Effective treatment of uterine cancer. How to treat cervical cancer: conservative and unconventional methods

Among malignant tumors of the female genital organs, endometrial cancer occupies a leading position. Previously, it was believed that this was a problem mostly for women during menopause. But in last years there is a tendency towards rejuvenation of this disease, which is associated with endocrine pathologies.

Endometrial cancer is a hormone-dependent tumor and serves as a target for sex hormones. The morphological structure of the cells determines the type of cancer: the tumor is usually located in the area of ​​the body and fundus of the uterus, very rarely in the part adjacent to the cervix.

The prognosis for cure is determined by the degree of cancer differentiation - cell maturity. The prognosis is worse for a poorly differentiated tumor, good for a differentiated one. The degree is indicated in English letters G1, G2, G3.

The type of tumor is determined by international system FIGO:

1. The tumor is only in the body of the uterus.
2. The cancer affects the cervix but does not spread beyond the uterus.
3. Metastases in the pelvis.
4. Distant metastases in other organs.

About the organ

The uterus is a very sensitive organ to hormones reproductive system. She participates in the gestation and birth of a child. Under the influence of estrogen, the inner layer, the endometrium, grows, which is needed for attachment and nutrition of the embryo.

Progesterone prepares the uterus for embryo implantation and reduces its contractile activity. An imbalance of sex hormones with a predominance of estrogen leads to cancer.

Cryosurgery

Application for surgery is very low temperatures called cryosurgery. The essence of the method is that Using a special device, the tumor is frozen to -180 degrees Celsius, after which it is removed. The manipulation is carried out with liquid nitrogen. The big advantage of this method is stopping the growth of the tumor and preventing its metastasis.

More often, the method is used for tumors in external areas. In gynecology, this is cervical cancer. Treatment internal organs possible with the use of a cryoprobe. To do this, a skin puncture is made, through which a cryoprobe is inserted under ultrasound control. Sometimes it can be several tubes. They supply the tumor with a liquid nitrogen, which creates an ice crust.

Advantages of this method:

• low trauma to healthy tissues;
• rehabilitation periods have been reduced;
• it is possible to influence a tumor located near blood vessels and nerves that interfere with a full operation.

Laser surgery

The method is used to treat pre-invasive stage cervical cancer. Through the vagina, the doctor directs a beam of focused laser beams to the pathological focus. Cancer cells are burned out, leaving a small wound in their place that heals quickly. The intervention is minimally invasive and there is virtually no blood loss.

Reproductive function and sexual desire don't suffer. For women, the procedure is painless. But it is ineffective when cancer grows deep into the cervix. Laser treatment benign formations on the cervix, vulva or vagina, as well as pathologies that can lead to malignant formations– erosion and dysplasia.

Conization

The operation is used to treat the cervix with cervical canal dysplasia and invasive cancer. The essence of the method is to remove a cone-shaped area with its apex facing the uterus. Its size depends on the extent of the pathological focus. Initially, conization was carried out using a scalpel, but the method had many complications, often accompanied by bleeding.

Loop electroconization is carried out with special electrodes of various sizes. The disadvantage of this method is that it is impossible to accurately determine the depth of exposure, which can lead to damage and necrosis of lymphatic and blood vessels. This operation increases the risk of developing endometriosis.

Laser conization is the most safe method. There is no bleeding, the vessels are sealed immediately during the intervention. The operation is performed under general anesthesia, because... complete immobilization of the woman is required.

The doctor talks about the nuances, advantages and disadvantages of the conization method in this video:

Hysterectomy

The type of hysterectomy depends on the degree of development cancerous tumor. Only in the absence of cancer germination is it possible to remove the uterus separately without affecting the rest reproductive organs. In other cases, it is removed with the appendages and neck.

The operation is performed using open access or laparoscopic method. Mandatory general anesthesia. After entering the abdominal cavity, the vessels feeding the organ are carefully ligated, the uterus is separated from the ligaments and cut off. Mandatory post-operative histological examination remote organ.

This will help you decide further tactics treatment, what treatment methods still need to be applied to ensure a sufficient life expectancy for the patient.

After checking abdominal cavity To check for the presence of pathological foci that may be tumor metastases, the surgical site is dried, and the vessels are examined for bleeding. The wound is sutured in layers, and an aseptic bandage is applied.

How to remove the uterus independent method Cancer treatment is used only in the early stages. Everything else must be supplemented with hormonal therapy, chemotherapy, and radiation.

Radical hysterectomy

This is an option to remove the uterus along with the appendages, ovaries, cervix, adjacent lymph nodes, tissue and top part vagina. It is used for advanced high-stage cancer, when the cancer grows through the uterus and metastasizes to regional lymph nodes.

The operation is difficult and highly traumatic both physically and mentally. It must be supplemented with chemotherapy and radiation therapy. Sometimes surgery is performed as a palliative procedure for late stages cancer. Survival in such cases rarely reaches five years after the intervention.

Trachelectomy

The operation is performed for cervical cancer and is an organ-preserving operation. This is an alternative to vaginal hysterectomy for stage 1 cervical cancer. The essence of the operation is to remove the cervix, upper part of the vagina, adjacent fatty tissue and lymph nodes.

The internal os and body of the uterus remain intact. This ensures conservation reproductive function and the possibility of becoming pregnant using IVF. In this case, the birth will be carried out by caesarean section.

Removal of pelvic organs

Cancer of the cervix or vagina, and primary cancer ovaries can grow into neighboring organs, give metastases to the sigmoid or rectum. In this case, complete exentration is necessary - removal of the pelvic organs.

During the operation, the uterus with appendages and ovaries, sigmoid and rectum, and all tissue located next to the uterus are removed. The method is dangerous due to disruption of innervation Bladder, performed by highly qualified surgeons.

To improve bowel function, a temporary colostomy is performed - the intestinal opening is sutured to abdominal wall and the feces come out through it. After complete healing of the junction in the colon, the colostomy is eliminated after 2-3 months.

Radiation exposure

The use of radiation to treat cancer increases the effectiveness of therapy. Preoperative irradiation is practically not used. Sometimes it is used as an independent method when surgical treatment is not possible. After surgery, radiation destroys the remaining cancer cells.

Treatment is carried out remotely, externally, or internal exposure. Sometimes the methods are combined. External therapy performed with a special apparatus 5 days a week for several weeks. The dose is selected individually by the radiation therapy doctor.

Internal irradiation is carried out 1-1.5 months after surgery. Special granules containing a radioactive substance are placed into the vagina in a hospital setting.

Radiation therapy is accompanied by unpleasant side effects:

• pain in the genital area and when urinating;
• weakness;
• diarrhea;
• increased frequency of urination.

Chemistry

This The treatment method includes the use of antitumor drugs and hormones. As an independent method it is used only on initial stages diseases. After surgical treatment For patients with a good prognosis, hormones are prescribed for the next 6 months, for patients with an unfavorable prognosis - for 2 years.

The most common chemotherapy drug combination is cisplatin, doxorubicin, and cyclophosphamide. For hormonal treatment antiestrogens, gestagens or a combination thereof are used.

Chemotherapy drugs are administered intravenously, by drip. Depending on the combinations used, chemotherapy courses are repeated every 3-4 weeks.

Side effects vary in severity:

• decrease in the number of leukocytes;
• anemia;
• decreased platelets and a tendency to bruise and bleed;
• damage to the oral mucosa, gastritis;
• nausea, vomiting, diarrhea.

Folk remedies

Methods traditional medicine may under no circumstances be used as self-treatment endometrial cancer. Self-medication of such pathology often leads to the development of advanced forms, with the spread of metastases to distant organs - liver, lungs, intestines.

Traditional medicine can be used as maintenance and restorative therapy after the main treatment of the tumor. To strengthen the immune system, it is recommended to use tincture of propolis and ginseng.

Decoctions of herbs such as wormwood, shepherd's purse, celandine, garlic arrows drink 50 ml up to 6 times a day. With the same solution traditional healers It is recommended to douche. A decoction of calendula flowers is also used for these purposes. You can learn more about this from this video:

All traditional medicine recipes should be used only after consultation with your doctor.

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Regular screenings can help detect cervical tumors or precancerous conditions in the earliest stages, when treatment is most effective. Modern techniques treatments can cure a woman and preserve reproductive function.

Cancer development is promoted by:

• infection oncogenic types human papillomavirus (HPV),
• chronic diseases of the cervix,
• precancerous conditions,
• weakening of the immune system,
• cytomegalovirus infection,
• early sexual life,
• a large number of abortions.

Symptoms
Signs of the disease appear in active stage tumor growth and involvement of surrounding tissues in the process. The following should cause concern and force a woman to undergo an urgent examination:

• atypical discharge,
• painful and heavy menstruation,
• bleeding during the intermenstrual period, after examination by a gynecologist, sexual contact,
• pain in the lower abdomen and lower back,
• painful sexual intercourse.

Stages
During cervical cancer, like other cancer pathologies, it is customary to distinguish 4 stages:

I – small tumor formation within the cervix,
II – the tumor has affected the parametrium,
III – infiltration of cancer into the tissue, pelvic walls, vagina, nearby lymph nodes,
IV – most dangerous stage when the bladder, rectum, bones, intestines, and internal organs are involved in the cancer process.

Methods for diagnosing cervical cancer
Before treatment for cervical cancer in Israel First medical Center Tel Aviv offers patients to undergo comprehensive examination. Diagnostics is designed to establish the size, type and exact localization of the neoplasm, the degree of spread of the process. For this purpose the following may be prescribed:

• PET-CT,
• HPV test,
• colposcopy,
• PAP test,
• tumor biopsy.

Treatment of cervical cancer
Oncology treatment in Israel has a special priority. Huge amounts of money are being invested in the development of this area. Application international protocols treatment allows us to talk about long-term remission even with advanced cervical cancer. In the early stages, Israeli doctors manage to achieve full recovery while preserving the woman’s ability to become pregnant and give birth to a child.

By radical method cervical cancer treatment remains surgical intervention. Additionally, courses of radiation and chemotherapy may be prescribed.

Israeli oncosurgeons prefer gentle laparoscopic operations, laser technologies, cryosurgery, allowing to preserve the organ. For laparoscopic surgery, it is enough to make several punctures in the abdominal cavity, through which surgical field Imaging tools and equipment are introduced. This method can be used to remove the tumor and part of the organ or perform a hysterectomy. The length of hospitalization after laparoscopic operations is on average 1-2 days, and postoperative recovery period goes away much faster than after traditional intervention.

At extensive lesions the tumor is removed along with the uterus, affected lymph nodes, part of the vagina, bladder, and rectum.

Innovative treatment of cervical cancer
In the former CIS countries, women with metastatic cervical cancer receive only symptomatic palliative treatment. In Israel, these patients are given a chance to live thanks to the use of innovative drugs. Molecular targeted therapy, treatment monoclonal antibodies are able to force the immune system to resist the disease and destroy cancer cells, stop the reproduction and growth of malignant cells. It is possible that a new treatment will soon supplant traditional methods which have many side effects.

Today, cancer is considered the most common cause death in age category up to 70 years old. Every year, every fourth patient dies worldwide. Uterine cancer is one of the most common oncological diseases among women it ranks fourth, with more than 500 thousand patients falling ill with it every year. A disease not recognized in time is not enough competent treatment may lead to fatal outcome. However, in the arsenal of modern doctors huge selection reliable diagnostic methods, with the help of which you can detect the disease itself early stage. Today, uterine cancer is being treated, and successfully - this is evidenced by inexorable statistics. Of course, there are patients with neglected forms diseases. One of the reasons for this is a late visit to the doctor. The insidiousness of the disease lies in the fact that at an early stage the disease is asymptomatic. A woman often does not suspect that she is sick and comes to the doctor about some other disease.

Is uterine cancer curable? Every woman probably asks this question after hearing cancer diagnosis. Today we can say that uterine cancer is curable. Moreover, for a disease detected on, gentle treatment methods can be used. Methods of therapy are a thing of the past, side effects which terrified the patients. Latest drugs chemotherapy, in which undesirable effects are minimized, radiation methods that act only on the tumor, without affecting healthy tissue... Today, organ-conserving surgery is not uncommon. Moreover, women reproductive age can become pregnant after some time. For successful treatment you need very little - attention to your health. It is enough to go 1-2 times a year preventive examination. But some women believe that nothing bad can happen to them; others simply do not have enough time, and a visit to the doctor is postponed until later. And some are simply afraid of possible examination. The reasons are different, but the result is the same - a health risk. Women who belong to a high-risk group should be especially wary.

Causes of the disease

Factors influencing the occurrence of the disease:

• Late menopause early attack menstruation
• Infertility, lack of childbirth, numerous abortions
• Use oral contraceptives
• Precancerous conditions: ulcers, erosion, inflammatory processes, polyposis, fibroids, mucosal hyperplasia
• Early start sexual relations, having multiple sexual partners, venereal diseases, infection with human papillomavirus
• Diabetes, hypertonic disease, obesity
• Poor nutrition, smoking, excessive alcohol consumption, large physical exercise
• Hereditary factors

Today it may seem surprising, but about the harmful factors that can cause oncological diseases, American researchers warned at the end of the last century. Poor nutrition, the presence of carcinogenic substances in products, unfavorable ecology, burdened heredity - unfortunately, the situation is only getting worse every year.

The worst thing is that some patients refuse to undergo treatment or, using different unconventional methods, they are trying to treat themselves, bombarding all kinds of healers with questions about whether uterine cancer can be cured. As a result, the lack of qualified medical care and lost time leads to the irreparable. But all you need to do is consult a doctor. Modern medicine has achieved amazing results, which is not surprising - oncology is currently one of the highest priority areas. However, it is impossible to single out any specific treatment method as the most effective. In the treatment of oncological pathologies it is important A complex approach, and it is possible to choose the right treatment tactics only in specialized clinics. Only then should one expect a successful cure.

Five-year survival rate timely treatment reaches 96%. But a disease diagnosed at a late stage is much less treatable and only no more than 60% of patients survive.

If a woman is diagnosed, treatment of the disease must be correct and timely. Before you begin to treat the disease, you should undergo a diagnosis so that the therapy is prescribed correctly, there are no relapses, and the woman can continue to have a normal life in the future. sex life, give birth to children.

In order to understand how to treat cervical cancer, the gynecologist prescribes special diagnostics. Cancer on this organ is discovered by chance, since it does not have obvious symptoms. It is possible to detect cervical cancer in a timely manner only if you regularly undergo examination by a gynecologist (once every six months) and take a cytology test.

Is cervical cancer curable?

Diagnostics involves the use of other methods that allow you to choose the right therapy. Many women are concerned about whether cervical cancer can be cured. It depends on what stage the disease is at and whether the cancer has metastasized. After the operation, doctors prescribe radiation therapy. It helps very well only in cases where there have been no relapses and no metastases.

When a woman comes to the clinic, the doctor collects the patient’s complaints, carefully studies the symptoms of the disease, and prescribes numerous diagnostic measures.
First of all, diagnosis involves examination of the vagina, for which the following methods are used:

1. Two-handed study.
2. Use of mirrors.
3. Rectal two-manual examination.

During such an examination, changes in the cervix can be detected. They come in three types, depending on the type of tumor and its growth on the tissue. Changes can be mixed, exophytic and endophytic in nature. Cancer syndrome is accompanied by other signs that appear during examination. If you press on the tumor or accidentally touch it, the tumor may begin to bleed. In this case, it is assigned additional examination which is carried out through the rectum. Its purpose is to clarify whether the tumor has spread to the pelvis and ligaments, especially the uterosacral ligaments.
The vaginal examination ends with a cytological examination or a biopsy.

If cervical cancer is suspected, then curettage of the cavity, cervix, and uterine canal is prescribed, in order to then conduct histology. The examinations are carried out in a clinic where there is a special instrument for studying, so it is impossible to do this on your own, as well as to cure the disease.
An excellent diagnostic method is ultrasound tomography, which detects malignant and benign formations. Images and results on the monitor help further visualize the disease and clarify its location.

To understand whether metastases have reached the lymph nodes or other organs, additional tests are prescribed. diagnostic procedures. It can be the following techniques:

1. Lymphography.
2. Ileocavagraphy.
3. Cystoscopy.
4. Sigmoidoscopy.
5. Intravenous pyelography.
6. Chest X-ray.

Sometimes computed and magnetic resonance imaging, a biopsy, which is done with a very thin needle, and colposcopy are prescribed. The latter technique is necessary to study the epithelium of the vagina, cervix, and vulva. It helps to detect dysplasia and finally confirm the diagnosis. Computed tomography carried out using contrast agent.

These techniques are used to prescribe and plan systematic radiation therapy treatment, especially in cases where lymph nodes are affected or recurrence is suspected.

How is the disease treated?

How to treat uterine cancer? At timely diagnosis and a correct diagnosis, when asked whether cervical cancer can be treated, doctors answer positively. Treatment is prescribed depending on what stage is diagnosed and whether other tissues or organs are involved. The development of a treatment regimen depends on many factors, including the woman’s age, the state of her body, health, and reproductive system.

The first stages of cervical cancer are treated by circular removal of the affected area. The operation is performed on organs such as the cervix, uterus, and appendages. In many cases, therapy is aimed at preserving organs, especially if the body of the uterus or cervix has been removed. In this case, the ovaries are moved up the abdomen, for which the patient’s vessels are used. This allows you to save the ovaries during therapy, since they do not fall into the irradiation zone.

A fairly common technique that allows you to cure cervical cancer involves removing the uterus, appendages and lymph nodes pelvis But most often it is used complex treatment. First, the operation is performed. Secondly, irradiation by remote method. Thirdly, gamma therapy.

If the third stage is diagnosed, then the fallopian canal is subjected to radiation therapy for surgery. Separately, radiation therapy as an independent method of treatment is prescribed if the tumor begins to grow and the inflammation has invaded other tissues and organs. In this case, there are serious contraindications to the operation. Therefore, radiation therapy is prescribed, special drugs, which should eliminate the tumor. As a rule, therapy and surgery go well together, which allows you to completely cure uterine cancer. In later stages it is prescribed symptomatic treatment, although chemotherapy is sometimes used.

After treatment, women are required to regularly visit the doctor so that he can monitor the condition of the pelvic organs and send a smear to the laboratory for cytological and histological examination. Additionally, an ultrasound and x-ray of the pelvic and chest organs are performed.

During the recovery period, a woman must adhere to the established schedule of visiting a gynecologist. At first you need to come once every 3 months, then for 5 years - every six months. In the next five years - once a year.

If at this stage a relapse occurs that is local in nature, then total or partial removal uterus, cervix, bladder or other organs. If single metastases develop, the woman must undergo chemotherapy. Painful metastases are removed using radiation therapy. To reduce the risk of relapse in postoperative period, radiation and chemotherapy are used simultaneously. This significantly reduces disease progression, in some cases by up to 50%.

To relieve pain, painkillers are prescribed and the nerve endings and plexuses.

Preventive actions

First of all, these include regular visits to the gynecologist. This is especially true for women who are 30 or more years old. You can ask a specialist to prescribe an ultrasound and conduct a cytological examination to prevent the appearance of tumors and inflammation. In order to avoid developing a predisposition to cancer, you need to stop smoking, use protection during sexual intercourse, and be regularly tested for viral and infectious diseases sexually transmitted diseases. If there are any alarming symptoms, then you should immediately consult a doctor to rule out cancer and begin treating those that are present.

Informative video

The first place in incidence among gynecological cancers is uterine cancer, or endometrial cancer. In Russia, up to 16 thousand new cases of the disease are detected every year, and the number of cases is constantly increasing.

The pathology mainly affects women after 60 years of age, but can also occur at older ages. at a young age. About 40% of patients become ill before menopause. IN last decade The incidence rate is growing at the fastest rate 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 leads to the fact that up to 90% of uterine cancer cases are diagnosed in early stage, which significantly improves the prognosis.

Causes and risk factors

With many oncological pathologies the exact cause of their occurrence is unknown. This also applies to uterine cancer. Pathology is considered a “civilization disease” that arises under the influence of unfavorable external conditions, nutritional characteristics and lifestyle.

Factors predisposing to uterine cancer:

• late first menstruation;
• only after 55 years;
• long;
• and hormonally active tumor of these organs (Brenner's cancer);
• obesity;
• diabetes;
• long-term use of estrogen hormones without combination with gestagens;
• treatment with antiestrogenic drugs (Tamoxifen);
• lack of sexual activity or pregnancy;
• cases of illness in close relatives.

Endometrial cancer of the uterus occurs against the background of a complex of disorders 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 estrogens. 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. Hormonal addiction absent. The tumor is characterized by a malignant course, quickly spreading deep into the tissues and through the lymphatic vessels.

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

The main stages of the formation of a malignant tumor of the uterus:

• lack of ovulation and increased estrogen levels under the influence of provoking factors;
• development of background processes – polyps and endometrial hyperplasia;
• precancerous disorders - atypia with hyperplasia 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 TNM staging and classification are used international federation obstetricians and gynecologists (FIGO).

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, there are different degrees differentiation of tumor cells: from G1 (high degree of cell maturity) to 3 (poorly differentiated tumor). The more pronounced the differentiation, the slower the neoplasm grows and the more less likely its metastasis. With poorly differentiated cancer, the prognosis worsens.

Depending on the microscopic structure distinguish such morphological types cancer:

• 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, these are irregular bloody issues in young women that do not coincide with the menstrual cycle. Postmenopausal women experience uterine bleeding. Young patients develop light leucorrhoea.

Bleeding occurs not only with endometrial cancer, but also with many other diseases. There are difficulties associated with this early diagnosis illness, 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 section belly. Long pain syndrome occurs when a tumor grows on the appendages and spreads throughout the peritoneum.

Copious watery or mucous discharge due to uterine cancer is typical for older women.

If the bladder is damaged, frequent painful urination. 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 high speed 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 along the 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 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. He is considered additional method to assess the effectiveness of treatment and early detection of relapses.

The simplest diagnostic method is aspiration of the contents of the uterus with a special syringe and histological examination (). At an early stage, the information content of this method does not exceed 36%; with a widespread tumor, its signs can be detected in 90% of patients. To increase the accuracy of the study, it can be carried out repeatedly. Aspiration biopsy does not require dilation of the cervical canal and is performed on an outpatient basis.

Instrumental diagnosis of uterine cancer:

• : The thickness of the endometrium in postmenopausal women should not exceed 4 mm.
• with a biopsy of a suspicious area of ​​the endometrium and its microscopic examination.

To determine the extent of the tumor and damage to the lymph nodes, it is carried out. Unlike ultrasound, the method helps to clarify the condition of the lymph nodes in 82% of patients.

An X-ray of the lungs is required to exclude metastases in them.

Is uterine cancer visible on ultrasound?

The doctor should be alerted to ultrasound data of the uterus if an increase in M-echo (endometrial thickness) of more than 4 mm in elderly women or 10-16 mm in patients before menopause is recorded.

If the M-echo value is more than 12 mm in young women, they are prescribed aspiration biopsy. 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;
• defeat internal pharynx, ovaries and lymph nodes.

Additional information is provided by color Doppler mapping - ultrasonography vessels, allowing to assess the speed and intensity of blood flow in the vessels of the uterus and the tumor focus.

Hysteroscopy – the most important method diagnostics, allowing to assess the severity and extent of the tumor and take material for histological analysis.

If uterine cancer is suspected, it is necessary to perform the walls of the cervical canal and endometrium.

How to detect uterine cancer with minimal lesion size?

A modern method for detecting the early stages of endometrial cancer is fluorescent diagnostics. Special substances are introduced into the body that selectively accumulate in cancer cells. When the inner surface of the uterus is irradiated with a laser, these substances begin to glow. This allows you to see tumor foci up to 1 mm and take a targeted biopsy. At an early stage, the sensitivity of such diagnostics reaches 80%.

The diagnosis is finally confirmed by uterine curettage. If the tumor is located in the upper part of the organ, it is recognized in 78% of cases, and with widespread lesions - in 100% of cases.

Uterine cancer must be differentiated from the following diseases:

• endometrial hyperplasia;

Treatment

If a woman is diagnosed malignant tumor reproductive system, the patient should be observed by a gynecological oncologist.

Treatment for uterine cancer is based on various combinations three methods:

1. Operation.
2. Irradiation.
3. Drug therapy.

The main method of treatment performed at any stage of the disease is removal of the uterus and appendages. If there is a poorly differentiated tumor or it penetrates deeply into the muscular layer of the organ, the pelvic lymph nodes, which may contain metastases, are additionally removed.

The operation is performed in 90% of women with an early stage of the disease. For others, it is contraindicated due to severe concomitant diseases. Development of new methods surgical intervention allows you to expand 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 treatment method is rarely used, only if 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 cervical canal and neck;
• 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, normal restoration is carried out over the next 6 months. menstrual cycle. Subsequently, a normal pregnancy is possible.

Chemotherapy is prescribed for poorly differentiated uterine cancer and non-endometrioid tumors, disseminated and recurrent cancer, if the tumor does not respond to the influence of gestagens. It is palliative in nature, that is, aimed at reducing severe symptoms caused by a tumor, but does not cure the disease. Drugs from the groups of anthracyclines, taxanes, and platinum derivatives are used. Postoperative (adjuvant) chemotherapy is not prescribed.

At home, a woman needs to rest more. Those around her should protect her from emotional stress. Nutrition for uterine cancer is complete and varied, excluding refined carbohydrates (sugar), limiting animal fats, fried and canned foods, spices, chocolate and other irritating foods. Dairy products and plant foods are very useful.

It is believed that some plants help cope with the tumor or improve the patient’s well-being:

• green tea;
• turmeric;
• beet;
• tomatoes;

Treatment tactics depending on stage

The question of how to cure uterine cancer is decided by the doctor after a thorough analysis of all the diagnostic information received. This largely depends on the stage of the tumor.

For cancer of the 1st degree (stage) it is used complete removal uterus and appendages (total hysterectomy and).

This operation is carried out if all of the following conditions are met:

• moderate and high tumor differentiation;
• the formation occupies less than half of the organ cavity;
• the depth of myometrial growth is less than 50%;
• there are no signs of tumor spread throughout the peritoneum (no cancer cells were found in peritoneal washings).

If the depth of penetration into the muscle layer is more than half its thickness, intravaginal injection is prescribed after surgery. radiation therapy.

In all other cases, removal of the genital organs is complemented by excision of the pelvic and, in some cases, para-aortic lymph nodes. Nodes located near the aorta are punctured during surgery and an urgent histological examination is performed. Based on its results, a decision is made to remove these formations.

After surgery, radiation is used. If surgery is not possible, only radiation therapy is used, but the effectiveness of such treatment is lower.

Hormonal therapy is not used at stage 1.

For stage 2 cancer, patients are advised to remove the uterus, appendages, pelvic (sometimes para-aortic) lymph nodes and postoperative radiation therapy. Irradiation is carried out according to 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 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 heavy bleeding. In these cases, emergency delivery is performed followed by hysterectomy.

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