color of meat slops or a purulent character, an ichorous (putrefactive) smell. A late symptom of cancer of the body of the uterus is pain in the lower abdomen, lower back and sacrum of a constant or cramping nature. Pain syndrome is noted when the serous membrane of the uterus is involved in the oncoprocess, compression by the parametric infiltrate of the nerve plexuses.

With the downward spread of cancer of the body of the uterus into the cervix, cervical stenosis and pyometra may develop. In case of compression of the ureter by a tumor infiltrate, hydronephrosis occurs, accompanied by pain in the lumbar region, uremia; when the tumor grows into the bladder, hematuria is noted. With tumor invasion of the rectum or sigmoid colon, constipation occurs, mucus and blood appear in the feces. The defeat of the pelvic organs is often accompanied by ascites. With advanced cancer of the body of the uterus, metastatic (secondary) cancer of the lungs and liver often develops.

Diagnosis of cancer of the body of the uterus

The task of the diagnostic stage is to establish the localization, the stage of the process, the morphological structure and the degree of differentiation of the tumor. Gynecological examination allows to determine the increase in the size of the uterus, the presence of infiltration of cancer parametrical and rectovaginal tissue, enlarged appendages.

Mandatory for cancer of the uterine body is a cytological examination of smears of the cervical canal and the contents of an aspiration biopsy from the uterine cavity. Material for histological examination is obtained using endometrial biopsy with a microcurette or separate diagnostic curettage during hysteroscopy. Pelvic ultrasound is an important diagnostic screening test for uterine cancer. Ultrasound scanning determines the size of the uterus, its contours, the structure of the myometrium, the nature of tumor growth, the depth of tumor invasion, localization, metastatic processes in the ovaries and lymph nodes of the small pelvis.

In order to visually assess the prevalence of uterine body cancer, diagnostic laparoscopy is performed. To exclude distant metastasis of uterine body cancer, it is shown that ultrasound of the abdominal organs, chest x-ray, colonoscopy, cystoscopy, excretory urography, CT of the urinary system and abdominal cavity are included in the examination. When diagnosing cancer of the body of the uterus, it is necessary to differentiate with endometrial polyps, endometrial hyperplasia, adenomatosis, submucosal uterine fibroids.

Treatment of uterine cancer

The treatment option for cancer of the body of the uterus is determined by the stage of the oncological process, the accompanying background, and the pathogenetic variant of the tumor. In case of cancer of the body of the uterus, gynecology uses the methods of surgical, radiation, hormonal, chemotherapeutic treatment. Chemotherapy with cisplatin, doxorubicin, cyclophosphamide. Taking into account the sensitivity of the tumor to hormonal therapy, courses of treatment with antiestrogens, gestagens, and estrogen progestogens are prescribed. With organ-preserving treatment of uterine body cancer (endometrial ablation), the ovulatory menstrual cycle is subsequently induced using combined hormonal preparations.

Prognosis for cancer of the body of the uterus

Further development of the situation depends on the stage of cancer of the uterine body, the age of the patient, the pathogenetic variant and differentiation of the tumor, the presence of metastasis and dissemination. A more favorable prognosis is observed in patients under 50 years of age with a hormone-dependent variant of uterine cancer and the absence of metastases: a 5-year survival rate in this group reaches 90%. The worst prognosis is observed in women older than 70 years with an autonomous variant of uterine body cancer - their 5-year survival threshold does not exceed 60%. Detection of metastatic lesions of the lymph nodes increases the likelihood of progression of endometrial cancer by 6 times.

contraception, timely surgical removal of feminizing tumors, etc.

Secondary prevention of uterine body cancer is reduced to the timely detection and treatment of background and precancerous proliferative pathologies, regular oncoscreening for women, and monitoring of patients at risk for endometrial cancer.