How quickly does uterine cancer grow? The first signs and symptoms of uterine cancer. Uterus and development of malignant process

Among all malignant neoplasms in women, uterine cancer is the most common, and its incidence and the number of young patients with this diagnosis are growing. Endometrial cancer is common to postmenopausal women, the average age of patients is 55-60 years, but it can also be found in young girls of fertile age. Features of hormonal levels during the postmenopausal period contribute to various hyperplastic processes of the endometrium. Such changes in the uterine mucosa most often become the “soil” on which cancer grows.

Since the presence of a tumor is accompanied by clinical manifestations already at an early stage, then the number of advanced forms (unlike cervical cancer) is small. The majority of neoplasms are detected quite early (more than 70% in the first stage of the disease), so such a tumor becomes a relatively rare cause of death. Endometrial cancer accounts for about 2-3% of all tumors of the female reproductive system.

Features of the anatomy and physiology of the uterus

Endometrial cancer of the uterus, often called simply uterine cancer, is a tumor that grows from the lining of the organ.

Knowledge of the main points of the anatomical structure of the uterus allows us to more accurately represent the essence of this insidious disease.

The uterus is an unpaired hollow organ, the main purpose of which is bearing a child and subsequent childbirth. It is located in the pelvic cavity, bordered in front by the bladder, and behind it is the wall of the rectum. This arrangement explains the appearance of a disorder of their function in the pathology of the internal female genital organs.

The body of the uterus (the upper section directly involved in pregnancy) consists of three layers:

• Endometrium- the inner layer, the mucous membrane lining the surface of the uterus from the inside, subject to cyclical changes under the influence of female sex hormones and intended for favorable implantation of a fertilized egg in the event of pregnancy. Under pathological conditions, the endometrium becomes a source of cancer development.
• Myometrium– a middle, muscular layer that can increase during pregnancy and is extremely important in labor. Tumors of smooth muscle origin (benign leiomyomas and malignant leiomyosarcoma) can grow from the myometrium;
• Serosa- part of the peritoneum that covers the outside of the uterus.

The functioning of the endometrium is maintained through complex interactions between the nervous and endocrine systems. The hypothalamus, pituitary gland and ovaries produce hormones that regulate the growth, development and subsequent rejection of the endometrium during the menstrual phase of the cycle if pregnancy has not occurred. It is violations of the neuroendocrine regulatory mechanisms that most often become the cause of diseases of the female reproductive system, including endometrial cancer.

Risk factors for endometrial tumors

As is known, in healthy tissue the development of a tumor is very unlikely, therefore the presence of disorders and predisposing factors is necessary that will cause a precancerous process and a subsequent tumor.

More often, endometrial cancer occurs in women who are overweight (obese), with diabetes mellitus, arterial hypertension, and among disorders of the female reproductive system the following predominate:

1. Early onset of menstruation;
2. Late onset of menopause;
3. Absence or only childbirth in the past;
4. Infertility;
5. Neoplasms in the ovaries that can synthesize estrogen hormones;
6. Various menstrual cycle disorders.

causes of endometrial cancer of the uterus

It is known that female sex hormones (estrogens) can accumulate in adipose tissue, so their concentration may increase in obesity. This leads to excessive growth (hyperplasia) of the endometrium and polyp formation. Diabetes mellitus is accompanied by significant endocrine and metabolic changes, including those in the genital organs. Pathology of the ovaries, disturbances in the hormonal regulation of the menstrual cycle, including those caused by stress and nervous overload, also contribute to the occurrence of various changes in the uterine mucosa that precede tumors.

In addition, we should not forget about the hereditary factor, when various genetic abnormalities predispose to the development of breast tumors, ovarian or endometrial cancer.

Precancerous changes and causes of endometrial tumors

The main cause of the tumor is most often an increase in estrogen levels, produced in the first phase of the menstrual cycle by the ovaries. These hormones promote the growth of the endometrium, increasing its thickness due to cell proliferation and the formation of convoluted glands necessary for the implantation of a fertilized egg. When there is a lot of estrogens, there is excessive growth of the endometrium (hyperplasia), increased proliferation (reproduction) of endometrial gland cells, which creates conditions for disruption of the division processes and the appearance of a tumor.

The processes that precede cancer are endometrial hyperplasiaand polyp formation. Most mature women have encountered such diagnoses at least once in their lives. The likelihood of tumor development as a result of these processes depends on the nature of the endometrial changes.

There are several types of hyperplasia:

• Simple non-atypical hyperplasia;
• Complex (adenomatous) non-atypical;
• Simple atypical hyperplasia;
• Complex (adenomatous) hyperplasia with atypia.

The first two options are characterized by excessive growth of the uterine mucosa with an increase in the number of glands in it. The term “adenomatous” means the presence of a large number of such glands, located close to each other and reminiscent of the structure of a benign glandular tumor - adenoma. Since the epithelial cells of the glands in this case do not differ from normal ones, these types of hyperplasia are called non-atypical (not accompanied by cell atypia) and are considered background processes that will not necessarily cause cancer, but may contribute to its development.

Simple and complex hyperplasia with atypia is a precancerous process, that is, the likelihood of developing a malignant tumor with such changes is quite high. Thus, in the presence of complex atypical hyperplasia, cancer develops in more than 80% of patients. Diagnosis of such changes requires special monitoring by gynecologists and appropriate treatment.

Polyps endometrium are focal growths of the mucous membrane and are most often found among elderly women. Since neoplastic (tumor) transformation of cells with cancer growth is possible in a polyp, it must also be removed.

Cancer that occurs against the background of hyperestrogenism is referred to as the so-called first pathogenetic type and it accounts for about 75% of all malignant neoplasms of the uterine body. Such tumors grow slowly, have a high degree of differentiation and a fairly favorable prognosis.

Sometimes a tumor develops without a previous hormonal imbalance, with a “healthy” endometrium. The reason for this phenomenon is unclear, but scientists have speculated about the possible role of immune disorders. This type of cancer is classified as second pathogenetic type(about a quarter of cases of cancer of the uterine mucosa). It has a poor prognosis, grows rapidly and is represented by highly malignant, poorly differentiated forms.

Third pathogenetic type Malignant endometrial tumors have recently begun to be identified and their development is associated with hereditary predisposition. This variant is usually combined with malignant tumors of the colon.

The age range of tumor development is noteworthy. Since hormonal disorders accompanied by hyperestrogenism are most often observed during the period of extinction of the hormonal activity of the female body and the onset of menopause, it is not surprising that endometrial tumors are more common in mature and elderly women. In addition, the described underlying conditions and risk factors are also more often diagnosed in older patients. In this regard, even if 15-20 years have passed since the onset of menopause, one should not forget about the possibility of tumor development in long-nonfunctioning organs of the reproductive system.

There is an opinion that long-term use of hormonal drugs can lead to the development of a malignant tumor of the uterine cavity mucosa. As a rule, this effect is achieved by medications with a high dosage of the estrogen component. Since modern hormone therapy drugs contain fairly low concentrations of estrogen and progesterone, the likelihood of tumor growth with their use is minimal, but women taking them still need to be examined regularly.

Features of classification and staging of uterine cancer

There are several classifications of endometrial cancer, but in practical oncology the most applicable:

1. According to the TNM system developed by the International Union Against Cancer;
2. Staging proposed by the International Federation of Obstetricians and Gynecologists (FIGO).

TNM system implies a comprehensive assessment of not only the tumor itself (T), but also the lymph nodes (N), and also indicates the presence or absence of distant metastases (M). Simplified, it can be represented as follows:

• T0 – the tumor was completely removed during curettage and is not detectable;
• T1 – tumor within the body of the uterus;
• T2 – the tumor grows into the cervix;
• T3 – periuterine tissue and the lower third of the vagina are affected;
• T4 – cancer extends beyond the pelvis, grows into the bladder and rectum.

The nature of the lesion of the lymph nodes is described as N0 - no lesion was detected, N1 - metastases are detected by lymphography, N2 - lymph nodes are enlarged and palpable.

The presence or absence of distant metastases is designated as M1 or M0, respectively.

In addition, a special index G has been introduced, denoting degree of cancer differentiation:

• G1 denotes well-differentiated tumors;
• G2 – cancers of moderate differentiation;
• G3 – poorly and undifferentiated tumors.

The G index is extremely important in assessing the prognosis of the disease. The higher the degree of differentiation, the better the prognosis and effectiveness of the therapy. Poorly and undifferentiated tumors, on the contrary, grow quickly, rapidly metastasize and have an unfavorable prognosis.

In addition to TNM, another classification is used that distinguishes Stages of development of uterine cancer:

• stage I (A-C) – when the tumor grows within the body of the uterus;

• stage II (A-B) – the tumor reaches the cervix, grows into its mucosa and stroma;

• Stage III (A-C) characterizes a neoplasm growing within the small pelvis; the peritoneum covering the outside of the uterus and the ovaries with fallopian tubes may be affected, but the bladder and rectum remain not involved in the pathological process;

• Stage IV (A-B), when the cancer reaches the walls of the pelvis and spreads to the wall of the bladder and rectum. During this period, distant metastases in other organs and lymph nodes can be detected.

Of no small importance is the histological type of structure of cancer of the uterine mucosa. Since the endometrium is glandular tissue, the so-called adenocarcinoma(glandular cancer), occurring in almost 90% of cases, mainly among patients over 50 years of age. In addition to adenocarcinoma, squamous cell, glandular squamous cell carcinoma, undifferentiated and other variants are possible, which are much less common.

The stage of the disease is determined after surgical treatment and pathohistological examination of the removed tumor, lymph nodes, fiber and other tissues. This allows you to most accurately determine the extent of organ damage, as well as establish the histological structure of the tumor itself and the degree of its differentiation. Taking these data into account, a treatment regimen is drawn up and a further prognosis is determined.

Metastasis of endometrial cancer

Metastasis is the process of cancer spreading through the blood, lymph, and serous membranes. This happens because tumor cells, due to their altered structure, lose strong intercellular connections and easily break away from each other.

Lymphogenic metastasis characterized by the spread of cancer cells with lymph flow from nearby and distant lymph nodes - inguinal, iliac, pelvic. This is accompanied by the appearance of new foci of tumor growth and an increase in the affected lymph nodes.

Hematogenous route is realized by spreading tumor emboli (clumps of cells circulating in the bloodstream) through vessels to other internal organs - lungs, bones, liver.

Implantation path metastasis consists in the spread of the tumor throughout the peritoneum when it grows into the wall of the uterus, periuterine tissue, and it is also possible to involve the appendages in this way.

The intensity of metastasis is determined by the size and growth pattern of the neoplasm, as well as the degree of its differentiation. The lower it is, the earlier and faster metastases will develop, not limited to regional lymph nodes.

How to suspect cancer?

The main signs characterizing the possible growth of a tumor in the uterine cavity are pain, dysfunction of the pelvic organs and the appearance of discharge from the genital tract, which are:

• Bloody;
• Purulent;
• Profuse leucorrhoea;
• Watery.

Uterine bleeding occurs in more than 90% of endometrial cancer cases. In women of reproductive age, these are acyclic bleeding not associated with menstruation, which can be quite long and heavy. Since this symptom is also characteristic of many other diseases and changes in the uterine mucosa, significant difficulties may arise in the timely diagnosis of cancer. This is partly due to the lack of oncological vigilance among gynecologists in relation to women who have not entered menopause. In an attempt to find other causes of bleeding, time may be lost, and the cancer will progress to an advanced stage of destruction.

In elderly patients during menopause, uterine bleeding is considered a classic symptom indicating the growth of a malignant neoplasm, so the diagnosis is usually made in the early stages of the disease.

Purulent discharge characteristic of large tumors, they appear during their disintegration (necrosis) or the addition of bacterial flora. This condition, when purulent discharge accumulates in the lumen of the uterus, is called pyometra. It is also not surprising that there is an increase in temperature, general weakness, chills and other signs of intoxication and inflammation.

Profuse leucorrhoea are characteristic of large neoplasms, and watery discharge is a rather specific sign of the growth of endometrial cancer.

Pain syndrome, which accompanies endometrial tumors, is characteristic of late stages of the disease, with a significant size of the tumor, growing into the walls of the pelvis, bladder or rectum. There may be persistent, quite intense, or cramping pain in the lower abdomen, sacrum and lower back, as well as disturbances in the process of emptying the bladder and intestines.

Lack of awareness among women about uterine cancer, lack of alertness among doctors regarding cancer, ignoring regular visits to the doctor or postponing them even when any symptoms appear, lead to loss of time and progression of the disease, which is detected in an advanced form. In such a situation, treatment is not always effective, and the risk of death from endometrial cancer increases.

Important to remember: self-healing in the presence of cancer is impossible, therefore only timely qualified assistance when the first symptoms of endometrial cancer appear is the key to a successful fight against it.

How to detect cancer?

If suspicious symptoms or complaints appear, a woman should first go to the antenatal clinic. The main diagnostic measures at the initial stage will be:

• Gynecological examination in mirrors;
• Aspiration biopsy or separate diagnostic curettage of the uterine cavity and cervical canal;
• Ultrasound of the pelvic organs;
• Chest X-ray;
• General blood test, urine test, hemostasis study (coagulogram).

These simple and accessible manipulations make it possible to exclude or confirm the growth of a tumor, determine its size, location, type, and the nature of damage to neighboring organs.

At examination in mirrors The gynecologist will make sure that there is no damage to the vagina and cervix, palpate and determine the size of the uterine body, the condition of the appendages, and the location of the pathological focus.

At aspiration biopsy or curettage, it becomes possible to take tissue fragments with subsequent cytological or histological examination of the tumor. In this case, the type of cancer and the degree of its differentiation are determined.

Ultrasound can be used as a screening for uterine tumors in women of all age categories. The method is accessible for research by a wide range of people, provides a large amount of information, and is also simple and inexpensive to implement. During the study, the dimensions, contours of the uterus, and the condition of the cavity are clarified (the width of the so-called median M-echo is assessed). On ultrasound, an important criterion for cancer will be the expansion of the median M-echo, changes in the contours of the endometrium, and echogenicity.

To clarify data on tumor growth and the condition of other pelvic organs, it is possible to conduct CT and MRI. These procedures also make it possible to study the pelvic lymph nodes and identify metastases.

Rice. 1 - ultrasound examination, Fig. 2 - hysteroscopy, Fig. 3 - MRI

Hysteroscopy is a mandatory study if endometrial cancer is suspected. Its essence lies in the use of a special device - a hysteroscope, inserted into the uterine cavity and allowing one to examine its inner surface with magnification. Also, during the procedure, a targeted biopsy is necessarily taken from the affected area. The information content of the method reaches 100%. Hysteroscopy ends with separate curettage of the cervical canal and the uterine cavity, which makes it possible to evaluate the changes separately and correctly determine the location of tumor growth.

A new method for diagnosing endometrial cancer can be considered fluorescence study, which is accompanied by the introduction of special substances that accumulate in the tumor (photosensitizers) with subsequent registration of their accumulation. This method makes it possible to detect even microscopic foci of tumor growth that are inaccessible to detection using other methods.

The final and decisive stage of diagnosis for cancer of the uterine mucosa will be a histological examination of tissue fragments obtained by curettage or hysteroscopy. In this case, it becomes possible to determine the type of histological structure of the tumor, the degree of its differentiation, and in some cases, the presence of tumor ingrowth into the muscular layer of the uterus and blood vessels.

The diagnosis is made after a comprehensive and comprehensive examination of the patient using all the required laboratory and instrumental techniques. Final staging is possible only after surgical treatment with the most accurate assessment of the nature of tissue changes.

From timely diagnosis to successful treatment

The main directions of treatment for uterine tumors are surgical removal of the affected organ, radiation therapy and the use of chemotherapy.

Surgery consists of complete removal of the uterus (extirpation) with the ovaries, tubes and pelvic lymph nodes. If the operation is difficult or contraindicated, then it is permissible to use modern laparoscopic techniques, in particular hysteroresectoscopic ablation of the endometrium. The essence of the method is the destruction (removal) of the mucous membrane and several millimeters of the underlying muscle layer (myometrium). Such manipulation is possible in women with early forms of cancer in the presence of severe concomitant pathology that does not allow extirpation or long-term hormonal therapy.

During the operation, the ovaries are necessarily removed, regardless of the patient’s age, since they produce female sex hormones, and also often and early become the site of growth of metastases. After surgery, young women develop the so-called post-castration syndrome due to hormone deficiency, but its manifestations disappear after 1-2 months.

It is worth pointing out that more than 10% of patients are elderly and have severe concomitant lesions from the cardiovascular, endocrine system (arterial hypertension, diabetes, obesity, etc.), liver or kidneys. In some cases, these disorders also require correction, since the patient may simply not be able to tolerate surgery or chemotherapy.

If surgical treatment is necessary, for example, for a cardiovascular disease with the subsequent prescription of anticoagulants, then there is a risk of developing massive and dangerous bleeding from the tumor. At the same time, surgery to remove the tumor can lead to the patient’s death from heart complications. In such situations, so-called simultaneous operations are performed: a team of cardiac surgeons operates on the heart simultaneously with a team of oncologists who remove a tumor of the uterine body. This approach allows you to avoid many dangerous complications, and also makes it possible to carry out adequate and complete surgical treatment.

Radiation therapy

For uterine cancer irradiation may be one of the components of combination treatment. As a rule, external beam radiation therapy is performed on the pelvic organs or a combined effect. Indications for this method of treatment are determined individually depending on the woman’s age, concomitant diseases, growth pattern and degree of cancer differentiation. For poorly differentiated tumors that grow deep into the endometrium and cervix, combined radiation exposure (external and intracavitary) is indicated.

Since the use of modern equipment makes it possible to reduce the possibility of side effects to some extent, radiation reactions are still inevitable. More often than others, the bladder, rectum, and vagina are affected, which is manifested by diarrhea, frequent and painful urination, and discomfort in the pelvis. If such symptoms appear, you must inform your oncologist.

Chemotherapy not used as a stand-alone method for the treatment of endometrial cancer, but is acceptable as part of combination therapy. The range of drugs effective against such tumors is very limited, and the most commonly used regimen is CAP (cyclophosphamide, doxorubicin and cisplatin). The drugs used in chemotherapy are toxic and have a cytostatic effect (suppress cell reproduction), which is not limited to tumor tissue, so side effects such as nausea, vomiting, and hair loss are possible. These manifestations disappear some time after discontinuation of cytostatics.

An important approach in the treatment of uterine cancer is hormone therapy, which can be an independent stage in young patients in the initial stages of the disease. It is possible to prescribe antiestrogens, gestagens or their combinations. Treatment with hormonal drugs is well tolerated by patients and does not produce significant adverse reactions.

After the first stage, which lasts about a year, the doctor must make sure that there is no tumor growth (morphological examination of the endometrium and hysteroscopy). If all is well, then you can begin to restore ovarian function and a normal ovulatory menstrual cycle. For this purpose, combined estrogen-gestagen drugs are prescribed.

Prognosis and prevention

The main indicators influencing the prognosis of endometrial cancer are the degree of differentiation (from the result of histological postoperative examination) and the extent of the tumor in surrounding tissues and organs. Usually, in the initial forms of the disease, the tumor is completely cured. Successful treatment is facilitated by early detection of the tumor.

Severe concomitant diseases and advanced age of patients not only greatly worsen the prognosis, but also limit the choice of methods for comprehensive comprehensive treatment.

With the third stage of endometrial cancer, about a third of patients survive, with the fourth - only about 5%, so it is very important to diagnose the tumor in time and not waste time.

All women treated for endometrial cancer are subject to constant dynamic monitoring by gynecological oncologists. In the first year, to prevent the possibility of relapse, it is necessary to examine the patient every four months, in the second year - once every 6 months, then - once every year. Not only a gynecological examination, ultrasound, but also an X-ray of the lungs are required to exclude the appearance of tumor metastases.

Prevention of uterine cancer is extremely important and should be aimed at maintaining normal hormonal levels and the ovulatory menstrual cycle, normalization of body weight, timely detection and treatment of background and precancerous changes in the uterine mucosa. An annual visit to the antenatal clinic, examination and ultrasound of the pelvic organs is mandatory. If any symptoms appear, you should consult a doctor as soon as possible. Any disease, including uterine cancer, is easier to prevent than to treat.

Video: uterine cancer in the “Live Healthy” program

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.

The cervix is ​​one of the most vulnerable places in the female reproductive system. A large percentage of patients suffer from cancer of this organ. What symptoms indicate this disease? Let's try to figure it out.

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The main signs of pathology

Not every woman knows how to identify cervical cancer, since its early manifestations are not specific.

Having discovered a light white discharge, not everyone will immediately go for a smear to examine the biomaterial. And not everyone undergoes preventive gynecological examinations.

However, it is the identification of the initial manifestations of the described pathology that is the basis for the formation of a therapeutic model of cancer.

Moreover, it is better to identify this disease in the early stages of development, since irreversible changes in the female reproductive system then begin to occur.

The symptoms and signs of the described disease are as follows:

1. Development of inflammation. Symptoms of cancer at the stage of its development are reduced to the appearance in the body various inflammatory diseases. The malignant nature of the tumor serves as a starting point for the development of colpitis or cervicitis. The above diseases have their own symptomatic picture, from which they can be identified.
2. Bloody discharge of vaginal origin. Bloody discharge from cervical cancer has brown or pinkish inclusions. They can be seen with the naked eye on light-colored underwear even during the absence of menstruation. Against this background, characteristic bleeding may develop, even when the fair sex has already passed menopause.
3. Growth in size of lymph nodes. The second oncological stage is characterized by spread to the structure of the nearest lymph nodes. This leads to pain in these organs.
4. Bleeding after sexual intercourse. The appearance of slight bleeding after sexual intercourse signals cancer in the female genital organs. The reason for this is the bleeding of the tumor due to mechanical damage to the penis.
5. Watery nature of the discharge. The disease is characterized by the disintegration of lymphocapillaries located in close proximity to the epithelial layer. This leads to the formation copious watery discharge. Such symptoms of cervical cancer at the stages of its manifestation serve as a signal for an urgent visit to the gynecologist.
6. Pain during sexual intercourse. Oncological damage to the uterine cervix leads to painful manifestations during sexual intercourse.
7. Purulent discharge. An increase in the size of the tumor leads to the decomposition of its tissue structures, against which purulent discharge appears with a strong unpleasant odor. At different stages of pathology development, this practically does not happen.
8. Changes in menstruation. For cancer in the female reproductive system become painful and long lasting. The disease causes large volumes of blood to be released from the body. These symptoms serve as a signal to immediately contact a gynecologist.

Important! Any suspicion of cancer in the cervix is ​​a reason to visit a gynecologist. You should not turn a blind eye to the changes occurring in the body, since early diagnosis gives a better chance of successful treatment.

Manifestation of late stages of the disease

The lack of proper treatment for the symptoms of oncology described above in the female reproductive system leads to the appearance of new signs. The reason for this is the growth of the primary size of the tumor followed by its growth into neighboring structures. Also at this stage, the active spread of metastases begins.

What does advanced cervical cancer look like?

1. The appearance of constipation. With the described illness, women experience constipation, accompanied by intestinal atony. Often, feces contain bloody spots or streaks of red color. Against this background, fistulas may appear.
2. Painful sensations. The cervix is ​​characterized by a lack of sensory receptors, against the background of which early manifestations of cancer are not painful. The feeling of pain in a woman’s genital area occurs only when the disease progresses to late stages associated with tumor growth. In such a situation, the area of ​​parametric fiber is affected, spreading to the nerve plexuses in the sacrum. Painful manifestations can be observed in the femoral region, perineum, rectum, lumbar area.
3. Problematic bowel movement. The final stages of cervical cancer are accompanied by the growth of the primary tumor into the rectal cavity. Against this background, problems arise at the time of defecation.
4. Swelling in the legs. Compression of the lymph nodes leads to swelling on the lower legs. The described symptom appears extremely rarely, so many do not attach the necessary importance to it. Treating cervical cancer with such symptoms is also problematic.
5. Urinary dysfunction. Some stages of cervical cancer are accompanied by problems with normal urination. The reason for this is cancer of the ureters and bladder. The final stages of oncology are accompanied by complete absence of urination. In addition to the absence, increased urination is also possible. This symptom occurs due to the attachment of the inflammatory process to the kidneys. Against this background, it is possible to detect bloody inclusions in the urine and pain at the time of emptying the bladder.

What does cervical cancer look like based on its general characteristics? Against the background of these symptoms, loss of appetite and significant weight loss are possible. Exhaustion of the body is accompanied by a feeling of general weakness and the development of asthenia. The causes of cervical cancer according to the listed symptoms are associated with intoxication of the body with compounds that are formed as a result of the decomposition of cancerous tumors.

In the early stages, symptoms of cervical cancer may be accompanied by:

• growth in the size of the liver;
• pain in the abdominal cavity;
• the appearance of a cough.

Advice! The appearance of any vaginal discharge should alert you. To prevent the pathology from reaching its final stages, you should visit a gynecologist at least once a year.

Speed ​​of spread of the disease

How quickly cervical cancer develops depends on many parameters, including the type of its nature. Against this background, the following types of pathology are distinguished:

• endophytic;
• xophytic.

Special diagnostics help identify a tumor inside the uterine cavity.

The xophytic type is characterized by mass distribution, since its signs appear already in the first stages occurrence of the disease.

How quickly this type of cervical cancer develops is indicated by the severity of its symptoms. The disease indicates the appearance of growths with compactions on the surface layer of the organ.

The rapid growth of a cancerous tumor is characterized by spreading beyond the boundaries of the affected organ. How long women live depends on the individual characteristics of the body and the properties of the immune system. Hematogenous and lymphogenous methods of spread of pathology lead to the appearance of cancer cells in many healthy organs:

• lung cavity;
• liver.

Treatment of cervical cancer with the described manifestations is almost impossible, since in most cases it ends in death. Much it is easier to prevent the development of the disease than to then wage a long struggle with her, which most often ends not in favor of the fair sex.

What causes the disease

Cervical cancer, the symptoms and signs of which we discussed earlier, occurs in the female body under the following circumstances:

• long period of tobacco smoking;
• weak expression of immune properties;
• a large number of births or abortions;
• diseases of a sexual nature;
• early period of girls' initiation into sexual intercourse;
• sexual intimacy with a large number of partners.

With strong immunity, the activity of this pathogenic agent fades, otherwise the specified disease begins to arise.

In addition to the viral papilloma itself, oncology can be caused by its subtypes, which have the eleventh and sixth numbers.

When diagnosed with stage 1 cervical cancer, how long it progresses depends on the individual characteristics of the human body.

Not long ago, oncogenic subtypes of papilloma were identified. Their very penetration into the female body leads to the appearance of tumor markers. The latter are signs of the onset of the disease. Is there a cure for cervical cancer?

Forecasts

How long do people live with stage 1 cervical cancer? We can safely answer that it’s not that long. However, this stage of the disease is the longest in terms of the vital activity of the body. Accurate diagnosis using various techniques allows you to determine the current stage of cancer.

Treatment consists of the following types of therapies:

• surgical;
• radial

Attention! The operation is not only removal of the affected area, but also by eliminating neighboring areas to which cancer cells could spread. In addition, radiation therapy is used, as it helps stop the development of metastases.

Video: Cervical cancer - symptoms and treatment

Oncology in the female reproductive system is very dangerous, as it often leads to death. To avoid this, it is necessary to visit a gynecologist in a timely manner, and send all suspicious vaginal discharge for laboratory testing.

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Cancer of the female reproductive system is far from a common malignant disease in modern oncology. In first place is noted, in second place - ovarian tumor and in third place - malignant neoplasm of the uterine body.

The causes of the occurrence and spread of cancer in the internal genital organs of women are varied, but rather they can be called predisposing factors. More often, postmenopausal women suffer from cancer of the ovaries, cervix and uterine body, but the manifestation of this pathology is also observed in the reproductive age of the fair sex.

Etiology and risk factors for cancer of the internal female genitalia

Cancer of the uterine body is especially evident in postmenopausal women, that is, during the period when hypothalamic dysfunction is determined and ovarian function completely fades. Postmenopause occurs between sixty and seventy years of a woman’s life, and menstruation does not occur for more than a year. If symptoms of bloody discharge from the genital tract appear during the postmenopausal period, then such a woman is in a background condition with suspected uterine cancer.

The main precancerous conditions of the uterine body, which can be more or less pronounced, are:

1. Focal endometrial adenomatosis;
2. Adenomatous polyp of the inner layer of the uterus;
3. Atypical endometrial hyperplasia.

Symptoms of precancer, both in postmenopausal and reproductive women, are bleeding from the vagina, which can occur without cyclicity.

The occurrence of cancer of the uterine body is often observed in the area of ​​its corners and bottom. The endometrium in these sections degenerates into the form of a polyp. This type of uterine tumor is called limited. If the entire endometrial layer is affected by a malignant process, they speak of a diffuse form of uterine cancer. The proliferation of the neoplasm occurs from the cells of the glandular epithelium of the surface layer of the endometrium. Based on the histological structure of atypical cells, three degrees of uterine cancer are determined:

1. Glandular cancer of mature stage;
2. Glandular - solid tumor;
3. Poorly differentiated cancer (solid).

Clinical signs of uterine cancer

The specific symptoms of cancer of the uterus and ovaries are poorly expressed, therefore, women may not contact a gynecologist for years, which leads to the neglect of the malignant process. According to patient reviews, an early symptom of uterine and ovarian cancer is liquid, whitish discharge from the genital tract. When a tumor develops, bloody streaks are added to the leucorrhea, and if an infection joins the process, the discharge becomes yellow or green with an unpleasant odor and causes itching in the perineum and labia majora.

In almost all patients with uterine cancer, the main symptom is uterine bleeding. If a woman is of childbearing age, this may manifest itself in the form of prolonged uterine bleeding (metrorrhagia). During menopause, bleeding occurs as a spot with an acyclic course. In postmenopause, the discharge takes on the color of meat slop with a putrid odor.

The symptom of pain is not present in all cancer patients with uterine and ovarian cancer. With infiltrative tumor growth, the affected endometrium fills the uterine cavity, and it begins to contract. This process is accompanied by a symptom of cramping pain in the lower abdomen, which radiates to the sacrum and perineum. Pain relief occurs after the uterus has emptied. Dull and constant pain in the lower abdomen appears when a tumor or metastatic lymph nodes compresses the nerve trunks, as well as when tumors grow in the walls of the uterus.

As a rule, with cancer in the uterus, the tubes and ovaries are affected, which greatly increase in size. Metastases when a tumor infiltrates into the uterus spread by implantation, through the blood and lymphatic channels. In invasive mature uterine cancer, metastases often progress through the lymphogenous route. When the tumor is localized in the lower segment of the uterine organ, metastatic lymph nodes in the iliac region are noted, and metastasis of the para-aortic nodes of the lymphatic system is observed in cancer of the upper parts of the uterus. Through the bloodstream, metastases can be directed to bone, lung and liver tissue.

Since female genitalia are considered visual organs, diagnosing possible pathologies does not present any particular difficulties. A gynecological examination of the genital organs consists of examination, palpation of the reproductive organs, as well as the use of hardware and surgical examination. Diagnosis of the inner layer of the uterus can be carried out using hysterography, ultrasound and curettage of the uterine cavity followed by cytology. If we consider the morphological structure of the endometrium with a uterine tumor at different phases of the menstrual cycle, we can note the following changes:

In the first phase, a thin and smooth endometrium, without visible blood vessels, is determined;

In the second phase, the inner layer of the uterus becomes red, swollen and thickened with folds (endometrial hyperplasia).

Histological examination of the contents of the uterine cavity during curettage or after a biopsy of an area of ​​the endometrium or a polyp, for example, in 90% of cases determines the cause of the pathological symptoms that have arisen.

Uterine organ testing involves inserting a hardware instrument into the uterus, which performs the role of diagnostics and biopsy of the internal cavity of the organ.

When malignant cells are detected in a histological analysis, the woman’s diagnosis is supplemented with an X-ray of the lungs and an ultrasound examination of the liver to monitor metastases of uterine cancer.

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Stages of development and treatment of endometrial tumor

A malignant tumor of the uterus is classified according to its shape, invasion and metastasis. There are international systems for determining the stage of endometrial carcinoma:

• Stage 1 - pronounced solid cancer or poorly differentiated carcinoma, limited to the endometrium or involving half of the myometrial layer, uterine enlargement of more than eight centimeters;
• Stage 2 – damage to the body and cervix with invasion of the endocervical glands and cervical stroma;
• Stage 3 - the malignant process is transferred to the tubes and ovaries, to the parametric tissue of the pelvis. Determination of metastases in the para-aortic nodes of the lymphatic system and in the vagina;
• Stage 4 – tumor growth into nearby organs and tissues: intestines, bladder, and also outside the pelvis. The presence of affected lymph nodes in the groin and peritoneum.

The treatment tactics for endometrial carcinoma depend on the patient’s age, the stage of the pathology, and the body’s sensitivity to therapy.

In most cases, treatment of uterine cancer is carried out surgically and with a combination of therapy. Radical intervention is expressed by complete amputation of the reproductive organ. According to diagnostic and prognostic data, the appropriate methods of tumor removal are selected:

• Removal of the uterine organ without a neck (subtotal amputation);
• Removal of the uterus and cervix (total amputation);
• Amputation of the uterus along with tubes and ovaries (radical extirpation);
• Removal of the uterus along with the tubes, ovaries, lymph nodes and upper part of the vagina (hysterosalpingo-oophorectomy).

Radiation therapy is almost always used after surgery, and sometimes radiation is started before surgery to stop and reduce the proliferation of cancer cells. Radiation treatment is also used intracavitarily to monitor the spread of cancer from the uterus to the cervix. If there are contraindications and the tumor is inoperable, irradiation is carried out as an independent treatment.

Exposure to rays is improved by hormonal drugs, namely progestins, which are taken in long-term regimens.

Rehabilitation measures for uterine cancer are carried out in stages. First, the woman is checked for the presence of complex endocrine, nervous and other pathologies that can serve as both an obstacle to the treatment process and a complication in the postoperative period. Therefore, such conditions of the body need to be monitored in postoperative life. Depending on the stage and histological structure of uterine carcinoma, after treatment, the further prognosis for the life and professional activities of the woman is determined, who must be registered at the oncology center, with a check every six months.

Preventive measures for the occurrence of a malignant process in the reproductive organs should be aimed at maintaining a healthy lifestyle, especially for postmenopausal women with annual preventive medical examinations and timely contact with specialists in the event of pathological conditions. Modern diagnostics make it possible to quickly and informatively identify possible pathologies, the main thing is to do this on time.

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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 likelihood 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?

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 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:

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. 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 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 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.

Uterine cancer is a malignant neoplasm of endometrial cells, i.e., the tissues lining the organ. It is considered one of the most common forms of oncology. It is more often diagnosed in women over 60 years of age, and occurs in isolated cases at a young age.

It is considered the main cause of carcinogenesis. Predisposing factors include high body weight, body irradiation, hypertension and ovarian pathologies.

Cancer of the uterine body has specific clinical manifestations, including uterine bleeding, which has nothing to do with menstruation, pronounced bleeding and discharge of leucorrhoea.

There are no problems establishing the correct diagnosis due to the characteristic symptoms of uterine cancer and the results of instrumental examinations. Not the last place in diagnosis is occupied by gynecological examination and laboratory tests.

Treatment is based on surgery, but must have a comprehensive approach. Additional therapeutic measures include chemotherapy and hormone replacement treatment.

According to the International Classification of Diseases, Tenth Revision, the disease has an individual code: the ICD-10 code will be C54.

Etiology

To date, the pathogenesis of cancer of the reproductive system remains unknown, however, experts in the field of gynecology and oncology believe that the most common cause of cancer development is hormonal imbalance.

Cancer of the uterine body can occur under the influence of such unfavorable factors:

• late attack;
• leakage;
• immunodeficiency states, in particular and;
• malignant;
• early onset of first menstruation;
• promiscuous sex life;
• or other endocrinological pathologies;
• long-term use of hormonal substances;
• excessively high body weight;
• infertility;
• complete lack of sexual activity;
• period of bearing the first child;
• early labor;
• repeated termination of pregnancy;
• the woman has a precancerous condition - endometrial hyperplasia or uterine polyps;
• long-term irradiation of the pelvic organs.

The main risk group is women over 60 years of age and with a family history. This means that one of the close relatives must be diagnosed with cancer in the following organs:

• ovaries;
• mammary gland;
• colon;
• Cervix.

Classification

Clinicians identify two common types of cancer of the uterus:

1. Hormone dependent. It is diagnosed in approximately 70% of situations and develops against the background of active stimulation of cavity tissues by female hormones (estrogens).
2. Autonomous cancer of the uterine body. Accounts for less than 30% of cases. A distinctive feature is that the tumor is found in elderly women who do not suffer from metabolic disorders, but have a history of uterine bleeding in the postmenopausal period and low body weight.

As the pathology progresses, it goes through several stages of development:

• functional disorders;
• morphological background changes;
• morphological precancerous transformations;
• malignant neoplasia.

Metastasis occurs in several ways:

• lymphogenous - para-aortic, inguinal and iliac lymph nodes are at risk;
• hematogenous - cancer cells are found in the lungs, liver and skeletal system;
• implantation - is realized when the tumor grows into the myometrium and perimeter or as a result of involvement of the greater omentum and visceral peritoneum in the pathoprocess.

The main classification is represented by the existence of several degrees of severity of the oncological process:

• 0 degree uterine cancer - considered a precancerous condition;
• 1st degree uterine cancer - the neoplasm does not spread beyond the organ, but grows into the endometrium; signs may be completely absent or resemble other gynecological disorders;
• uterine cancer stage 2 - the cancer process involves the cervix, endocervix and cervical stroma;
• uterine cancer stage 3 - characterized by the presence of local and regional metastases (the ovary, serous membrane, vagina and lymph nodes undergo metastasis);
• Stage 4 uterine cancer - damage to the large intestine, bladder, distant internal organs and lymph nodes is observed.

How long patients live after complex therapy depends on the stage at which the tumor is diagnosed.

Cancer can differ in microscopic structure, against which the tumor can be of the following types:

• clear cell carcinoma;
• squamous cell carcinoma;
• glandular squamous cell carcinoma;
• serous cancer;
• mucinous cancer.

The oncological process happens:

• highly differentiated;
• moderately differentiated;
• poorly differentiated;
• undifferentiated.

Morphological types largely determine the degree of malignancy and prognosis. For example, undifferentiated cancer has the most unfavorable course, while squamous cell tumors are easy to treat and have a high probability of recovery.

Cancer growth in the uterus has several growth options:

• exophytic - germination into the lumen of the organ;
• endophytic - the tumor grows into the thickness of the muscle wall;
• mixed.

Symptoms

Uterine cancer can be completely asymptomatic for a long time. The following are the first signs of uterine cancer in the early stages:

• heavy menstruation;
• mild pain in the lower abdomen;
• inability to conceive a child for a long time;
• menstrual irregularities - periods become irregular and acyclic.

During the postmenopausal period, symptoms of uterine cancer in women will be quite specific - scanty or heavy uterine bleeding.

Signs of late stage uterine cancer:

• increased pain in the lower part of the anterior wall of the abdominal cavity;
• spread of pain to the sacrum and lumbar region;
• copious discharge of leucorrhoea with a foul odor;
• intestinal disorder;
• the presence of pathological impurities in the stool - blood and mucus;
• frequent and painful urge to urinate;
• a sharp decrease in body weight, despite normal or increased appetite;
• an increase in the size of the abdomen due to the accumulation of a large amount of fluid in the abdominal cavity;
• attacks of nausea and vomiting;
• pain and discomfort during sexual intercourse.

When the lesion is complicated by the spread of metastases, the clinical picture will be supplemented by signs of damage to one or another internal organ. For example, if the skeletal system is involved in the oncological process, the symptoms of endometrial cancer of the uterus will be supplemented by frequent fractures.

Diagnostics

If symptoms of uterine cancer occur, it is necessary to seek qualified help from a gynecologist as soon as possible, who will prescribe instrumental and laboratory diagnostic measures. The doctor must carry out primary diagnostic procedures:

• studying the medical history of not only the patient, but also her close relatives - to search for a provocateur or confirm the influence of genetic predisposition;
• familiarization with life history - to identify a provocateur that has nothing to do with other diseases;
• manual and instrumental gynecological examination;
• deep palpation of the anterior wall of the abdominal cavity;
• a detailed survey - to identify the severity of symptoms, which will indicate the type and stage of cancer.

The most informative laboratory tests:

• blood chemistry;
• general analysis of urine and blood;
• samples to determine cancer markers;
• hormonal tests;
• microscopic examination of feces;
• vaginal smear culture.

The following instrumental procedures can accurately confirm the diagnosis of uterine cancer:

• hysteroscopy;
• X-ray of the sternum;
• Ultrasound of the pelvic organs and peritoneum;
• colonoscopy;
• cystoscopy;
• CT and MRI;
• excretory urography;
• diagnostic laparoscopy.

The first signs and symptoms of uterine cancer may resemble the development of other pathologies. During differential diagnosis, oncology must be distinguished from the following diseases:

Often women are interested in the question of whether uterine fibroids can develop into cancer. Myoma is usually not dangerous and does not become malignant. However, cancerous degeneration is possible under the influence of unfavorable factors - poor lifestyle, irregular sexual contacts and peritoneal injuries.

Treatment

The choice of treatment tactics is influenced by several factors:

• stage of the oncological process;
• the severity of symptoms and signs of uterine cancer;
• morphological structure of the pathological focus.

Treatment for uterine cancer will be complex:

• surgery;
• radiation therapy;
• oral administration of hormonal substances;
• chemotherapy.

If stage 1 uterine cancer is diagnosed, a procedure such as endometrial ablation is usually used. In other cases, the operation may have the following options:

• panhysterectomy;
• excision of the uterus followed by bilateral adnexectomy or lymphadenectomy;
• bougienage of the cervical canal.

Prevention and prognosis

To prevent women from developing cancer of the reproductive system, it is necessary to adhere to the following general preventive measures:

• complete renunciation of addictions;
• engaging in protected sex only;
• proper and balanced nutrition;
• competent use of medicinal substances;
• body weight indicators are within normal limits;
• prevention of body exposure;
• timely detection and treatment of gynecological and endocrine pathologies that can cause the development of oncology;
• visit a gynecologist at least 4 times a year - to detect the first signs of uterine cancer as early as possible.

Cancer of the uterine body has an ambiguous prognosis, which depends on the stage of progression of the tumor at which the diagnosis was made and treatment began. If stage 1 uterine cancer is diagnosed, the five-year survival rate is 98%, stage 2 is approximately 70%, stage 3 is on average 30%, and stage 4 is only 5%.

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