Uterine cancer first signs and symptoms. Diagnostic examination methods. Symptoms and signs of uterine cancer

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

Causes of uterine cancer

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

• In overweight women;
• In women with;
• In women with diabetes;
• In menopausal women taking;
• If started before age 12;
• If occurred at the age of over 55 years;
• If the woman has never been pregnant;
• In older women (than older woman, the higher the risk of developing uterine cancer);
• In women with;
• In women being treated for breast cancer and taking the medicine Tamoxifen;
• In women who have inherited a special gene that increases the risk of developing uterine and bowel cancer;
• In women who frequently drink alcoholic beverages.

Types of Uterine Cancer

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

• Endometrial cancer (adenocarcinoma)

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

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

This tumor is less common, occurring in approximately 15% of uterine cancer cases.

Symptoms and signs of uterine cancer

The main symptoms of uterine cancer are. Uterine bleeding due to uterine cancer may appear in different time cycle and, as a rule, are quite abundant.

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

Sometimes uterine cancer can manifest as scanty symptoms that do not stop for weeks.

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

• Pain in the lower abdomen
• with an unpleasant odor
• Losing weight for no apparent reason
• Increased fatigue, weakness

Diagnosis of uterine cancer

A gynecologist may notice signs of uterine cancer during a routine gynecological examination. Uterine cancer may be indicated by an increase in the size of the uterus and a change in its shape (deformation).

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

• Ultrasound of the uterus

• Hysteroscopy and endometrial biopsy

• Surgery for uterine cancer

Typically, in the early stages of uterine cancer, the first step is surgery to remove the uterus (hysterectomy). In order to reduce the risk of relapse (re-growth of the tumor), doctors, as a rule, remove not only the uterus, but also the uterine appendages (fallopian tubes and ovaries), as well as The lymph nodes that could be affected by the tumor. On our website there are separate articles devoted to this topic: and.

• Radiotherapy

Radiotherapy for uterine cancer can reduce the risk of relapse (re-growth of the tumor) after surgery, or can be prescribed as a self-treatment, and also in combination with chemotherapy.

• Hormone therapy

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

• Chemotherapy

Chemotherapy drugs prevent division cancer cells and tumor growth. These medications may be prescribed as tablets or IVs. Chemotherapy may use one drug or a combination of several drugs.

After treatment for uterine cancer

After completing treatment for endometrial cancer, a woman requires careful monitoring by her doctor. Regular examinations and examinations will allow you to detect recurrence of cancer in time if the disease returns. Discuss with your doctor how often you need to see each other.

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

After treatment for uterine cancer, more than late stages Medical examinations are required every 3 months during the first year, every 3-6 months during the second year and then once a year.

If uterine cancer cannot be cured

In some cases, even despite adequate and modern treatment, uterine cancer can never be cured. In this case, the woman is prescribed supportive treatment that helps cope with pain and prolong life for as long as possible.

In the early stages, signs of a tumor may be absent or appear in the form of subtle discomfort.

As the malignant process develops, the following symptoms are observed:

• abnormal bleeding from the vagina or mucous discharge streaked with blood;
• vaginal bleeding after sexual intercourse, douching and gynecological examinations;
• change in the duration of menstruation:
• pain in the lower abdomen, intensifying during sexual intercourse;
• weakness, fatigue;
• weight loss;
• long-term temperature not higher than 37.5 degrees (subfebrile temperature);
• anemia.

All signs are nonspecific and may indicate other gynecological diseases. The duration of symptoms is of decisive importance.

Vaginal discharge with cervical cancer is often irregular and may have nothing to do with menstrual bleeding(this is the first thing women should pay attention to).

Diagnosis of cervical cancer

Identification of the disease begins with a conversation between the doctor and the patient. The gynecologist conducts a detailed questioning about all the symptoms of the disease, studies the patient’s medical history (information about all diseases suffered in the past is important).

Then a manual gynecological examination is performed, a smear is taken for cytology and, if necessary, a colposcopy is performed. Sometimes it is possible to determine the type of tumor (endophytic, exophytic or combined).

Then more detailed diagnostic procedures are carried out:

• ultrasonography , allowing you to accurately determine the size of the tumor (in Lately Ultrasound tomography is also used to obtain a more visual image);
• histological examination : for this purpose a biopsy is performed or diagnostic curettage using an electrosurgical loop - scraping from the cervical canal and uterine walls;
• radiography to detect possible metastases in the lungs and other organs;
• CT scan, which also makes it possible to detect the spread of the malignant process along lymphatic system and detect changes in the liver and abdominal organs (if necessary, the study is carried out using contrast agents);
• blood analysis(general, biochemical, as well as tests for tumor markers);
• cytological examination(PAP test, also known as Papanicolaou test);
• lymphography(study of the lymphatic system);
• irriography (X-ray examination rectum to detect tumor spread).

PCR analysis is also used to detect the papilloma virus. PCR (polymerase chain reaction) allows not only to detect a virus, but also to determine its oncogenicity (activity and ability to provoke the development of malignant tumors).

Detection of the human papillomavirus (HPV) is not a direct indication of the presence of uterine cancer: it is only a basis for constant monitoring by a gynecologist and a more serious attitude towards your health. Women at risk should be tested at least once a year.

Video: All about uterine cancer

Treatment

Treatment for cervical cancer is carried out comprehensively.

Apply:

• surgery (hysterectomy: removal of the uterus, appendages, pelvic tissue with lymph nodes);
• radiation therapy- remote and intracavitary (carried out in combination with surgery or chemotherapy at stages 3-4 of the disease, when radical excision is ineffective);
• chemotherapy — drug treatment is carried out with cytostatics;
• immunotherapy(treatment with interferons that increase and modulate the body’s immunity).

Can cervical cancer be cured completely, that is, without subsequent relapses? The answer to this question depends on the stage at which doctors began treatment for the disease. If the tumor is detected at the initial stage, successful treatment and long-term remission are possible in almost 90%.

Nutrition (diet)

Modern medicine confirms the fact that combining basic treatment with diet therapy accelerates recovery even in the case of such a serious illness as cervical cancer.

The basis of dietary nutrition for uterine cancer should be vegetables, fruits and berries grown in environmentally friendly conditions. favorable conditions without the use of chemical additives. Research has shown that daily food consumption plant origin inhibits tumor growth. Preference should be given to fruits with bright colors and greenery: these products inhibit malignant processes.

In many regions, observe fruit diet in winter it is quite difficult: in this case it is necessary to increase the content in the diet fresh vegetables and berries - carrots, beets, turnips, cabbage, pumpkins, cranberries, lingonberries.

It is also useful to include in the diet:

• fermented milk products (cottage cheese, cheeses, yoghurts);
• cereal crops (especially valuable oatmeal, as well as sprouted wheat grains);
• garlic and horseradish;
• nuts of all kinds;
• legumes.

It is better to cook food by steaming or in the oven. Vegetables and fruits are best consumed raw. It is also useful to drink herbal decoctions from sage, yarrow, nettle, wormwood, plantain, St. John's wort. Herbal medicines have a depressing effect on cancer cells, increase the body's immunity, and also stop bleeding.

Some foods should be completely excluded from the menu:

• smoked meats;
• animal fats;
• fried foods;
• spicy seasonings;
• confectionery;
• cocoa and chocolate;
• strong tea and coffee;
• alcohol;
• semi-finished products;
• "fast food";
• carbonated drinks.

A special menu with an abundance of vitamins and useful substances, restoring strength, should be followed at the stage of recovery after surgery, radiation and drug therapy.

Example menu for uterine cancer:

Breakfast #1: fresh carrot juice.
Breakfast No. 2: buckwheat with whole grain bread, green tea.
Dinner: pearl barley soup with vegetables, stewed beets, baked fish, tea with milk.
Dinner: cottage cheese casserole, avocado and green vegetable salad, fresh fruit juice.
Before bedtime: kefir or fruit juice.

In addition to diet, proper organization of the daily routine contributes to recovery - good sleep, relaxation, being in the fresh air. It is advisable to spend the rehabilitation period in a specialized sanatorium-resort institution.

Forecast

Patients are certainly interested in the question: how long do people live with uterine cancer? Even the most qualified specialist. The survival prognosis is influenced by a large number of concomitant factors - the stage of the disease, the patient’s age, the state of the body, the state of the immune system.

At stage 1, competent surgical treatment in combination with subsequent radiation therapy ensures survival for 5 years in more than 85-90% of patients.

If the disease is detected at stage 2, the chances are reduced to 60%, since malignant processes can already begin to spread to surrounding healthy tissue. In this case, a correctly designed course of radiation and chemotherapy after surgical excision of the tumor is important.

The survival rate of patients with stage 3 cancer for 5 years is reduced to 35-40%, since the tumor metastasizes to nearby organs. Full recovery with a grade 3 tumor it is unlikely.

At stage 4, only 10% of patients overcome the five-year period - subject to constant palliative treatment. The probability of death is very high: stop the spread of cancer cells through blood vessels and vessels excretory system is not possible, and multiple metastases quickly lead to functional failure lungs, liver and other organs.

Fear of the unknown is something that can break any person. The format of this thesis also fits into a terrible diagnosis for women - uterine cancer. Treatment of a spiritually broken woman is difficult, often unsuccessful. That is why we decided to draw the attention of readers to this terrible disease and show that early stage uterine cancer is not a death sentence. Moreover, in many cases, modern medicine gives women a chance to find the happiness of motherhood, so it is important to know what the first signs and symptoms are characteristic of uterine cancer.

Organ structure

To make the process of pathology more understandable, let’s say a few words about the structure of the female reproductive organ. Visually, the uterus looks like an inverted pear (see photo). At the top there is a wide “pear-shaped” base - the fundus of the uterus, to the bottom (towards the vagina) there are:

• body;
• isthmus;
• Cervix.

The tissue that makes up the organ is formed by 3 layers:

• endometrium - a mucous layer facing inward (on top the endometrium is lined with epithelial cells);
• myometrium - muscle (middle) layer;
• perimetry - the outer shell.

Types of uterine cancer

Depending on the location of malignant neoplasms, they are distinguished:

• cancer of the uterus;

Cervical cancer (CC)

The main statistical data characteristic of the disease in our country are given in the table:

According to the activity of the pathology, they are distinguished:

• aggressive;
• low-aggressive - affects the epithelium lining the cervix, does not affect other tissues;
• microinvasive - differs from the previous type only in that individual tumor cells grow beyond the epithelium.

Cancer of the uterus

This disease is less common than cervical cancer. Due to the fact that the endometrium is affected by pathology, the disease is also called endometrial cancer.

Early stages of the disease

The early stages include the zero and first stages:

• 0 - preinvasive carcinoma (carcinoma in situ);
• I - tumor is limited to the body of the uterus;
• IA - limited to the endometrium;
• IB - extends to at least half the thickness of the myometrium.

Symptoms in the early stages

Initial symptoms and characteristic signs of uterine cancer in the early stages

The first signs and symptoms are mild:

1. Vaginal discomfort is noted.
2. Appear small discharge blood after sexual intercourse and heavy lifting.
3. There is copious mucous discharge.
4. Disruptions in the menstrual cycle are recorded.

Among women diagnosed with cancer, many pointed to the absence of the first signs of uterine cancer at early stage. It follows that the only way detect pathology in the initial stages - promptly undergo medical examinations y .

Diagnostics

The presence of atypical epithelial cells (dysplasia) in the cervix is ​​determined visually by the gynecologist and serves as the first sign of oncology.

To confirm or refute the suspected diagnosis, the doctor prescribes one or more studies indicated in the table.

Treatment of uterine cancer in the early stages

Depending on the degree of the disease, the following methods are used:

• laser surgery;
• cryosurgery;
• conization;
• trachelectomy.

Features of tumor treatment at stage 0:

In the first stage of oncology, surgical intervention is deeper. The doctor’s task at this stage is to make every effort to preserve the organ and carefully remove areas containing cancer cells.

If we're talking about O childbearing age, everything possible is being done to ensure that the woman does not lose her fertile function (she can subsequently conceive a child and give birth).

The main methods of treating stage 1 oncology:

In some cases, surgery is supported by immunotherapy. The doctor prescribes hormone therapy to the patient, including anti-estrogenic drugs, provided that the tumor has receptors for these hormones.

Under no circumstances wait until the first signs appear and initial symptoms uterine cancer. They simply may not exist. An annual examination by a gynecologist is a procedure that will protect you from a terrible diagnosis.

The causative agent of the disease is human papillomavirus with high oncogenicity: 16.18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, 82 serotypes. Of these, the first three are the most dangerous.

Therefore, do not allow promiscuity and use barrier products. Another factor influencing the occurrence of cancer pathology is bad habits. Avoid to minimize risk.

If you observe at least one of the above signs and symptoms of uterine cancer, consult your doctor immediately!

What puts you at higher risk

Let's look at the factors that contribute to the development of uterine cancer:

• Availability bad habits in women, in particular smoking and drug addiction;
• indiscriminate change of sexual partners (read about effective contraception here);
• early start sex life;
• hormonal disorders(consultation with an endocrinologist will help correct this);
• obesity;
• impossibility of conceiving/giving birth to a child due to various reasons up to 30 years;
• hypertension;
• ovarian pathologies (treated by a gynecologist);
• diabetes;
• abortions;
• acute diseases liver;
• weakening protective functions body.

In addition, it has been proven that unprotected sex with a man whose last sexual partner suffered from uterine oncology, can also cause the formation of uterine cancer.

Stages and lifespan

Doctors distinguish 4 stages of cancer pathology:

• 1 tbsp. - the tumor is localized in the body of the uterus, determined during the examination;
• 2 tbsp. - the lesion covers the cervix;
• 3 tbsp. - stage of metastasis in the vagina and damage to parametric structures;
• 4 tbsp. - metastases actively spread beyond the boundaries of the pelvis and into the abdominal cavity.

The life expectancy of patients, as well as the prognosis for recovery and preservation of life, depends on many related factors - general state women, age, period of oncology diagnosis.

The 5-year survival rates are shown in the table:

In the first 2 - 3 years after remission, relapses occur in more than 50% of cases, so patients must constantly undergo routine examinations see a gynecologist, and also follow preventive measures.

If correct treatment of uterine cancer is carried out at stages 1 - 2 and all medical recommendations are followed, patients who have undergone surgery can have every chance of a long and full life. Late detection of problems in most cases causes death within the first 10 years of life after surgery.

How quickly does the disease develop?

It is impossible to establish the exact period of progression of uterine cancer and the spread of cancer. It is known that the disease rapidly changes from one stage to another, so the pathology is usually diagnosed at stages 2, 3 or 4.
The development of the disease and its rapid course are influenced by:

• presence/absence of other chronic or acute diseases in the patient;
• state of the immune system;
• stability of blood circulation at the site of the cancer focus;
• type and location of pathological cells.

The timing of the formation and development of uterine cancer depends on the combination of these factors.
Scientists have found that on average, a cancerous tumor forms within two years. Further progression and growth of the formation depends on the degree of differentiation of the affected cells.
With a poorly differentiated type of cancer, the tumor consists of a large number of abnormal cells that spread quickly (from several months to 1 - 2 years); there is also a high risk of metastasis to nearby internal systems and blood flow.
With a highly differentiated type of pathology, healthy and affected tissues are almost identical, and the tumor can form within 2 to 5 years, the danger of spreading metastases is minimized. If a tumor is suspected, consultation with an oncologist is necessary.

The difference between pathology and fibroids

Myoma is benign tumor, this is its main difference from uterine cancer. But it is necessary to understand that the primary symptoms of these diseases are similar. In addition, if you do not consult a doctor in a timely manner and late detection of fibroids, it can develop into oncopathology (observed in 1.5 - 2% of all cases). More information about fibroids is described here.
Therefore, only a comprehensive examination of the patient, including:

• examination by a gynecologist;
• curettage of the uterus;
• Ultrasound and MRI pelvic organs.

Consequences

The neglect of the oncological process can significantly threaten the safety of life, and very often, in the absence of adequate treatment, death occurs.

In the early stages of uterine cancer, doctors try to preserve the female reproductive organs and fully restore their functioning. But after such operations, adhesions and various seals form on the walls of the vagina and uterus.
In more difficult situations women have their uterus, vagina and ovaries completely or partially removed, which in turn entails an irreversible loss of the possibility of childbearing, as well as changes in the patient’s hormonal levels. Therefore, to normalize further life activity, women after surgery are prescribed hormonal medications.

It should be noted that chemotherapy, which is always used in the treatment of uterine cancer, also negatively affects all internal systems of the body. It will take at least 3 years to restore the correct functioning of all affected functions.

And finally, if you suddenly heard from a doctor terrible diagnosis, do not forget: a disease diagnosed in the early stages is not a reason for despair. It can be successfully treated, and modern medicine gives the young woman every chance to become a happy mother in the future.

You can ask your gynecologist any questions you may have.

For more information about the causes and symptoms of uterine cancer, watch the video:

Still have questions?

Ask a question to a doctor and get an online consultation with an oncologist on the problem that concerns you, free or paid.

On our website AskDoctor, more than 2,000 experienced doctors work and are waiting for your questions, who daily help users solve their health problems. Be healthy!

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 the fate of postmenopausal women, average age patients are 55-60 years old, but it can also be detected in young girls of fertile age. Features of hormonal levels during the postmenopausal period contribute to various hyperplastic processes endometrium. Such changes in the uterine mucosa most often become the “soil” on which cancer grows.

Since the presence of a tumor is accompanied 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.

Knowing the basics anatomical structure 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, bordering on the front bladder, 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.

Body of the uterus ( upper section, directly involved in pregnancy) consists of three layers:

• Endometrium – inner layer, mucous membrane lining the surface of the uterus from the inside, exposed 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– middle, muscular layer, capable of increasing during pregnancy and extremely important in the implementation labor activity. 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 in menstrual phase cycle if pregnancy does not occur. 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. It leads to excessive growth(hyperplasia) of the endometrium, polyp formation. Diabetes accompanied by significant endocrine and metabolic changes, including those of 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 control from 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 hormonal activity 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 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. Because the modern drugs for hormone therapy contain quite low concentrations estrogen and progesterone, the likelihood of tumor growth with their use is minimal, but women taking them still need to be regularly examined.

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 International Federation obstetricians and gynecologists (FIGO).

TNM system implies comprehensive assessment 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 boundaries of the pelvis, grows into bladder, 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, possibly affecting the peritoneum covering the outside of the uterus, the ovaries with fallopian tubes, however, 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 route 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 it is acyclic bleeding, not related to 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 older menopausal patients, uterine bleeding is considered a classic symptom indicating growth. malignant neoplasm Therefore, the diagnosis is made, as a rule, 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 characteristic of large neoplasms, and watery discharge- enough specific sign 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 all women age categories. The method is available for research wide range persons, 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 important criterion cancer there will be an expansion of the median M-echo, a change in the contours of the endometrium, 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 during 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 is complete removal uterus (extirpation) with 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, which does not allow extirpation or long-term hormone 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 in women young The so-called post-castration syndrome develops 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 associated 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 avoids many dangerous complications, and also makes it possible to conduct adequate and complete surgical treatment.

Radiation therapy

For uterine cancer irradiation may be one of the components 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 allows to reduce the possibility of side effects to some extent, nevertheless radiation reactions inevitable. More often than others, the bladder, rectum, and vagina are affected, which is manifested by diarrhea, frequent and painful urination, discomfort in the pelvis. If such symptoms appear, you must inform your oncologist.

Chemotherapy not used as independent 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 cytostatic effect(suppress cell proliferation), 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 with initial stages diseases. 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.

Heavy accompanying illnesses and the 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. Annual visit required antenatal clinic, examination and ultrasound of the pelvic organs. 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 in this moment, unfortunately, they do not turn out to be.