Oncological diseases of the uterus are today among the most common pathologies in women; according to statistics, doctors record about 600 thousand new cases every year in the world. Most often, the disease is diagnosed in the age group of 35-55 years, later - in very rare cases. Malignant processes of this localization have a high mortality rate, so all women should know the symptoms and signs of uterine cancer, this will allow timely action to be taken and avoid irreparable consequences.
Uterus and development of malignant process
The uterus is the most important component of the reproductive system. It is a hollow smooth muscle organ, unpaired, pear-shaped, in women of childbearing age with an average length of 5 to 9 cm. According to its structure, the uterus itself is divided into sections: the cervix, body and fundus; and its wall consists of three layers: perimetry, myometrium and endometrium (internal mucous membrane of the organ).
The appearance of symptoms and signs of uterine cancer occurs as a result of mutation of endometrial cells that begin uncontrolled abnormal division, leading to the appearance of a tumor. Along with the growth of the tumor, the process of spreading of malignant cells begins, first through the lymph nodes, then through the blood vessels to vital organs (kidneys, liver, lungs).
Symptoms and signs of cancer depend on the extent of the pathological disease. Conventionally, according to the size of the tumor and the affected area, the process is divided into four stages:
Damage to other organs leads to disruption of their work and the vital functions of the entire organism, because malignant cells displace healthy ones, but, due to their immaturity, are not able to perform their functions. The development of a malignant process irreversibly leads to death if the first signs and symptoms characteristic of uterine cancer are not detected in a timely manner and special treatment is not started.
Manifestation of the disease in the initial stages
The oncological process is characterized by a long asymptomatic course, so signs of uterine cancer in the early stages are observed infrequently, all of them are subtle and erased. The growth of the tumor leads to the appearance of certain changes in the body, which should signal the need for an unscheduled visit to the gynecologist.
The first symptoms of early stage uterine cancer include vaginal discharge (leucorrhoea). They can be watery, white, mucous, interspersed with blood, odorless or, conversely, foul-smelling. The retention of leucorrhoea in the vagina leads to the development of inflammatory processes and the addition of infections, which is manifested in the appearance of purulent discharge with a characteristic odor.
A woman should be alerted to the appearance of contact bleeding. They can appear during sex, after intercourse, during douching, after lifting weights. Particular attention should be paid if spotting appears during menopause. An abnormal phenomenon is considered to be heavy bleeding, single or multiple, lasting 10-12 days, painful, especially when bleeding occurs in postmenopause.
The development of cancer may be indicated by the appearance of discomfort, irritation (not associated with allergic reactions), changes in the skin of the labia and itching. In addition, tumor processes in the organ lead to the appearance painful sensations during sexual intercourse.
In number initial signs and symptoms of uterine cancer include deterioration in general condition, the appearance of weakness, and decreased performance.
Manifestation of the disease in late stages
The signs of uterine cancer become more pronounced in the later stages of the oncological process. The transition of malignant cells to nearby lymph nodes is accompanied by an increase in their size and the appearance of pain in their area.
Severe pain in the affected area appears already at the 4th stage of the process, because There are practically no nerve endings directly in the organ. The process of metastasis affects the nerve plexuses of the sacral region, accompanied by back pain.
Damage to the urinary system is manifested by problems with urination (frequency or difficulty emptying), as well as pain and the appearance of blood in the urine. Violation often leads to ascites (formation of dropsy in the abdominal cavity) and an increase in the volume of the abdomen. Fluid retention in the body and compression of the pelvic lymph nodes leads to swelling of the lower extremities.
Heavy vaginal discharge remains a characteristic symptom of uterine cancer, but in the later stages it is accompanied by a fetid, putrid odor.
In advanced stages of oncology of this localization, changes in the condition of the breast are often observed (the mammary gland is part of the reproductive system and reacts to pathological processes in its other organs). A woman may notice changes in shape, soreness, and discharge from the nipples during the non-lactation period.
Symptoms and signs of the last stage of uterine cancer include the following changes:
- causeless weight loss;
- loss of appetite;
- temperature increase;
- indigestion (constipation, diarrhea);
- development of anemia.
Carefully! Often women, even with third-degree uterine cancer, retain an absolutely healthy, thriving appearance(this is also noticeable in the photographs of many patients), serious changes begin to progress at the very last, fourth stage.
Dangerous disease and causes of its occurrence
Most women today are concerned with the question of what reasons can cause the development of an abnormal, life-threatening process? This problem is being actively studied by doctors all over the world; there is no final conclusion about the causes of cell mutation, but the most likely and dangerous factors that can lead to the disease are:
- infertility;
- too early onset of the first menstruation;
- late onset of menopause;
- absence of childbirth;
- tumor processes in the ovaries that produce estrogen;
- previous endometrial hyperplasia;
- obesity (fat tissue provokes estrogen synthesis);
- consequences of hormone therapy in the treatment of breast cancer;
- metabolic disorders, diabetes mellitus;
- precancerous conditions (ulcers, scars, polyps, endocervicitis, condylomas, etc.);
- Lynch syndrome (formerly known as nonpolyposis colon cancer). This is a hereditary pathology that increases the risk of developing cancer in other organs, including the uterus.
Diagnostic examination methods
The attending physician will be able to diagnose this pathology and determine which treatment methods will be most effective based on the results of a comprehensive examination, including:
Laboratory tests (smear, blood, urine) are also carried out; depending on the patient’s condition, consultation with specialized specialists may be necessary to select a treatment method.
Disease treatment program
If a localized malignant tumor is detected at an early stage of the disease, patients are prescribed hysterectomy (organ resection). If the neoplasm has begun to grow and has affected adjacent tissues, then removal is carried out fallopian tubes, ovaries, upper part of the vagina, nearby lymph nodes. To increase the effectiveness of treatment and reduce the risk of relapse, patients are prescribed: radiotherapy before surgery, chemotherapy after.
The inclusion of hormone therapy (Tamoxifen, Progestin) in the treatment program is due to the need to suppress the activity of estrogens and progesterone, which contribute to the growth of a cancerous tumor. If surgery is contraindicated for the patient, a treatment program is drawn up by combining radiotherapy with a course of hormone therapy.
In Israel today they use the latest cancer treatment method - targeted therapy. It differs from chemotherapy and radiotherapy in that it affects only mutated, malignant cells, stopping their growth and development, and does not have a negative effect on healthy tissues and organs. Judging by the reviews of patients on the forums, this treatment method is easier to tolerate and has virtually no side effects.
Attention! Cancer is one of the most dangerous diseases, stop it folk remedies impossible! Only special medical techniques can help.
It is difficult to speak definitively about how long cancer survivors live. All prognosis for recovery depend on the stage of the disease, the chosen technique and the general condition of the woman’s body. After treatment of oncology in the early stages with tumor removal, the five-year survival rate exceeds 80%; if the process moves to the fourth stage, the favorable prognosis decreases to 10-15%, but there are still chances.
Common symptoms of uterine and ovarian cancer.
Cancer of the uterus and ovaries is one of the most dangerous and at the same time common oncological diseases of the female reproductive system. Any tumor develops when exposed to unfavorable factors when cells human body begin to increase and take on gigantic proportions.
Recently, asymptomatic diseases, including tumors of the uterus and ovaries, have become quite common. Such diseases are not always accompanied by pathological discharge, and even a doctor cannot always determine this disease without special studies. The latent course of the disease implies the absence of other symptoms, such as cycle failure, pathological discharge, bleeding, and others. Often, a tumor becomes an accidental discovery in a doctor’s office, where a woman came for a completely different issue. That is why every woman should undergo a preventive examination by a gynecologist at least 2 times a year.
Nirenberg Irina Stepanovna (Doctor of the 1st category, Ph.D.)
"I recommend using Phytotampons.
Tumors of the uterus and ovaries can be benign or malignant. A benign tumor grows slowly, is isolated from the tissues surrounding it, and does not grow into nearby organs and vessels. Abdominal pain associated with a growing benign tumor of the uterus and ovaries occurs when the tumor begins to put pressure on nearby organs. As a rule, surgery eliminates the disease. Malignant tumors (cancer) are dangerous because they affect not only the main organ, but also the underlying ones. Unlike a benign tumor, a malignant one develops and grows quickly. It very quickly metastasizes to nearby organs.
Malignant tumor cells are carried to new places by the flow of lymph (interstitial fluid) or blood, which contributes to their rapid growth and spread. The main feature of cancer tumors is the ability to form many foci of development in the body, in other words, to metastasize. Sometimes a malignant tumor develops again after treatment, that is, it recurs. Cancer is a malignant tumor that develops from epithelial cells. A malignant tumor - sarcoma develops from connective tissue cells.
Malignant tumors of the uterus and ovaries develop more often between the ages of 40 and 60 years. In particular, cancer of the cervix and ovaries often occurs at the age of 40-50 years, and cancer of the uterine body - after 50, but cancer of the labia majora and minora occurs most often after 60 years.
The appearance of uterine and ovarian cancer often preceded by chronic gynecological diseases. Almost always, a malignant tumor develops against the background of a variety of precancerous ailments. Important role The inflammatory process plays a role in the appearance of ovarian and uterine cancer, often preceding cancer and creating conditions for its development.
Favorable soil for the development of cancer is created due to inflammatory diseases and erosion of the uterine cervix. Erosion is ulceration of the mucous membrane. Basically, erosion appears in the presence of chronic inflammatory diseases, which are accompanied by pathological discharge.
If a woman has diagnosed with uterine and ovarian cancer, symptoms may be as follows:
- feeling of heaviness in the stomach
- copious mucus discharge from the genital tract
- bleeding
- increase in waist size
- pain during intercourse
- lack of appetite
However, the general condition of the patient in most cases can worsen only in very advanced cases. Almost all patients feel completely healthy for a long time.
The main method of treating cancer is surgery in parallel with radiation therapy. Patients often have their uterus and ovaries removed (castration by hysterectomy). Women who have undergone this operation are wondering: how long do they live after removal of the uterus and ovaries? However, this is a question of the patient’s own desire to live long and fully. After the operation, problems of lack of sexual desire and depression are possible, but modern medications alleviate this condition. Thanks to the operation, women return to normal life. However, you will have to constantly monitor your health and regularly take hormone tests.
Prevention of uterine and ovarian cancer
To prevent the development of uterine and ovarian cancer, endocrine diseases should be treated in a timely manner, and long-term use of estrogens in large doses for the purpose of treatment should be abandoned. Preventive examinations by a gynecologist are of great importance.
Of the benign tumors of the female genital organs, the most common are ovarian cysts and fibroids (fibroids, myomas) of the uterus.Ovarian cyst
Ovarian cysts are formations that are cavities of various shapes and sizes formed in the ovary. Most often they have a round shape, and their wall (shell) is made up of stretched ovarian tissue. The content of ovarian cysts can be of various types: clear liquid, jelly-like mass, fat and hair, chocolate-colored liquid, blood, etc. The most common signs of a cyst are discomfort in the lower abdomen, a feeling of heaviness, fullness and pressure on the lower abdomen.
Cysts can lead to menstruation irregularities, bleeding, and infertility. Often, the presence of a cyst pressing on the bladder and rectum leads to difficulty urinating (frequent urge) and disrupts bowel function. If the cyst reaches a large size, the woman notices an enlargement of the abdomen. Sometimes patients themselves palpate the edge of a spherical tumor or the entire tumor, if it is sufficiently mobile. Ovarian cysts must be surgically removed.
Removing a cyst - a chance to get pregnant
Surgical removal of the cyst eliminates the disease. Otherwise, the tumor leads to disruption of the activity of nearby organs and disrupts the normal conditions of blood circulation in the pelvis. With mobile cysts (“pedunculated cysts”), there is a danger of its twisting and necrosis. In these cases, there is a threat to life and only emergency surgery can save the patient. Sometimes the contents of the cyst become infected, pus forms in its cavity and the tumor turns into an abscess limited by the cyst capsule.
In other cases, purulent-inflammatory disease of the tubes and ovaries is limited by scar tissue and eventually a cavity appears filled with pus and resembles a cyst. In both the first and second cases, only surgical removal of a purulent tumor eliminates the disease. Benign cysts can develop into malignant ones over a long period of time. Therefore, women who are offered surgery for an ovarian cyst, even in the absence of painful symptoms, must agree to surgical removal of the tumor.
If pregnancy is difficult, laparoscopic surgery to remove an ovarian cyst can be an excellent treatment option with a guaranteed result in the treatment of female infertility.
Uterine fibroids
Uterine fibroids are a benign tumor that develops from the muscle tissue of the uterus. Signs of this tumor also include discomfort, a feeling of heaviness and pressure in the lower abdomen. Just like ovarian cysts, fibroids often lead to problems with urination and bowel function. Fibroids can reach large sizes, sometimes they consist of individual nodes, which in thin women can be felt through the abdominal wall.
In some cases, the fibromatous node grows towards the uterine cavity and is connected to its wall only by a thin stalk. Such a node can be “born” through the vagina. One of the characteristic signs of fibroids is bleeding that coincides with menstruation. With fibroids growing into the uterine cavity, menstruation, which occurs on time, lasts a long time, and the amount of blood lost increases. The more the tumor develops, the longer and heavier the menstrual bleeding becomes.
Fibroma removal
In these cases, only removal of the fibroids leads to a cure. Surgical removal of fibroids is also performed in cases of large tumor sizes, rapid growth, multiple nodes, pain, and disturbances in the functioning of nearby organs. For small fibroids that do not grow over a long period of time and do not manifest themselves in any way, surgery is not necessary.
It should be taken into account that when ovarian function fades, after the cessation of menstruation, a reverse development and reduction (atrophy) of fibroids is often observed. Therefore, in some cases, in the treatment of fibroids, it is permissible to limit oneself to conservative measures (hormonal treatment). However, if fibroids are detected, a woman should be under constant supervision of a gynecologist. Only a gynecologist who monitors a woman for a long period can decide on the choice of treatment method in each individual case.
MALIGNANT TUMORS OF THE UTERUS, CERVIX AND OVARIES
Malignant tumors, unlike benign ones, develop and grow rapidly. They relatively quickly grow into adjacent tissues and organs and destroy the walls of blood vessels. Individual small parts of malignant tumors are carried to nearby or distant tissues and organs by the flow of interstitial fluid (lymph) or blood. Small tumor particles brought to new places also grow and spread quickly. Consequently, one of the features of malignant tumors is their ability to create multiple foci of development and spread in the body, that is, to give so-called metastases.
Malignant tumors sometimes develop even after treatment, that is, they cause relapses of the disease. Malignant tumors that develop from cells of the integumentary tissue (epithelium) are called cancer. Other malignant tumors - sarcomas - develop from connective tissue cells.
Why?
The causes of malignant tumors have not yet been clarified. It is only firmly established that the occurrence of cancer is often preceded by a number of changes in the body, in particular chronic and long-term diseases. A malignant tumor almost always develops due to various painful changes. Cancers most often occur in middle and old age (40-60 years). For example, cervical cancer and ovarian cancer occur most often between the ages of 40 and 50, uterine cancer occurs after 50 years, and cancer of the external genitalia occurs mostly after 60 years.
Sometimes cancer affects women at a young age (25-35 years). Inflammatory processes, which often precede cancer and create conditions for its occurrence and development, play a major role in the occurrence of cancer of the female genital area.
Precancerous diseases
Inflammatory diseases and erosions of the cervix create favorable conditions for the development of cervical cancer.
- Cervical erosion. Erosion (ulcer) of the cervix is a defect in its mucous membrane. It is formed due to the desquamation of the surface layers of the mucous membrane that covers the cervix. Most often, erosion occurs in chronic inflammatory diseases accompanied by leucorrhoea. Under the influence of the inflammatory process, the whiter surface layers of the cervix are exfoliated, the cervix is “exposed” and becomes loose. Thus, any disease of the genital organs, accompanied by discharge, can lead to the formation of cervical erosion. Cervical erosion is a manifestation of one or another painful condition of the reproductive system or the entire woman’s body. A disease similar to erosion is inversion of the cervical mucosa.
- Mucosal eversion(ectropion) occurs due to tears in the cervix that occur during childbirth. In this case, the mucous membrane of the cervical canal is exposed and it is easily exposed to adverse effects from the vagina and its secretions. Cervical cancer can arise from the so-called “leukoplakia” (white plaque), which is an area of thickening of the cervix.
- Polyps. Sometimes the basis for the development of the cancer process can be loose, lush growths of the mucous membrane of the cervical canal. These growths, called polyps, can be single or multiple, spreading beyond the cervix, deep into the uterine cavity. In these cases, we are no longer talking about polyps, but about polyposis.
- Excessive growth - endometrial hyperplasia uterine cancer, which is sometimes observed in old age, can also contribute to the development of uterine cancer. Malignant neoplasms of the ovaries also most often occur against the background of inflammatory and other female diseases. Finally, it should be remembered that over a long period of time, benign tumors can acquire malignant properties and degenerate. Cases of malignant degeneration of harmless ovarian cysts are often observed. Cancer occurs in patients with uterine fibroids approximately ten times more often than in other women. The frequency of coincidence between fibroids and uterine cancer makes us take this disease very seriously.
When does cancer start?
Cancer occurs on the basis of the above and other painful changes in the woman’s genital organs, but not always, but only in the presence of certain, not yet fully understood conditions. Consequently, these diseases, or “pre-cancer” as they are called, do not necessarily and do not always lead to the development of cancer. However, the fact that with them cancer occurs more often than under other equal conditions should be alarming, and gynecologists call for timely and radical treatment of these diseases.
Contact our clinic in order to promptly undergo a full range of tumor diagnostics and a course of treatment using the most modern methods. Read further on our website about uterine cancer and cervical cancer, as well as about modern cancer treatment protocols in Israel.
– neoplasms of the cervix and body of the uterus, developing from cells of epithelial, muscle or connective tissue, with a tendency to invasive growth, germination of surrounding organs and blood vessels, recurrence and the formation of metastases. The development of pathology may be indicated by discharge from the genital tract (watery, bloody, purulent), cramping or constant pain, urination and defecation disorders. Diagnosis of malignant tumors of the uterus is based on data from a gynecological examination, colposcopy, ultrasound, oncocytology, biopsy, hysteroscopy, and RDV. Treatment combines surgical, radiation, chemotherapy, and hormone therapy.
General information
The term “malignant tumors of the uterus” combines a group of morphologically heterogeneous tumors arising from the endometrium, muscular or connective layer of the uterus. In gynecology and oncology, these include adenocarcinoma, cancer and sarcoma (leiomyosarcoma) of the uterus. Malignant tumors can affect the body and cervix. Cervical cancer (CC) is the most common cancer of the female genital organs; The highest incidence of cervical cancer is observed in perimenopause, but women of reproductive age are also susceptible to the disease. Uterine cancer occurs approximately 10 times less frequently than cervical cancer, mainly in patients over 50 years of age. IN last years There has been an increase in the proportion of malignant uterine tumors in the structure of female cancer incidence, which puts the issues of prevention and early detection of pathology among the most pressing medical and social problems.
Causes of malignant tumors of the uterus
The incidence of malignant tumors of the uterus is closely related to age, the state of menstrual, reproductive and sexual function, social and living conditions, geographical and other factors. An important role in the development of uterine cancer belongs to hormonal disorders, primarily hyperestrogenism and luteal insufficiency.
Risk factors for cervical cancer are early onset of sexual activity, frequent changes of sexual partners, and unprotected sex. Background precancerous processes, which have a high risk of transformation into invasive cancer, can be initiated by viruses - highly oncogenic strains of HPV and HSV type 2. Changes in the cervix, which are regarded as optional precancer, include true erosion and pseudo-erosion, leukoplakia, flat condylomas, polyps of the cervical canal.
The state of the cervical epithelium is greatly influenced by the vaginal microbiocenosis. Therefore, STDs, recurrent nonspecific colpitis and cervicitis lead to changes in the microecology of the vagina and disruption of the protective physiological barriers of the genital tract. The occurrence of malignant tumors of the cervix is greatly promoted by smoking, occupational hazards, and heredity.
In the pathogenetic aspect, uterine cancer is considered as a predominantly hormonal-dependent pathology. From this position, patients with feminizing ovarian tumors, PCOS, adenomyosis, uterine fibroids, and dysfunctional uterine bleeding are in the area of greatest risk for uterine cancer. Polyps and atypical endometrial hyperplasia are identified as background precancerous processes. In addition, the likelihood of malignant tumors of the uterus is greater in women with no history of pregnancy, childbirth or breastfeeding, with late menopause, and living in industrial cities. Uterine sarcoma usually develops from a rapidly growing fibroid.
Of the extragenital pathologies, malignant tumors of the uterus are most often accompanied by liver diseases (liver failure, hepatitis, fatty hepatosis, cirrhosis), endocrine disorders (diabetes mellitus, obesity), and hypertension. It is known that with an increase in body weight by 10-25 kg compared to the norm, the risk of developing endometrial cancer increases 3 times, and when gaining more than 25 kg excess weight- 9 times.
Classification of malignant tumors of the uterus
Malignant neoplasms of the uterine body can be represented by the following morphological types: adenocarcinoma (up to 80% of tumors), squamous cell, glandular squamous cell, undifferentiated cancer and leiomyosarcoma. Endometrial cancer can have exophytic, endophytic or mixed growth.
Clinical classification
Clinical classification distinguishes 4 stages of uterine cancer:
Stage 0- atypical endometrial hyperplasia (precancer).
Stage I- the tumor is localized within the body of the uterus:
- Ia – limited to the endometrium
- Ib – grows into the myometrium less than 1 cm
- Ic – grows into the myometrium deeper than 1 cm, but does not affect the serous membrane
Stage II- the tumor spreads to the body and cervix (cervical canal).
Stage III- the tumor extends beyond the uterus, but is localized within the pelvis:
- IIIa – the serous membrane of the uterus grows, metastases can be detected in regional lymph nodes or appendages
- IIIb – parametrial tissue grows, metastases in the vagina can be detected
IV stage- the tumor extends beyond the pelvis and invades the bladder and/or rectum.
Cervical cancer staging
Stage 0- cervical intraepithelial neoplasia.
Stage I- the tumor is localized within the cervix:
- Ia – invasion into the stroma to a depth of no more than 3 mm
- Ib – invasion into the stroma to a depth of more than 3 mm
Stage II- the tumor spreads to the upper and middle third of the vagina, the body of the uterus or parametric tissue.
Stage III- the tumor spreads to the walls and lower part of the vagina, parametric tissue up to the walls of the pelvis, metastasizes to the pelvic lymph nodes.
IV stage- the tumor invades the bladder and/or rectum and gives distant metastases.
Symptoms of malignant tumors of the uterus
Cervical cancer
Initial forms of cervical cancer are asymptomatic or with mild symptoms. Malignant tumors of this localization are characterized by bloody discharge of varying intensity (usually spotting), which during reproductive age is acyclic in nature, and during menopause it is characterized by erratic, prolonged bleeding. Bloody discharge often appears after sexual intercourse, defecation, physical activity. Between bleedings, patients pay attention to the appearance of profuse, watery leucorrhoea, which in the later stages becomes serous-bloody, with a putrid odor.
Pain from malignant tumors of the cervix is localized in the lower abdomen, in the sacrum and lower back, and spreads to the thigh and rectum. Initially, the pain syndrome occurs at night, then it becomes constant, and the pain becomes unbearable. When the tumor conglomerate compresses the lymphatic and blood vessels, swelling of the external genitalia and lower extremities appears. In advanced forms of cervical cancer, the functions of the rectum and bladder are disrupted; with tumor invasion of organs, blood appears in the urine and feces, and urinary or rectal fistulas are formed.
Cancer of the uterus
Malignant tumors localized in the body of the uterus have the following characteristic manifestations: bloody discharge from the genital tract, abdominal pain and dysfunction of adjacent organs. The earliest signs of uterine cancer include the appearance of spotting or heavy bleeding. They may take the form of metrorrhagia, menorrhagia, or periodic bleeding during menopause. Sometimes neoplasia manifests itself as leucorrhoea of a serous-bloody or purulent nature.
In the early stages of the development of malignant tumors of the uterus, cramping pain occurs. After another painful attack, as a rule, pathological discharge from the uterine cavity appears or intensifies. In the later stages, the pain becomes constant and intense - it is caused by compression of the pelvic nerve plexuses by the cancerous infiltrate. Somewhat later, symptoms of dysfunction of the bladder and rectum appear: increased urination, tenesmus, difficulty in bowel movement. When the cancer process is far advanced, cancer intoxication occurs and cachexia develops.
Sarcoma of the uterus
Refers to non-epithelial malignant tumors of the uterus. It can affect both the cervix and the body of the uterus. It often forms inside fibromatous nodes, so it can resemble the clinical appearance of one of the forms of uterine fibroids. Sarcoma accounts for about 3-5% of all malignant tumors of the uterus. The absence of a capsule causes rapid invasive growth of the tumor.
The first clinical signs are usually menstrual irregularities or acyclic bleeding, which is sometimes profuse. Characterized by severe pain and rapid increase in size of the uterus. In the later stages, anemia, cancer cachexia, and ascites develop. Uterine sarcoma early gives distant metastases, mainly to the lungs, liver and spine.
Diagnostics
It is almost impossible to recognize malignant tumors of the uterus in the early stages, based only on the collected history and clinical picture, due to the nonspecificity of symptoms and complaints. Therefore, during the examination of patients, additional instrumental and laboratory methods are used to clarify the structure, localization and prevalence of neoplasia.
At the first appointment, the gynecologist, along with a standard survey, clarifies the presence and number of pregnancies, births and abortions in the patient; past gynecological diseases (especially background processes, sexually transmitted infections), the nature of the menstrual cycle. When examined using mirrors, attention is paid to visible changes in the tissue of the cervix, its mobility and shape. Vaginal or rectovaginal examination for endometrial cancer or sarcoma can detect a dense, enlarged uterus and the presence of infiltrates in the parametrium.
For the early diagnosis of cervical cancer, a smear examination for oncocytology, syphilitic cervical ulcers, hyperplastic transformation of the endometrium, intracavitary radiation therapy, and symptomatic treatment are of great importance.
The main scope of surgical treatment for uterine cancer is hysterectomy with adnexectomy, which, if necessary, is supplemented by lymphadenectomy. Radiation treatment is also used in the pre- and postoperative period. If progesterone receptors are detected in a specific tumor, hormonal therapy with gestagens is prescribed. Chemotherapy is used when uterine cancer has spread beyond the pelvic area, but its effectiveness is very limited.
Prevention
Prevention of malignant tumors of the uterus consists of timely detection and treatment of precancerous conditions, systematically undergoing preventive examinations with a Pap test, and preventing STDs. It is important to monitor weight, blood pressure, glycemic levels, treat extragenital pathologies, and get rid of bad habits. To protect adolescent girls from cervical cancer in the future, preventive vaccination against highly oncogenic HPV strains is proposed.
The first place in incidence among gynecological cancers is uterine cancer, or endometrial cancer. In Russia, up to 16 thousand new cases of the disease are detected every year, and the number of cases is constantly increasing.
The pathology mainly affects women after 60 years of age, but can also occur at a younger age. About 40% of patients become ill before menopause. In the last decade, the incidence rate has increased most rapidly in women under 29 years of age.
The tumor is accompanied by the rapid onset of symptoms that force the woman to see a doctor. This results in up to 90% of uterine cancer cases being diagnosed at an early stage, which significantly improves the prognosis.
Causes and risk factors
For many cancer pathologies, the exact cause of their occurrence is unknown. This also applies to uterine cancer. Pathology is considered a “disease of civilization” that occurs under the influence of unfavorable external conditions, dietary habits and lifestyle.
Factors predisposing to uterine cancer:
- late first menstruation;
- only after 55 years;
- long;
- and hormonally active tumor of these organs (Brenner's cancer);
- obesity;
- diabetes;
- long-term use of estrogen hormones without combination with gestagens;
- treatment with antiestrogenic drugs (Tamoxifen);
- lack of sexual activity or pregnancy;
- cases of illness in close relatives.
Endometrial cancer of the uterus occurs against the background of a complex of disturbances in hormonal balance, metabolism of fats and carbohydrates.
The main pathogenetic types of the disease:
- hormonal-dependent (in 70% of patients);
- autonomous.
In the first option, ovulation disorders in combination with obesity or diabetes lead to increased production of estrogen. Acting on the inner uterine layer - the endometrium, estrogens cause increased proliferation of its cells and their increase in size and change in properties. Gradually, hyperplasia becomes malignant, developing into precancer and uterine cancer.
Hormone-dependent uterine cancer is often combined with a tumor of the intestine, breast or ovary, as well as with ovarian sclerocystosis (Stein-Leventhal syndrome). This tumor grows slowly. It is sensitive to progestogens and has a relatively favorable course.
Signs that increase the risk of hormone-dependent cancer:
- infertility, late menopause, anovulatory bleeding;
- ovaries and hyperplastic processes in them (thecomatosis);
- obesity;
- improper treatment with estrogen, adrenal adenoma or cirrhosis of the liver, causing hormonal changes.
The autonomous variant often develops in postmenopausal women against the background of ovarian and endometrial atrophy. There is no hormonal dependence. The tumor is characterized by a malignant course, quickly spreading deep into the tissues and through the lymphatic vessels.
There is a genetic theory of cancer, according to which cell mutations are programmed into DNA.
The main stages of the formation of a malignant tumor of the uterus:
- lack of ovulation and increased estrogen levels under the influence of provoking factors;
- development of background processes – polyps and endometrial hyperplasia;
- precancerous disorders - atypia with hyperplasia of epithelial cells;
- preinvasive cancer that does not penetrate beyond the mucous membrane;
- minimal penetration into the myometrium;
- pronounced form.
Classification
Cancer of the uterine body is classified depending on the size of the tumor, its penetration into the muscle layer, growth in surrounding organs, damage to the lymph nodes and the presence of distant metastases. Both the TNM staging system and the International Federation of Obstetricians and Gynecologists (FIGO) staging are used.
A tumor that does not extend beyond the endometrium is called preinvasive. It is designated as carcinoma in situ, Tis, or stage 0.
There are 4 stages of uterine cancer
1. The tumor affects only the body of the uterus:
- endometrium (T1a or IA);
- myometrium to half depth (T1b or IB);
- more than half the depth of the myometrium (T1c or IC).
2. Malignant cells are found in the cervix:
- only in the glandular layer (T2a or IIA);
- the tumor penetrates into the deep layers of the cervix (T2b or IIB).
3. The tumor spreads to the vagina, appendages or lymph nodes:
- damage to the outer serous layer of the uterus and/or appendages (T3a or IIIA);
- spread to the vagina (T3b or IIIB);
- there are metastases to the pelvic or peri-aortic lymph nodes (N1 or IIIC).
4. Stage 4 uterine cancer with metastases:
- into the bladder or rectum (T4 or IVA);
- to the lungs, liver, bones, distant lymph nodes (M1 or IVB).
In addition, different degrees of differentiation of tumor cells are distinguished: from G1 (high degree of cell maturity) to 3 (poorly differentiated tumor). The more pronounced the differentiation, the slower the tumor grows and the less likely it is to metastasize. With poorly differentiated cancer, the prognosis worsens.
Depending on the microscopic structure, the following morphological types of cancer are distinguished:
- adenocarcinoma;
- light cell;
- squamous;
- glandular squamous;
- serous;
- mucinous;
- undifferentiated.
The morphological type largely determines malignancy. Thus, the course of undifferentiated cancer is unfavorable, but with a squamous cell tumor the probability of recovery is quite high.
The neoplasm can grow exophytically (into the lumen of the uterus), endophytically (into the thickness of the muscle wall) or have a mixed nature.
Cancer is localized in the area of the fundus and body of the uterus; tumors are found less frequently in its lower segment.
Symptoms
Often, a patient consults a doctor when she experiences the first signs of uterine cancer in the early stages. First of all, this is irregular bleeding in young women that does not coincide with the menstrual cycle. Postmenopausal women experience uterine bleeding. Young patients develop light leucorrhoea.
Bleeding occurs not only with endometrial cancer, but also with many other diseases. This may cause difficulties in early diagnosis of the disease, especially in young women. They can be observed for a long time about.
Other symptoms of uterine cancer appear in later stages. When blood accumulates in the organ cavity, pain appears in the lower abdomen. Long-term pain syndrome occurs when the tumor grows on the appendages and spreads throughout the peritoneum.
Copious watery or mucous discharge due to uterine cancer is typical for older women.
If the bladder is damaged, frequent painful urination may occur. If the rectum is involved, constipation, pain during bowel movements, and blood in the stool appear.
General signs of cancer pathology are weakness, deterioration in performance, nausea, lack of appetite, weight loss.
How quickly does uterine cancer develop?
With a high degree of differentiation, the tumor grows slowly over several years. Poorly differentiated forms have a high rate of proliferation of malignant cells. In this case, a clinically significant tumor can develop within several months.
Metastasis
The spread of cancer cells is possible through the lymphatic tract, blood vessels and peritoneum.
Lymphogenic metastasis occurs in the nearest (regional) pelvic lymph nodes. At an early stage and high differentiation (G1-G2), the probability of lymph node involvement does not exceed 1%. If cancer cells invade the myometrium, the risk of metastasis increases to 6%. If the tumor affects a large area, penetrates deep into the uterine wall or spreads to the cervix, metastases in the lymph nodes are found in 25% of patients.
Hematogenous metastasis occurs later. Tumor cells travel through blood vessels to the lungs, bones and liver.
Implantation metastases occur on the peritoneum and omentum when the outer layer of the uterus grows and the fallopian tubes are damaged.
Diagnostics
Screening studies for early detection of formation are not carried out. It is believed that for timely recognition you only need to be observed annually by a gynecologist.
Testing for tumor markers, the most common of which is CA-125, is not usually performed. It is considered an additional method for assessing the effectiveness of treatment and early detection of relapses.
The simplest diagnostic method is aspiration of the contents of the uterus with a special syringe and histological examination (). At an early stage, the information content of this method does not exceed 36%; with a widespread tumor, its signs can be detected in 90% of patients. To increase the accuracy of the study, it can be carried out repeatedly. Aspiration biopsy does not require dilation of the cervical canal and is performed on an outpatient basis.
Instrumental diagnosis of uterine cancer:
- : The thickness of the endometrium in postmenopausal women should not exceed 4 mm.
- with a biopsy of a suspicious area of the endometrium and its microscopic examination.
To determine the extent of the tumor and damage to the lymph nodes, it is carried out. Unlike ultrasound, the method helps to clarify the condition of the lymph nodes in 82% of patients.
An X-ray of the lungs is required to exclude metastases in them.
Is uterine cancer visible on ultrasound?
The doctor should be alerted to ultrasound data of the uterus if an increase in M-echo (endometrial thickness) of more than 4 mm in elderly women or 10-16 mm in patients before menopause is recorded.
If the M-echo value is more than 12 mm in young women, aspiration biopsy is prescribed. If this value is 5-12 mm, hysteroscopy and targeted biopsy are performed (taking material from a suspicious area).
If a tumor is detected on ultrasound, you can determine:
- size and contours of the uterus;
- myometrial structure;
- tumor location;
- depth of germination into the myometrium;
- damage to the internal pharynx, ovaries and lymph nodes.
Additional information is provided by color Doppler mapping - ultrasound examination of blood vessels, which allows one to assess the speed and intensity of blood flow in the vessels of the uterus and the tumor focus.
Hysteroscopy is the most important diagnostic method, allowing one to assess the severity and extent of the tumor and take material for histological analysis.
If uterine cancer is suspected, it is necessary to perform the walls of the cervical canal and endometrium.
How to detect uterine cancer with minimal lesion size?
Modern method detection of early stages of endometrial cancer - fluorescent diagnostics. Special substances are introduced into the body that selectively accumulate in cancer cells. When the inner surface of the uterus is irradiated with a laser, these substances begin to glow. This allows you to see tumor foci up to 1 mm and take a targeted biopsy. At an early stage, the sensitivity of such diagnostics reaches 80%.
The diagnosis is finally confirmed by uterine curettage. If the tumor is located in the upper part of the organ, it is recognized in 78% of cases, and with widespread lesions - in 100% of cases.
Uterine cancer must be differentiated from the following diseases:
- endometrial hyperplasia;
Treatment
If a woman is diagnosed with a malignant tumor of the reproductive system, the patient should be observed by a gynecological oncologist.
Treatment of uterine cancer is based on various combinations of three methods:
- Operation.
- Irradiation.
- Drug therapy.
The main method of treatment performed at any stage of the disease is removal of the uterus and appendages. If there is a poorly differentiated tumor or it penetrates deeply into the muscular layer of the organ, the pelvic lymph nodes, which may contain metastases, are additionally removed.
The operation is performed in 90% of women with an early stage of the disease. For others, it is contraindicated due to severe concomitant diseases. The development of new methods of surgical intervention makes it possible to expand the possibilities of surgical treatment.
If the tumor does not penetrate deeper than 3 mm, it can be removed by ablation (“cauterization”) during hysteroscopy. This way you can save the organ. However, the likelihood of incomplete removal of the lesion is quite high, therefore, after such treatment, regular monitoring by an oncologist in a specialized institution is necessary.
Radiation therapy for uterine cancer as an independent method of treatment is rarely used, only when it is impossible to remove the organ. Most often, radiation is given after surgery (adjuvant radiotherapy) to destroy any remaining cancer cells.
This combination is indicated in the following cases:
- deep germination of the neoplasm into the myometrium;
- spread to the cervical canal and cervix;
- metastases to lymph nodes;
- poorly differentiated or non-endometrioid tumor.
Modern treatment methods: radiotherapy – IMRT and brachytherapy. The IMRT method involves targeted irradiation of the tumor with minimal damage to surrounding tissue. Brachytherapy is the introduction of special radioactive substances into the tumor site that act directly on cancer cells.
For endometrial precancer in young women, hormonal therapy with progestins is possible. These hormones block the activating effect of estrogen on the tumor, preventing its further growth. Hormones are used for advanced (disseminated) cancer, as well as for its recurrence. Their efficiency does not exceed 25%.
At an early stage, taking hormones according to a certain scheme lasts about a year. The effectiveness of therapy is monitored using a biopsy. If the result is favorable, the normal menstrual cycle is restored over the next 6 months. Subsequently, a normal pregnancy is possible.
Chemotherapy is prescribed for poorly differentiated uterine cancer and non-endometrioid tumors, disseminated and recurrent cancer, if the tumor does not respond to the influence of gestagens. It is palliative in nature, that is, it is aimed at reducing severe symptoms caused by the tumor, but does not cure the disease. Drugs from the groups of anthracyclines, taxanes, and platinum derivatives are used. Postoperative (adjuvant) chemotherapy is not prescribed.
At home, a woman needs to rest more. Those around her should protect her from emotional stress. Nutrition for uterine cancer is complete and varied, excluding refined carbohydrates (sugar), limiting animal fats, fried and canned foods, spices, chocolate and other irritating foods. Dairy products and plant foods are very healthy.
It is believed that some plants help cope with the tumor or improve the patient’s well-being:
- green tea;
- turmeric;
- beet;
- tomatoes;
Treatment tactics depending on stage
The question of how to cure uterine cancer is decided by the doctor after a thorough analysis of all the diagnostic information received. This largely depends on the stage of the tumor.
For stage 1 cancer, complete removal of the uterus and appendages is used (total hysterectomy and).
This operation is carried out if all of the following conditions are met:
- moderate and high tumor differentiation;
- the formation occupies less than half of the organ cavity;
- the depth of myometrial growth is less than 50%;
- there are no signs of tumor spread throughout the peritoneum (no cancer cells were found in peritoneal washings).
If the depth of penetration into the muscle layer is more than half its thickness, intravaginal radiation therapy is prescribed after surgery.
In all other cases, removal of the genital organs is complemented by excision of the pelvic and, in some cases, para-aortic lymph nodes. Nodes located near the aorta are punctured during surgery and an urgent histological examination is performed. Based on its results, a decision is made to remove these formations.
After surgery, radiation is used. If surgery is not possible, only radiation therapy is used, but the effectiveness of such treatment is lower.
Hormonal therapy is not used at stage 1.
For stage 2 cancer, patients are advised to remove the uterus, appendages, pelvic (sometimes para-aortic) lymph nodes and postoperative radiation therapy. Irradiation is carried out according to a combined scheme: intravaginally and remotely.
For stage 3 cancer, combined surgical and radiation treatment is performed. If the tumor has grown into the walls of the pelvis, its complete removal is impossible. In this case, radiation therapy is prescribed through the vagina and remotely.
If radiotherapy and surgery are contraindicated, treatment depends on the hormonal sensitivity of the tumor: either progestins or chemotherapy are prescribed.
For stage 4 tumors, palliative chemotherapy in combination with hormones is used. These substances help destroy distant metastases of cancer in other organs.
Recurrence of the tumor is also treated with the use of hormones and chemotherapy. For recurrent lesions located in the pelvis, palliative radiotherapy is performed. Relapses most often occur during the first 3 years after treatment. They are localized mainly in the vagina, lymph nodes and distant organs.
Uterine cancer and pregnancy
During pregnancy, pathological changes are almost impossible to recognize. Tumor growth during pregnancy is most often not observed. However, uterine cancer during pregnancy can be accompanied by miscarriage, placental abruption, fetal death and severe bleeding. In these cases, emergency delivery is performed followed by hysterectomy.
If a young woman has completed the full course of treatment with good results, she may become pregnant in the future. To restore fertility, doctors prescribe courses of hormonal therapy that restore normal reproductive function.
How long do they live with uterine cancer?
This depends on the stage of detection of the disease and sensitivity to hormones. With the hormone-dependent variant, 85-90% of patients live for 5 years or more. In the autonomous form in elderly women, this figure is 60-70%. However, in the 3rd stage of any form, life expectancy of more than 5 years is recorded in a third of patients, and in the 4th stage - only in 5% of cases.