Initial stage of uterine cancer symptoms. What is hysterectomy surgery and how does it differ from hysterectomy? Manifestations in postmenopause

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Uterine cancer is one of the most common cancers. According to various data, in terms of prevalence it is in second place after a malignant tumor localized in the mammary gland.

Uterine cancer most often affects older patients. However, like other oncological pathologies, uterine cancer is rapidly becoming younger. In modern gynecology, the first symptoms and signs of uterine body cancer can be diagnosed in young women. According to statistics, signs of uterine cancer are detected in women before menopause in 40% of cases.

Usually, uterine cancer is detected in late stages in older women. Early stages of detection are more typical for women of reproductive age. However, in order to identify the disease at an early stage, it is necessary to consult a specialist in time and undergo an examination. The gynecologist determines the first symptoms and signs and prescribes appropriate treatment.

As you know, the uterine wall is not homogeneous. In the structure of the uterine body, three interconnected layers can be distinguished.

1. The parametrium or serosa, which is the outer layer of the uterus.
2. The myometrium is a muscular layer that is considered the middle uterine layer.
3. The endometrium or mucous membrane called the inner layer of the uterus.

Myometrium in the structure of the uterine body performs several important functions. Thanks to the muscle layer, the uterus increases in size during pregnancy and contracts during menstruation and childbirth.

The first signs of cervical cancer affect the lining of the uterus. The endometrium includes a functional and basal layer. The superficial functional layer grows during each cycle under the influence of sex hormones, thus preparing for possible conception. If pregnancy does not occur, the grown layer is rejected, which is accompanied by the onset of critical days. The reserves of the basal layer allow the restoration of the mucous membrane.

As cervical cancer progresses at an early stage, all layers are gradually involved in the malignant process. The tumor then spreads to the cervix and surrounding tissues. Over time, distant organs may be affected due to the occurrence of metastases.

Causes

Cervical cancer can have many causes and predisposing factors. Often, the appearance of signs and symptoms of pathology becomes a complex of various causes and the lifestyle that a woman leads.

A variety of factors can predispose you to the development of uterine cancer. Uterine cancer can be either hormone-dependent or autonomous in nature. Gynecologists note that in most cases, the occurrence of the first signs and symptoms of cancer is associated with hormonal imbalance and the reasons that lead to it.

The entire reproductive system of a woman depends on the normal ratio of sex hormones. Thanks to the optimal ratio of sex steroids, a woman experiences a regular two-phase cycle with the presence of ovulation, which allows conception to occur. The endometrium also grows and is shed under the influence of necessary sex hormones.

However, when exposed to certain unfavorable factors, this balance is disrupted. Functional and then structural disorders occur. The endometrium may grow excessively. Over time, the first signs and symptoms of atypia often appear.

For adequate functioning of the reproductive system the correct ratio of progesterone and estrogen is important. In many pathologies, there is an excess amount of estrogen with consistently low progesterone.

Gynecologists identify the following factors that lead to hormonal imbalances and the appearance of early stages of the oncological process:

• early onset of the first menstruation and puberty in general;
• the appearance of signs of menopause after 55 years;
• prolonged absence of ovulation;
• endocrine disorders;
• PCOS;
• excess body weight, which contributes to excessive estrogen production;
• diabetes;
• long-term use of estrogen-containing medications;
• treatment with drugs against breast cancer, such as Tamoxifen;
• irregular nature of sexual activity;
• absence of pregnancies and subsequent births;
• hereditary predisposition;
• pathology of the liver, which utilizes estrogens;
• hypertension.

Hormone-dependent uterine cancer is often detected with signs of a malignant tumor of the intestine or mammary gland. Typically, such a neoplasm progresses slowly and is sensitive to progestogens. If the tumor is detected at an early stage, the course can be considered favorable.

The following signs are identified that increase the risk of symptoms of uterine cancer:

• infertility;
• anovulatory bleeding;
• late onset of menopause;
• follicular cysts on the ovaries and tecomatosis;
• excess body weight;
• incorrect estrogen therapy;
• adrenal adenoma;
• cirrhosis of the liver.

Autonomous uterine cancer is often diagnosed in older women and develops against the background of pathologies such as ovarian or endometrial atrophy. Such a tumor is rarely detected in the early stages, as it progresses quickly and has a poor prognosis.

Some scientists are of the opinion that according to which cell transformation is embedded in DNA. This is the so-called genetic theory of the development of uterine cancer.

The development of uterine cancer occurs in accordance with the following stages.

1. Anovulation and increase in estrogen.
2. The occurrence of background pathological processes, for example, polyposis and endometrial hyperplasia.
3. The appearance of precancerous conditions, in particular hyperplasia with signs of atypia.
4. The development of preinvasive cancer, which is an early stage of uterine cancer.
5. The first signs of slight penetration of malignant cells into the myometrium.
6. Severe cancer of the uterine body.

Women who are at risk should regularly visit a gynecologist and undergo examination.

Stages and types

Experts classify the severity of uterine body carcinoma by determining the stage. In general, the stages indicate the size of the tumor, the depth of penetration into the myometrium and the nature of the spread of the oncological process to surrounding tissues, the presence of metastases.

Early stage uterine cancer is called pre-invasive cancer. In another way, this pathology is defined as stage zero cancer. Typically, at this early stage of the cancer process, there are no signs or symptoms. It is possible to identify the disease through the use of laboratory and instrumental diagnostic methods.

Gynecologists distinguish four stages of uterine cancer.

• Stage 1 is characterized by damage to the endometrium (A). During the early first stage, the myometrium may be affected up to half of the layer (B) or the entire muscular layer (C).
• Stage 2 is characterized by involvement of the cervix in the pathological process. If the tumor is present exclusively in the glandular layer - A, if the tumor penetrates into the deep layers - B.
• Stage 3 involves the penetration of malignant cells into the serosa and appendages (A). Vaginal involvement is sometimes observed (B). In the most severe cases, metastasis occurs to surrounding lymph nodes (C).
• Stage 4 means the appearance of metastases. If metastases develop only in the bladder and intestines - A. If metastases occur in the lungs, liver and bones - B.

It is known that in the early stages, for example, pre-invasive and first, the prognosis is more favorable. However, the first symptoms and signs often appear in the third and fourth stages.

The prognosis of the disease depends not only on the stage. The earlier appearance of the first signs and symptoms depends on the degree of cellular differentiation:

• high;
• average;
• low.

The neoplasm grows more slowly with a highly differentiated neoplasm of the uterine body. The likelihood of a cure for this type of cancer is significantly higher. Poorly differentiated tumors have the first signs and symptoms at an early stage. It is quite difficult to cure such a pathology.

There are the following morphological types of uterine cancer:

• squamous;
• adenocarcinoma;
• clear cell;
• glandular squamous;
• mucinous;
• serous;
• undifferentiated.

The most common tumor is adenocarcinoma. The formation can be localized in the area of ​​the fundus of the uterus, as well as in its lower segment.

Symptoms and signs

Often, women consult a doctor about the first signs of pathology. This may be acyclic bleeding or an increase in menstrual flow. After examination, in some cases, uterine cancer is detected.

Many of the first signs and symptoms of uterine body cancer, especially in the early stages, coincide with other gynecological pathologies:

• profuse leucorrhoea associated with damage to the lymphatic capillaries;
• increased bleeding during menstruation;
• bleeding;
• discharge of the color of meat slop due to the disintegration of tumor tissue;
• pain in the lower back and abdomen;
• frequent painful urination;
• constipation;
• bleeding during bowel movements, which may be accompanied by pain;
• swelling of the legs;
• increase in abdominal circumference.

Early first signs usually include abnormal discharge, which can be observed in the second or third stage. Early stages, such as pre-invasive and first stages, are usually not accompanied by symptoms. The appearance of the first signs is associated with the spread of cancer and tumor growth.

In advanced stages, the first signs are:

• pain of varying intensity;
• swelling;
• deterioration in general health, which may manifest itself as weakness, dizziness, low-grade fever.

Usually the first signs of a deterioration in a woman’s general well-being are associated with poisoning of the body by tumor waste products. One of the early symptoms is also anemia.

Diagnostic and treatment methods

Diagnosing uterine cancer in the early stages is somewhat difficult. In order to identify the first signs of a malignant process, the following studies are carried out.

1. Aspiration biopsy in the early stages it is not informative enough, however, as the tumor progresses, its symptoms can be identified in 90% of cases. The procedure is performed on an outpatient basis.
2. Ultrasound of the pelvic organs is a simple and reliable way to identify various gynecological diseases. In the early stages, a sign such as endometrial hyperplasia should alert patients. As a rule, in such cases, additional research is carried out.
3. Hysteroscopy is an instrumental diagnostic method that allows you to diagnose and treat certain formations. The hysteroscope is inserted into the uterus through the cervical canal. The method allows for curettage and biopsy for further histological analysis.

To identify metastases, it is necessary to perform MRI, CT and X-ray of the lungs. The functions of the bladder and bowel, which are often affected by uterine cancer, are assessed through cystoscopy and rectoscopy.

Treatment involves a combination of several techniques:

• surgical intervention;
• radiotherapy;
• chemotherapy.

The main method of treatment, which is used at any stage of the disease, is removal of the uterus and appendages. The volume of intervention depends on the degree of spread of the oncological process. Organ-conserving operations can be performed for early stage - preinvasive cancer.

Radiation is often given after surgery to remove any remaining cancer cells. It is practically not used as an independent method.

Chemotherapy is used to treat the signs and symptoms of a tumor. This tactic is not recommended as the main method of treatment. For hormone-dependent forms of the malignant process, doctors also prescribe hormonal therapy.

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How quickly does cervical cancer develop? For each woman with this diagnosis, the disease develops differently, so at the first ailment it is necessary to seek help from a specialist.

How quickly do different types of cervical cancer develop?

How long cervical cancer will develop depends on many factors, including the environment, lifestyle, and nutrition.

Cervical cancer

This disease is not a rapidly developing disease. The whole process can take 10 or even 20 years. However, there are cases of rapid growth of tumor cells. Therefore, you should not delay with this; the first signs should be a reason to contact a specialist. Using special equipment, it is possible to diagnose a precancerous condition, which is much easier to cure.

Note! If treatment is not started in time, then it is likely that after 10 years the tumor will enter an advanced and more dangerous stage, which can no longer be treated.

According to statistics, 0.3% of women have an advanced stage of malignant neoplasm. This means that metastases have begun to penetrate other organs and tissues, thus disrupting their functioning.

Squamous cell carcinoma

Despite the fact that this form of tumor is asymptomatic, it can be diagnosed during a routine examination by a gynecologist. Over time, the cancer tumor begins to grow, and then the first symptoms appear. Squamous cell carcinoma is a tumor in which immature cells are formed, and they multiply very quickly, so the course of the disease from the first to the last stage occurs rapidly.

Adenocarcinoma

This type of tumor is hormone dependent and is most common in menopausal women. The neoplasm is aggressive in nature and begins to metastasize to other organs, lymph nodes and blood. After this, the development of the disease is rapid.

Exophytic cancer

A malignant tumor of this form is noticeable already in the first stages. The pathology occurs with visible symptoms, these are compactions and growths on the neck.

Endophytic cancer

This type of malignant neoplasm is already in an advanced stage. The whole process takes place in the uterus itself, so diagnosis will require special equipment.

A malignant tumor has the ability to grow quickly and extend beyond the uterus itself. It metastasizes into human organs and tissues, and is also transported in the blood throughout the body. In this case, the lymph nodes are affected.

How quickly does cervical cancer develop by stage?

To begin with, we can distinguish the zero stage, or precancerous condition. Having noticed it at the first stage, there is a 100% guarantee of its complete removal from the body. In this case, cancer will develop with minor changes in the epithelium. This process happens slowly.

First stage

Cancer cells begin to grow and a tumor forms. The neoplasm does not affect nearby organs and tissues. Metastases may spread to the cervical canal.

Second stage

The tumor is significant in size and, in the absence of proper treatment, begins to grow beyond the uterus. The pelvis and vagina are affected.

Third stage

The tumor grows more and more, they affect the ureters and metastasize to the lymph nodes. Metastases also grow in the pelvic area and other nearby organs. The tumor also affects the walls of the vagina.

Fourth stage

This is a severe form of malignant tumor, in which metastases penetrate the bladder and rectum. At this stage of development of the tumor, metastases can affect the lungs, liver, kidneys and bones. How long it takes for stage 4 cervical cancer to develop will depend on the body. To a greater extent, the progression of the disease occurs very quickly, and the lymph nodes are also affected.

How quickly does cervical cancer develop from a precancerous condition?

How long a cancer will develop depends on a number of factors, including the histology of the tumor, existing pathologies, body resistance, etc.

The onset of a malignant tumor is preceded by dysplasia, when epithelial cells are modified and block the work of healthy cells. Most often this happens in the transition zone, i.e. in the place where the cervix and the cervical canal meet.

It is quite difficult to say exactly how quickly uterine cancer develops in the body. Therefore, it is worth undergoing an annual examination by a specialist. If cancer cells are not removed in time, then within 2 years, or even less, a malignant tumor will appear, which will become increasingly difficult to cure.

The progression of cervical cancer may take 2 years and during this time go through all 4 stages, or may not show signs for 10 years. However, you should not rely on universal statistics; in each case, the entire process of development of a neoplasm occurs differently. There are cases when dysplasia did not move further and went away on its own over time. It is best to contact a specialist and be observed by him, especially if there are predisposing factors to the development of a cancerous tumor. On average, the minimum time for transition from stage to stage is 2 years.

How long it takes for cervical cancer to develop largely depends on the woman herself. Lifestyle, proper nutrition and regular monitoring by a specialist play a role here. If any discomfort occurs, you should consult a gynecologist who will conduct an examination and identify its cause. After all, the process of formation of cancer cells can be rapid, and in the final stages it is incurable. Therefore, it is very important to monitor your health.

Oncological pathologies of the female reproductive system are quite common. One of the common diseases of this kind is uterine cancer.

This disease is called differently - endometrial cancer, cancer of the uterine body, cancer of the uterine mucosa, etc. All these oncological processes are uterine cancer.

Disease concept and statistics

Uterine cancer is a malignant tumor process that develops from the inner epithelial layer - the endometrium.

On average, this disease is found in 2-3% of the female population. Endometrial cancer can occur in every woman, however, women over 45 are most susceptible to this type of cancer.

Classification

Oncologists classify uterine cancer into two types: autonomic and hormonal.

Autonomous cancer accounts for 1/3 of all cases of uterine oncology. This form of the disease occurs suddenly without any prerequisites or reasons.

Experts believe that such oncology is of hereditary etiology or occurs under the influence of traumatic injuries.

The picture shows a uterine cancer cell under a microscope

The hormonal type of uterine cancer develops due to hormonal changes in the female body. This type of cancer accounts for 2/3 of all cases of endometrial cancer. It is characterized by pronounced disturbances of endocrine-metabolic origin.

According to histological data, cancer of the uterine body can be:

• Leiomyosarkinoma;
• Glandular squamous cell oncology, etc.

Depending on the degree of differentiation of cellular structures, cancer can be highly differentiated, poorly differentiated or moderately differentiated.

Causes

As mentioned above, endometrial cancer can be hormone-dependent or autonomous in nature. Based on this, we can identify several characteristic causes of uterine body cancer:

• Increased stimulation of the epithelial uterine layer by estrogen hormones;
• Metabolic disorders such as obesity, diabetes, hypertension;
• Hormone-producing ovarian tumors;
• Adenoma of the adrenal cortex;
• Treatment with hormone-containing drugs;
• The presence of severe liver pathologies accompanied by disturbances in metabolic sex-hormonal processes (hepatitis, etc.);
• Negative heredity, such as the presence in blood relatives of oncological formations in the intestines, mammary gland, ovaries or in the body of the uterus;
• Late onset of menopause;
• Lack of pregnancies with natural births;
• Long-term use of oral contraceptives like Dimethisterone;
• Irradiation of pelvic organs, etc.

Symptoms of uterine cancer in women

Signs of oncological formations of the uterine body are very diverse, however, in the early stages of the development of the cancer process, any symptoms are usually absent.

First signs

Among the first alarming symptoms of uterine cancer, uterine bleeding not associated with menstruation stands out.

A similar sign, according to oncologists, is observed in almost 7-9 out of ten patients.

Such bleeding may vary in nature:

• Abundant;
• Scarce;
• Multiple;
• Breakthrough;
• One-time;
• Intermittent, etc.

Contact bleeding that occurs as a result of sexual intercourse, gynecological examination, lifting heavy objects, douching, etc. is very typical for uterine cancer.

In addition to discharge, when uterine cancer reaches advanced stages of development, it can be recognized by the following symptoms:

1. Hyperthermia with low-grade fever;
2. Nagging pain in the lumbar area, perineum, abdomen;
3. A noticeable reduction in performance, excessive and rapid fatigue, even to the point of exhaustion;
4. Sexual intercourse is accompanied by pain, which can also appear after it;
5. Refusal to eat;
6. Problems with bowel movements such as constipation or diarrhea;
7. Severe weight loss.

How to identify uterine cancer by symptoms before menopause?

In women who are premenopausal, it is considered quite normal to have uterine bleeding, which gradually becomes scarce and bothers you less and less.

If an oncological process begins to develop in the uterine body, then the typical reduction in symptoms does not occur, and it often happens that uterine discharge, on the contrary, becomes more abundant and frequent.

What manifestations can be observed in postmenopause?

During menopause, women usually do not have menstruation. Therefore, if sudden vaginal discharge occurs, you should always suspect the presence of a uterine cancer process.

Moreover, the frequency of such bleeding, its duration, intensity and abundance at this age no longer matter.

Stages and their lifespan

Oncologists distinguish several sequential degrees of uterine cancer:

• At the first stage Oncological formation is located directly in the uterine body. The probability of recovery is about 80-90%;
• At the second stage During the oncological process, the tumor formation penetrates beyond the boundaries of the uterine body and affects the cervical canal (cervix), however, nearby organs are not affected. Recovery occurs in approximately ¾ of cases;
• On third stage of cancer, the oncological process spreads to the appendages and vagina. Survival rate is about 40% of patients;
• On fourth stage of cancer of the uterine body, tumor processes spread beyond the pelvic region, the formation grows into the intestinal and bladder tissues. Survival rate – no more than 15%.

Consequences

Cancer of the uterine body is a very dangerous pathological condition. If there is no adequate therapy, then uterine cancer will certainly lead to the death of the patient.

Often, cancer of the uterus requires its removal along with the appendages, part of the vagina and the cervix. However, this factor usually does not play a significant role, because cancer is found mainly in women aged 45-60 years with adult children.

Pathways of metastasis

In case of cancer in the body of the uterus, the main routes of metastasis are vessels and nodes, and at the terminal stage the circulatory system also participates in the spread.

First, the lesion spreads to the lymph node structures in the iliac region and hypogastric zone. Much less often, the lesion affects other groups of pelvic lymph nodes.

Metastasis extends to the cervical canal and beyond the uterine body. In a hematogenous manner, metastases penetrate from the upper uterine region into the appendages; in addition, the vagina, and sometimes even the kidney or liver or bone tissues are affected.

Diagnostics

The diagnostic process for uterine cancer begins with a gynecological examination using speculum. The patient is then sent for an ultrasound examination, which reveals the true size and structure of the uterus, as well as the structure and thickness of the endometrium.

The photo shows what uterine cancer looks like on ultrasound diagnostics

The resulting biomaterial is often scraped. This procedure is performed using general anesthesia in a hospital setting.

When analyzing for the detection of tumor markers for uterine cancer, the following markers are used:

• Carcinoembryonic antigen;
• HCG or human chorionic gonadotropin.

Thanks to its introduction into gynecological oncology practice, it was possible to save the lives of many patients.

How quickly does the disease develop?

The rate of development of the oncological process in the uterine body is determined by the histological type of formation, concomitant pathologies, the strength and intensity of the body's anticancer resistance, the adequacy of therapy, the age of the patient and other similar factors.

Therefore, it is impossible to say for sure how long it will take for the final development of the cancer process in the uterine body.

The difference between pathology and fibroids

They call the process of hyperplastic enlargement of uterine tissue that occurs as a result of traumatic factors, frequent abortions, curettage, a large number of sexual partners, genitourinary inflammation, lack of orgasms in women, etc.

Cancer of the uterine body and fibroids have absolutely nothing to do with each other. These are completely different pathologies, so fibroids never degenerate into cancer.

Benign uterine hyperplasia is formed in the muscular layer of the organ, and oncology - in the epithelial layer. When fibroids are detected, observation tactics are usually chosen to determine whether the fibroids are growing or not.

For this purpose, the patient undergoes a gynecological examination every six months. As for direct scientific evidence of the relationship between cancer and fibroids, there is no evidence.

Treatment and prevention

In general, it depends on individual prognostic results:

1. The basis of treatment is surgery, which involves removing the uterine body along with the ovaries.
2. Sometimes radio irradiation is performed before and after surgery to reduce the risk of cancer recurrence, but such treatment has absolutely no effect on survival rates;
3. In addition to surgery, chemotherapy is used. Such an approach to treatment is justified when the tumor process is widespread, as well as when the tumor is autonomous, has active metastasis, and relapses. Platinum drugs such as Cisplatin, Carboplatin, Adriamycin, as well as Doxorubicin, Taxol, Epirubicin, etc. are used. For hormonal-dependent oncology of the uterine body, chemotherapy treatment is ineffective;
4. Hormone therapy provides good therapeutic results. For such treatment, progestagen drugs are usually used: Megeys, Depostat, Provera, 17-OPK, Farlugal, Depo-Provera, etc. These drugs can be combined with Tamoxifen or prescribed without it. If active metastasis occurs and treatment with progestogens is ineffective, Zoladec is prescribed. Sometimes I combine hormonal treatment with chemotherapy.

When determining the appropriate therapeutic method, the oncologist takes into account several decisive factors such as the physiological state of the patient, the presence of endocrine disorders, histological parameters, tumor size and extent, etc.

Preventive measures are the most effective anti-cancer measure. Primary preventive actions involve avoiding factors that provoke such cancer, such as obesity, diabetes and infertility.

In other words, you need to strictly control weight, treat fertility and diabetes.

There are also secondary preventive measures that involve timely detection and treatment of inflammatory pathologies and precancerous conditions.

Women over 40 are recommended to undergo annual screening examination using transvaginal ultrasound. This procedure makes it possible to detect cancer of the uterine body in its infancy, which significantly increases the chances of recovery and long life.

If a precancerous disease is discovered in the patient, then it must be treated.

Patient survival prognosis

Every year the number of cancer patients with cancer of the uterine body increases; every year this pathology is detected in half a million patients. But timely diagnosis and an adequate approach to the treatment process make it possible to achieve a high and favorable survival prognosis.

In general, the prognosis for the survival of cancer patients is determined by the stage of initiation of therapy, the degree of cell differentiation, etc.

For example, with a highly differentiated formation with the first degree of development, the survival rate will be 96%, and with a low degree of cell differentiation and 4 degrees of development, the survival rate does not exceed 18%.

The following video will tell you how to recognize and treat uterine cancer:

Uterine cancer is a common malignant neoplasm of the uterine body in women. It is also called endometrial cancer

Uterine cancer occupies 1st place in the structure of female oncological diseases of the reproductive system, cervical cancer ranks 2nd. Among all female malignant tumors, endometrial cancer is second only to breast cancer.

Uterine cancer most often affects women after menopause (over 50 years of age), with the peak incidence observed in women aged 65-69 years. Approximately 5-6% of cancer cases in women are uterine cancer. The most common symptom of endometrial cancer is the appearance of bloody discharge from the vagina outside of menstruation, which should always be a reason to consult a gynecologist.

In most cases, uterine cancer begins in the cells that make up the inner lining of the uterus - the endometrium, which is why uterine cancer is often called endometrial cancer. Less commonly, a malignant tumor forms from the muscle tissue of the uterus. This tumor is called a uterine sarcoma, and its treatment may differ from that of endometrial cancer. This article mainly describes endometrial cancer.

The exact cause of uterine cancer is unclear, but there are factors that may increase your risk of developing the disease. One of them is hormonal imbalance. In particular, the risk of developing uterine cancer increases with increasing levels of the hormone estrogen in the body. Hormonal imbalance can be caused by a number of reasons, including menopause, obesity, diabetes and hormone replacement therapy. The risk of developing uterine cancer also increases slightly with long-term use of a breast cancer drug called tamoxifen.

Symptoms of uterine cancer

The first signs of uterine cancer are watery leucorrhoea and bloody discharge from the vagina outside of menstruation. Gradually, the discharge becomes more abundant, more reminiscent of uterine bleeding. As a rule, any bloody vaginal discharge in menopausal women is suspicious for cancerous changes.

Possible signs of uterine cancer in women of reproductive age are:

• heavier periods than usual;
• vaginal bleeding between periods.

More rare symptoms of endometrial cancer may include pain in the lower abdomen and discomfort during sexual intercourse.

If the cancer reaches an advanced stage, it may manifest itself as:

• pain in the back, legs or pelvic area;
• lack of appetite;
• fatigue;
• nausea and general malaise.

Vaginal leucorrhoea, and especially bloody discharge not associated with menstruation, should be a reason for mandatory consultation with a gynecologist. These symptoms are characteristic of many diseases: polyps or fibroids of the uterus, sexually transmitted infections, cancer of the uterus and other parts of the female reproductive system.

Causes and risk factors for uterine cancer

The body is made up of millions of different cells. Cancer develops when some of them begin to multiply indefinitely, forming a voluminous neoplasm - a tumor. A malignant tumor can affect any part of the body where a failure occurs in the system regulating cell division and growth.

Cancer of the uterine body is prone to rapid growth and spread to neighboring organs and tissues. Typically, cancer cells spread throughout the body through the lymphatic or circulatory system. The lymphatic system is a collection of nodes and channels distributed throughout the body and interconnected like the circulatory system. Through lymphatic and blood vessels, tumor cells can spread to any part of the body, including bones, blood and organs. This is called metastasis.

Factors that increase the risk of developing uterine cancer:

• Age. The risk of developing uterine cancer increases with age; in most cases, the disease is diagnosed in women over 50 years of age.
• Estrogen. The risk of developing uterine cancer is related to the level of estrogen in the body. This is one of the hormones that regulate the female reproductive system. Estrogen stimulates the release of the egg from the ovary, the division and growth of endometrial cells. Progesterone prepares the lining of the uterus to receive an egg from the ovary. Normally, estrogen levels are kept in check by progesterone. But the hormonal balance in the body can be disrupted. For example, after menopause, the body stops producing progesterone but still produces small amounts of estrogen. This estrogen causes endometrial cells to divide, which can increase the risk of developing uterine cancer.
• Hormone replacement therapy. Because of the link between estrogen and uterine cancer, estrogen hormone replacement therapy should only be given to women who have had their uterus removed. In other cases, a combination of estrogen and progesterone must be given to reduce the risk of uterine cancer.
• Overweight or obesity. Since estrogen can be produced by fat tissue, being overweight or obese increases estrogen levels in the body. This significantly increases the risk of developing uterine cancer. The risk of developing uterine cancer in overweight women is 3 times higher than in women of normal weight. In case of obesity, it is 6 times higher than in women with normal weight. Therefore, it is important to know how to calculate body mass index.
• Lack of childbirth. Women who have not given birth are at higher risk of developing uterine cancer. This may be because the increase in progesterone and decrease in estrogen during pregnancy protects the lining of the uterus.
• Tamoxifen. Women who have taken tamoxifen (a hormonal drug to treat breast cancer) may have an increased risk of developing uterine cancer. However, the benefits of tamoxifen treatment outweigh this risk.
• Diabetes. Women with diabetes are twice as likely to develop uterine cancer than others. Diabetes increases insulin levels in the body, which in turn can stimulate estrogen production.
• Polycystic ovary syndrome (PCOS). Women with polycystic ovary syndrome (PCOS) are more susceptible to developing uterine cancer because they have higher levels of estrogen in their bodies. In women with PCOS, cysts form on the ovaries, which can cause symptoms such as irregular or light periods, amenorrhea, as well as problems conceiving, obesity, acne and excess hair growth (hirsutism).
• Endometrial hyperplasia. Endometrial hyperplasia is a thickening of the lining of the uterus. Women with this condition have an increased risk of developing uterine cancer.

Diagnosis of uterine cancer

The primary diagnosis of uterine cancer is carried out by a gynecologist. He performs a gynecological examination and may perform a number of other tests if necessary. If you suspect uterine cancer, your gynecologist will refer you for a consultation with a gynecologist-oncologist, whom you can select by clicking on the link. In addition, additional tests and examinations will be required.

Blood for tumor markers.

To diagnose uterine cancer, a blood test is sometimes performed because the cancer releases certain chemicals into the blood, called tumor markers.

However, the results of blood tests for tumor markers are not always accurate and reliable. The presence of tumor markers in the blood does not mean for sure that you have uterine cancer, and in some women with uterine cancer, these substances are not found in the blood.

Transvaginal ultrasound

You may also have a transvaginal ultrasound (ultrasound). This is a type of diagnosis that uses a small scanning device in the form of a probe. It is inserted into the vagina to obtain a detailed image of the inside of the uterus. This procedure may be slightly uncomfortable, but is usually not painful.

Transvaginal ultrasound can detect thickening of the uterine mucosa, which may indicate the presence of a cancerous tumor.

Uterine biopsy

If a transvaginal ultrasound shows thickening of the uterine walls, you will most likely be prescribed a biopsy to clarify the diagnosis. A biopsy involves taking a small sample of cells from the lining of the uterus (endometrium). This sample is then tested in a laboratory for the presence of cancer cells.

A biopsy is performed in various ways:

• aspiration biopsy - a small flexible tube is inserted into the uterus through the vagina, which absorbs endometrial cells;
• hysteroscopy with biopsy - a small optical device is inserted into the uterus through the vagina, with which the doctor can examine the uterine mucosa and use a special surgical instrument to take a tissue sample from a suspicious area of ​​the mucosa.

As a rule, if uterine cancer is suspected, complete removal of the endometrium is performed during hysteroscopy - curettage. This is a simple surgical procedure performed under general anesthesia. The removed tissue is then sent to a laboratory for analysis.

Additional studies for uterine cancer

To determine the stage of cancer, tumor size, the presence of metastases (daughter tumors) and develop optimal treatment tactics, additional studies are prescribed:

• a chest X-ray to check if the cancer has spread to the lungs;
• magnetic resonance imaging (MRI) to identify metastases and clarify the size of the tumor;
• computed tomography (CT) scan, which uses a series of X-rays to create a detailed image of the inside of the body to check whether the cancer has spread to other organs;
• additional blood tests to check the general condition of the body and the functioning of certain organs.

Stages of uterine cancer

There are the following stages of endometrial cancer:

• stage 1- tumor within the body of the uterus;
• stage 2- cancer has spread to the cervix;
• stage 3- the neoplasm has spread beyond the uterus, damaging the surrounding tissues or lymph nodes;
• stage 4- The cancer has spread to the soft tissue of the abdomen or to other organs, such as the bladder, bowel, liver or lungs.

The chances of a cure for uterine cancer depend on the stage at which the disease is diagnosed. If uterine cancer is diagnosed at stages 1 or 2, you have a 70–80% chance of living another five years. Many women with stage 1 cancer are completely cured.

If the disease is diagnosed at stage 3, you have a 40-50% chance of living another five years. In approximately 25% of cases, uterine cancer is diagnosed at the fourth stage. By this time, the chances of living at least another five years are only 20–30%.

Treatment of uterine cancer

The main method for endometrial cancer is removal of the uterus, ovaries and fallopian tubes. Sometimes, depending on the stage and extent of the cancer, a combination treatment is used: after surgery, a course of radiation or chemotherapy is prescribed to kill any remaining cancer cells, if any.

In rare cases, in young women who have not yet reached menopause, the uterus is left in place to preserve reproductive function. Then uterine cancer is treated with hormone therapy.

In late, incurable stages of the tumor, chemotherapy is usually used. In this case, the goal of treatment is to achieve remission, when the cancer tumor decreases in size, thereby improving well-being and quality of life. But even in advanced cases of cancer, surgical treatment is sometimes performed to remove as many tumor cells as possible. In addition, radiation, hormonal or chemotherapy are prescribed to relieve pain, reduce the size of the remaining tumor and slow its growth.

Surgery for uterine cancer

The main method of treating stage 1 uterine cancer is extirpation of the uterus with appendages- complete removal of the uterus, cervix, ovaries and fallopian tubes. The surgeon may also take samples of cells from lymph nodes in the pelvis and abdomen, as well as other surrounding tissue. If cancer cells are found in them, the operation is complemented by removal of the lymph nodes.

Most often, an extirpation involves making one large incision in the abdomen so that the surgeon can access the uterus and remove it. This is called laparotomy. Sometimes it is possible to remove the uterus and appendages through small pinpoint incisions - laparoscopic access. During laparoscopic extirpation of the uterus and appendages, several small incisions are made through which a special optical device (laparoscope) and other surgical instruments are inserted. This allows the surgeon to see what is happening inside the abdomen and remove the uterus through the vagina.

Recovery after laparoscopic surgery is much faster, since the intervention is less traumatic for the body.

After surgery, even while in bed, it is recommended to start moving as soon as possible. This is important for improving blood circulation and preventing blood clots from blocking blood vessels. Your doctor at the hospital should show you exercises that will help you avoid complications.

Another possible treatment method With The earliest stages of uterine cancer are endoscopic endometrial ablation. This is the most gentle method of surgical treatment of a malignant tumor of the uterus. Ablation is used in pre- and postmenopausal women, when hysterectomy is contraindicated for health reasons and the woman does not plan to have children. The operation is performed without incisions. Special instruments are inserted through the vagina and cervix, which, using electric current or laser energy, destroy the entire endometrium along with cancer cells.

For stage 2 and 3 uterine cancer, extended hysterectomy is performed, that is, the uterus, cervix, upper part of the vagina, fallopian tubes, ovaries and fatty tissue with lymph nodes surrounding these organs are removed. After surgery, radiation or chemotherapy is often required to reduce the risk of tumor recurrence.

If the tumor has reached a large size and cannot be completely removed, cytoreductive surgery is performed - removing the maximum possible volume of cancer cells. The purpose of such an operation is to relieve symptoms, prolong life and improve its quality.

Radiation therapy for uterine cancer

Radiation therapy is used in combination with surgery to shrink a tumor before surgery or to prevent cancer from recurring after a hysterectomy. Radiation is sometimes used in cases where surgery is not possible.

Two types of radiation therapy are used to treat uterine cancer:

• contact radiation therapy (brachytherapy), when a plastic applicator with a radioactive source is inserted into the uterus and irradiation occurs with a large dose of directly affected tissue, with minimal impact on healthy organs;
• external beam radiotherapy, when the pelvic area is irradiated using a special device that focuses the rays at the location of the tumor, the effect extends to the surrounding tissue.

You will need to come to the hospital for external beam radiation therapy sessions five days a week, with a break on the weekends. The session lasts several minutes. The course of radiation therapy lasts about four weeks, depending on the stage of the cancer and the location of the tumor in the uterus.

In addition to external beam radiation therapy, some women also undergo contact radiation therapy (brachytherapy). There are different types of brachytherapy with low, medium or high dose radiation. At a low dose, radiation occurs more slowly, so the device can remain in the uterus longer. Contact radiation therapy is usually performed in a hospital setting. Discuss this with your doctor.

Radiation therapy has side effects: skin irritation and redness, hair loss, severe fatigue. Radiation therapy to the pelvic area can affect bowel function and cause nausea and diarrhea. Most side effects will go away once treatment is completed, but about 5% of women develop chronic side effects such as diarrhea and anal bleeding.

Chemotherapy for endometrial cancer

Chemotherapy is used more often after surgery to reduce the risk of cancer coming back as much as possible. Chemotherapy also treats late stages of cancer, when it is not possible to completely remove the tumor. Then this treatment method helps slow down the growth of the tumor, reduce the severity of symptoms, prolong life and improve its quality.

Typically, chemotherapy is carried out in cycles, periods of treatment - courses of chemotherapy, alternated with periods of rest so that the body can recover. Medicines are most often administered intravenously. Treatment is usually carried out in a hospital, but chemotherapy at home is sometimes allowed. This should be discussed with your doctor.

Side effects of chemotherapy:

• nausea;
• vomit;
• hair loss;
• fatigue.

The risk of blood poisoning (sepsis) also increases because chemotherapy weakens the body's ability to fight infections. Side effects should go away when you finish treatment.

Hormonal therapy for uterine cancer

Since the development of endometrial cancer may be associated with the influence of estrogen, in some cases hormonal therapy is used for treatment. Usually, for these purposes, synthetic progesterone or hormones that affect the function of the reproductive system are prescribed. Medicines are often administered intramuscularly at varying frequencies, depending on the treatment regimen. Sometimes they switch to tablet forms of hormones.

Hormone therapy is mainly used to treat early uterine cancer in young women for whom it is important to preserve reproductive function. If treatment is successful and the tumor has disappeared, women are given another hormone therapy regimen to restore their menstrual cycle. This takes about 6 months.

Sometimes hormonal therapy is used as a preparatory step for surgery to reduce the size of the tumor. Less commonly, this type of treatment is prescribed at a later stage or if the cancer has grown again.

Treatment may have side effects, including mild nausea, mild muscle cramps, and weight gain. During therapy, menstruation stops and artificial menopause develops. Discuss this with your doctor.

Clinical trials

Much progress has been made in the treatment of uterine cancer. The life expectancy of women diagnosed with uterine cancer increases every year. It was possible to reduce the number of side effects from treatment. This is made possible in part by clinical trials, where new treatments and combinations of treatments are compared with standard ones.

For some cancer patients, participation in clinical trials offers a chance for a cure because the research uses new drugs that may be very effective in treating cancer. As a rule, these drugs are expensive, but are prescribed free of charge if you participate in the study.

If you are offered participation in a clinical trial, you will need to carefully read the study information and provide written consent. You can refuse or stop participating in the trial; this will not affect your treatment.

There is a unified database of clinical trials that are currently being conducted or planned to be conducted in Russia in the Oncology profile. With this information you can.

Living with uterine cancer

Surgery for uterine cancer and other treatment methods are difficult to tolerate. During the recovery period, which can take from one and a half to three months, you should not lift anything heavy (for example, children or heavy bags) or do housework that involves heavy physical exertion. It is recommended that you stop driving for 3-8 weeks after your hysterectomy.

At the end of the course of treatment, you need to undergo regular scheduled examinations. All women treated for uterine cancer are monitored by an oncologist. During scheduled visits to the doctor, the woman undergoes the necessary tests and sometimes undergoes instrumental studies (ultrasound, MRI, etc.) to monitor the tumor.

Sex and social adaptation after hysterectomy

Uterine cancer and its treatment can affect your sex life in the following ways:

• Premature onset of menopause: removal of the ovaries can provoke premature decline of a woman’s reproductive function and a failure in the production of sex hormones. Symptoms of menopause include vaginal dryness and loss of sex drive.
• Vaginal changes: After radiation treatment for uterine cancer, the vagina may become narrower and less elastic. Sometimes this is an obstacle to intimacy. The use of vaginal dilators can help - special plastic cones that need to be inserted into the vagina to stretch its walls. You can stretch the vagina while having sex, or using your fingers or a vibrator.
• Decreased libido: After treatment for uterine cancer, many women lose interest in sex. Treatment can cause severe fatigue, diagnosis can cause nervous shock, and the inability to have children can cause confusion and depression.

Therefore, a temporary loss of interest in sexual activity is quite natural. Try to discuss your feelings with your partner. If you notice that problems in your sex life do not go away over time, find a good psychotherapist. Your doctor may prescribe you a course of antidepressants or suggest psychotherapy sessions. There are cancer support groups where you can get advice from someone who has been through the same thing as you.

To get advice, moral support, help in solving legal and even medical issues, you can visit the portal “Movement Against Cancer” or “Project CO-Action”, which provides comprehensive support for people with cancer. All-Russian 24-hour hotline for psychological assistance to cancer patients and their loved ones 8-800-100-01-91 And 8-800-200-2-200 from 9 to 21 o'clock.

Benefits for cancer patients

Paid sick leave is issued for the entire period of treatment and rehabilitation. If, after treatment, work limitations remain or the woman can no longer perform her previous job (for example, related to hazardous working conditions), she is sent for a medical examination to register disability. In the future, a cash disability benefit will be provided.

Cash benefits are also paid to unemployed citizens caring for a seriously ill person. Your attending physician should provide you with more detailed information.

Patients with cancer have the right to receive free medicines from the list of preferential medicines. To do this, you will need a prescription from your doctor. Sometimes a prescription is issued by a medical commission.

Prevention of uterine cancer

Unfortunately, there are no reliable ways to definitely protect yourself from uterine cancer. However, there are many factors known that, by avoiding them, can significantly reduce the risk of endometrial cancer.

The most effective way to prevent uterine cancer is to maintain a normal weight. The best way to avoid becoming overweight or obese is to eat right and exercise regularly.

A low-fat, high-fiber diet is recommended, including whole grains and at least five servings of vegetables and fruits per day (totaling about 400-500 grams per day). Some research suggests that a diet rich in soy products may help prevent uterine cancer. Soy contains isoflavonoids that protect the lining of the uterus. In addition to soy itself, you can eat tofu cheese. However, reliable evidence for this hypothesis is still insufficient.

For most people, at least 150 minutes (two and a half hours) of moderate-intensity aerobic activity (such as cycling or brisk walking) per week is recommended. It is best to distribute this load throughout the week into at least five separate workouts. If you have never exercised or haven't exercised for a long time, get a medical examination before you start exercising.

Research results have shown that long-term use of oral contraceptives may reduce the risk of developing uterine cancer. Other types of birth control, such as the contraceptive implant and intrauterine system, release progestogen (synthetic progesterone). It may also reduce the risk of developing uterine cancer.

Who is treating?

Which doctor should I see if I have uterine cancer?

Using the NaPravku service you can find a gynecologist-oncologist or oncologist. If necessary, you can call an oncologist at home. On our website you can choose an oncology clinic or oncology center by reading reviews and other information about them.

The interest of patients about how to treat uterine cancer is very important, and the answer to it will be visible only after a complete diagnosis, during which the type of disease and stage will be determined. The main types of treatment for this disease are:

Surgical intervention

Usually you have to resort to this type of treatment in the initial stages. The most common procedure is a hysterectomy - removal of the uterus and ovaries, as well as its appendages.

Women are often concerned about hysterectomy, how painful it is and how large a suture remains in the peritoneum after hysterectomy.

Depending on the extent of the cancer, the surgeon will perform either a simple hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, upper part of the vagina, and nearby tissue).

For postmenopausal patients, the surgeon will also perform a bilateral salpingo-oophorectomy, which involves removing both the fallopian tubes and the ovaries.

A hysterectomy can be performed as a traditional surgery with 1 large incision or laparoscopy, which uses several smaller incisions.

A hysterectomy, when there is a possibility of cancer, is usually performed by a gynecological surgeon, who is a surgeon who specializes in surgery on a woman's reproductive system.

Hyperectomy, the removal of the uterus using robotic technology through small holes, can also be used to treat cancer.

At the same time, along with removing the uterus, the surgeon may remove lymph nodes near the tumor to determine whether the cancer has spread beyond the uterus.

Chemotherapy

Chemotherapy is the use of medications to help cancer cells die, usually by stopping the cancer cells' ability to grow and divide.

Chemotherapy is administered by an oncologist or gynecologic oncologist - a doctor who specializes in treating cancers of the female reproductive system with drugs.

When treating endometrial cancer, chemotherapy is usually given after surgery, either together with or instead of radiation therapy. Chemotherapy is also given if endometrial cancer comes back after initial treatment.

Systemic chemotherapy enters the bloodstream to reach cancer cells throughout the body. Common methods of administering chemotherapy include an intravenous tube placed into a vein using a needle, or a tablet or capsule that is swallowed by patients.

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific period of time. The patient can simultaneously take 1 drug or combinations of different drugs.

The goal of chemotherapy is to destroy the cancer left after surgery or to shrink the cancer and slow the growth of the tumor if it returns or has spread to other parts of the body.

Side effects of chemotherapy depend on the person, the type of chemotherapy and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite and diarrhea. These side effects usually disappear after treatment is completed.

Advances in chemotherapy over the past 10 years include the development of new drugs to prevent and treat side effects, such as antiemetics for nausea and vomiting and hormones to prevent low white blood cell counts if needed.

Other potential side effects of chemotherapy for uterine cancer include inability to become pregnant and early menopause if the patient has not already had a hysterectomy (see Surgery above). Rarely, some medications cause hearing loss. Others may cause kidney damage. Patients may be given an additional intravenous injection to protect their kidneys.

Radiation therapy

There is both a remote method of treatment and a contact (internal) method. This is a fairly effective method, and is often used in cases where the surgical method is impossible or in cases where the disease occurs a second time (relapse).

Radiation therapy is the use of high-energy X-rays or other particles to kill cancer cells. A doctor who specializes in providing radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a given period of time. The most common type of radiation therapy is called external beam radiation therapy, which is radiation received from a machine outside the body.

Some women with uterine cancer need both radiation therapy and surgery. Radiation therapy is most often given after surgery to destroy any cancer cells remaining in the area. Radiation therapy is rarely given before surgery to shrink the tumor. If a woman is unable to undergo surgery, the doctor may recommend radiation therapy as an alternative option.

Radiation therapy options for endometrial cancer may include radiation therapy directed to the entire pelvis or applied only to the vaginal cavity, often called intravaginal radiation therapy (IVRT) or vaginal brachytherapy.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements and will depend on the extent of radiation therapy administered. Most side effects usually disappear soon after treatment is completed, but long-term side effects causing bowel or vaginal symptoms may occur.

Doctors sometimes advise their patients not to have sexual intercourse during radiation therapy. Women can resume normal sexual activity within a few weeks after treatment if they feel ready to do so.

In most cases, it is used after the later stages of the disease, when the spread extends beyond the initial localization.

Hormone therapy is used to slow the growth of certain types of uterine cancer cells that have hormone receptors on them. These tumors are usually adenocarcinoma and are grade 1 or 2 tumors.

Hormone therapy for uterine cancer often involves a high dose of the sex hormone progesterone in pill form. Other hormonal therapies include aromatase inhibitors often used to treat women with breast cancer, such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasine).

Aromatase inhibitors are medications that reduce the amount of the hormone estrogen in a woman's body, stopping tissues and organs other than the ovaries from producing it.

Hormone therapy may also be used for women who do not have surgery or radiation therapy, or in combination with other treatments.

Side effects of hormone therapy in some patients include fluid retention, increased appetite, insomnia, muscle pain, and weight gain. They do not pose any danger to the body.

You should also change your diet if you have uterine cancer: alcohol and foods that provoke cancer should be excluded from your diet. You need to eat more garlic, vegetables, broccoli, and fruits.