Uterine cancer after surgery. Uterine cancer: symptoms and signs, life prognosis at different stages

Exposure of the tumor to ionizing rays allows achieving a positive effect, since tumor cells quite sensitive. Radiation therapy causes virtually no damage to healthy cells, even after removal of the uterus and appendages. This is the most gentle method, unlike surgical intervention, which is carried out everywhere today and the consequences are minimal. Radiation therapy after removal of the uterus is one of the most effective today.

Radiation is often carried out in combination with chemotherapy and is indicated for use at any stage of development of the oncological process. The radiation therapy method can be prescribed after removal of the uterus and appendage. While surgery may be completely ineffective.

Radiation hysterectomy is mainly carried out after surgery in order to eliminate the remaining, other abnormal structures in the structure of cells in uterine cancer in women. The basis of the radiation therapy method is the therapeutic effect, despite training with ionizing rays, the harm from which is insignificant. Although this irradiation is contraindicated if women have:

• radiation sickness;
• thrombocytopenia;
• feverish condition;
• tumor disintegration;
• severe bleeding due to tumor decay;
• myocardial infarction;
• tuberculosis;
• diabetes mellitus;
• liver, kidney failure;
• stage 4 cancer;
• anemia;
• multiple metastases.

How is radiation exposure performed?

Radiation is usually prescribed:

• at stages 1-2 of cancer after surgery to remove the uterus;
• when the tumor spreads to regional lymph nodes;
• at the time of palliative therapy;
• at stage 4 cancer, if the operation did not bring significant results;
• for prophylactic purposes to prevent relapses.

Types of radiation therapy

It is possible to carry out external, intracavitary, contact or internal radiation therapy.

1. Remote therapy is carried out by exposing the rays to the lesion site, but at a certain distance from the skin without contacting it.
2. Intracavitary therapy is carried out to destroy the tumor, for which a special device is inserted into the uterine cavity.
3. Contact therapy is carried out by bringing a radioactive drug into contact with the skin. Before the procedure, the doctor will tell you in detail about this technique and what the woman may feel during the procedure.
4. Internal therapy consists of the introduction of initially certain drugs into the uterine cavity and subsequent application of ionizing rays in order to suppress the malignant tumor.

The main goal of therapy is to maximize the impact on the affected area, reduce recovery period for the body. When radiation is given, it is important for women to:

• normalize nutrition;
• walk more in the fresh air;
• follow all doctor's instructions.

How to prepare

Preparatory procedures for radiological treatment include:

• referring the patient for an MRI to clarify the location of the tumor;
• prescribed by a doctor required doses for irradiation, taking into account the obtained test results.

The duration of the procedure is no more than 35 minutes. It is carried out in a specially designated room in compliance with all technological requirements for safety purposes. Women are asked to lie down on the couch and remain motionless while the ionization source is applied.

Nothing should prevent free entry x-rays. For convenience and separation from the affected area, healthy areas of the body are covered with protective material.

What are the possible consequences after irradiation?

Many patients after radiation therapy complain of the following consequences:

• nausea, vomiting;
• severe intoxication of the body;
• indigestion;
• stool disorder;
• signs of dyspepsia;
• the appearance of burning and itching on the skin in part;
• dryness in the vaginal mucosa and genitals.

Doctors say that such consequences do occur and recommend that women survive it somehow this period, pay more attention to relaxation, do what you love. It is important to get enough sleep and gain strength after a course of radiotherapy. In addition, at home you need to treat the affected area herbal preparations to avoid burns during treatment. At the same time, do not use cosmetics and perfumes until the wounds are completely healed after surgery.

There may be consequences in the form of allergic reactions after the procedure. Therefore, you should not take thermal hot baths for a week. It is better to avoid visiting a bathhouse or sauna for a while.

What's the forecast?

After removal of the uterus and appendages, a woman, of course, will have to forget about childbearing, but radiation therapy at early stages 1-2 of cancer gives quite positive prognoses. Perhaps even complete healing from the application of radio waves and up to 5 sessions in stages.

But, unfortunately, it is no longer possible to stop the uterine tumor process at stages 3-4. All such efforts can only be aimed at relieving discomfort in patients and stabilizing the growth of a malignant tumor.

After the treatment process, women are advised to quickly survive the effects of radiation exposure on the body. Spa treatment V rehabilitation period, also conducting a course of massage, physiotherapy, balneotherapy, acupuncture, radon baths.

If irradiation is carried out and serious complications arise, then, most likely, a disability group will be assigned if the operation led to a significant loss of ability to work.

In addition, it will be possible to begin sexual activity no earlier than 8 weeks after radiation therapy. Still, at first, women need to take care, gain strength, and heal the wounds left in the postoperative period. Although doctors claim that radiation therapy after removal of the uterus along with its appendages, the operation does not affect a woman’s sexuality and psychological activity.

Having sex is not at all contraindicated, but first it is advisable to visit a gynecologist for an examination, who will tell you when you can start sexual activity and how long you need to wait for wounds and scars to heal.

Informative video

Collapse

Surgery to remove a cancerous uterus is often supplemented with radiation therapy. Ionizing rays do not harm healthy structures. Radiation therapy after removal of the uterus and appendages is considered a gentle way to destroy remaining atypical structures and metastases. The procedure can be supplemented with chemotherapy and is prescribed at any stage of tumor development.

Why is it used and how is it done?

Radiation therapy is indicated in the following cases:

• to remove abnormal structures at the initial stages of the oncological process;
• for the comprehensive fight against uterine cancer;
• after removal of the uterus to prevent relapse of the disease;
• in advanced stages of uterine cancer, when surgery does not bring results.

Irradiation leads to disruption of the functioning of the ovaries, which causes premature cessation of menstruation. That's why radiation treatment patients is carried out with caution. In some cases, the ovaries are moved from the irradiated area to another location before the intervention. This reduces the risk of injury during the procedure.

The operation is performed sequentially:

1. The patient lies down on medical table, which has the ability to move in different directions. It is important that the woman remains motionless during the session. Otherwise, the rays will not reach the tumor and can damage healthy tissue.
2. Women who cannot stay in one position for a long time are secured with special belts.
3. After the last radiation therapy session, the patient undergoes additional diagnostic tests.
4. The doctor advises the patient about the features of the recovery period and gives recommendations for correcting nutrition and lifestyle.

During the procedure, women do not feel pain or discomfort

Types of radiation therapy

After surgery, ionizing radiation is prescribed for distant metastases and residual cancer cells. Surgery may also be indicated if there is a high risk of recurrence of the pathology after a hysterectomy. The intervention is performed remotely, intracavitary, contact.

In the first case, the radiation appears at a certain distance from the lesion. In the contact type of procedure, the device is attached to the patient’s skin. With the intracavitary method, atypical cells are removed by introducing a special device to the lesion.

Before radiation therapy, diagnostic measures are necessary. They allow you to accurately calculate the required radiation dose. The doctor informs the patient about the consequences of the intervention and prescribes medications to be taken during the rehabilitation period.

A balanced diet and following all the specialist’s recommendations will help you recover faster after surgery.

Preparation for the procedure

The specialist describes the treatment plan in detail, calculating the radiation dose per full course therapy and separately for each session. The doctor determines the duration of the course of treatment and the duration of one procedure. Before starting radiation therapy, the following preparatory procedures are performed:

• At the hospital, the patient is offered disposable clothing. If a woman wants to stay in her clothes, then she should take care of some nuances:

1. things should not fit the body or restrict movement;
2. the jacket must have an open collar.

• If necessary, the patient is fixed to the table using belts, mattresses and other fasteners. These measures are necessary in order to completely limit the patient’s movements during the intervention.
• Healthy tissues and organs are covered with special protective blocks to protect them from radiation exposure.
• Before the procedure, the doctor can take a control photo to assess the correct positioning of the woman relative to the medical device.

The first radiation therapy session will be the longest. The duration of each subsequent procedure is gradually reduced.

Patients should adhere to several basic rules before treatment:

• do not dry your hair with a hairdryer;
• hide irradiated areas under clothing when leaving home;
• stop using cosmetics and sunscreen for a while;
• minimize physical activity;
• try to go outside after sunset;
• consume enough fluid.

10 days before treatment, the patient needs to adjust her diet. At this time, pickled foods, carbonated and alcoholic drinks, spices, and spicy dishes are completely excluded. A week before radiation therapy, doctors recommend that a woman do breathing exercises and increase rest time.

List of other preparatory activities

Consequences of radiation

Radiation therapy provokes a number of negative consequences. These include:

1. Intoxication of the body, manifested by weakness and nausea.
2. Abnormal stool in the form of chronic diarrhea.
3. Skin irritation in the irradiation area and the appearance of red rashes on it.
4. Increased dryness of the vaginal mucous membranes.

Forecast

After removal of the reproductive organ, a woman will forever have to forget about reproductive function. But surgery performed in conjunction with radiation therapy gives a high probability full recovery. The success of treatment largely depends on the stage of the detected disease. The best results from treatment are achieved in the early stages of development pathological process. Complete healing from cancer is possible after 5-6 sessions of radiation therapy.

Radiotherapy equipment

Stop the spread of abnormal cells in stage 3 cancer with complex therapy It will be difficult, but at 4 it will be impossible. Radiation therapy in advanced cases is necessary to minimize pain and slow down the division of cancer cells.

After treatment, the woman is advised to undergo physiotherapeutic measures:

• balneotherapy;
• radio wave baths;
• acupuncture.

If radiation therapy provokes health problems, then the woman is given a disability group. Sexual activity is allowed only 2 months after the intervention.

Oncologists say that radiation therapy does not affect the psychological state and sexual desire women. Having sexual activity after surgical operation not contraindicated, but before starting sexual relations It is advisable to consult a gynecologist.

Radiation therapy after a hysterectomy is one way to reduce the risk of problems recurring. The procedure can be carried out remotely, intracavitary and contact. The intervention method and duration of therapy are determined by the doctor based on the characteristics of the oncology course.

Removal of the uterus is an operation called hysterectomy, which is prescribed for serious indications. There are different techniques and options for surgical intervention: with or without appendages, abdominal method or laparoscopy. Unfortunately, surgical procedures to remove the uterus are one of the leading operations in the field of gynecology. According to statistics, a third of women after 45 years undergo excision of an important organ. In most cases, such an operation is not only advisable, but can also save the patient’s life.

Indications for hysterectomy

Excision of important female organ does not always mean its total liquidation (extirpation). Sometimes doctors leave the cervix, ovaries and fallopian tubes during surgery. Removal of the organ is required when oncological processes in it or the appendages, massive bleeding that does not respond to conservative treatment, to stop the development of the septic process on the pelvic organs (purulent metroendometritis). More often, removal of the uterus occurs due to pathological processes that are not life-threatening to the woman.

Uterine fibroids

Leiomyoma, fibromyoma or myoma (fibrosis) of the uterus is benign education which occurs in the myometrium ( muscle layer) organ. This is the most common disease of women after 45 years of age, however, the doctor will never prescribe surgical intervention without serious reasons. A small tumor is treated and conservative methods, but sometimes it is impossible to do without surgery. If uterine fibroids are detected in at a young age, then gynecologists especially try to preserve a woman’s reproductive function.

In modern medicine, surgery to remove the uterus in the presence of fibroids is prescribed for the following pathologies:

• the neoplasm is localized on the neck of the organ;
• fibromatous nodes put pressure on neighboring tissues and organs, which causes constant pain in the patient;
• there is a risk of degeneration of a benign tumor into cancer;
• signs that the pedunculated fibroid will eventually undergo torsion, which will lead to necrosis;
• the development of fibroids occurs along with uterine prolapse or prolapse of the reproductive organ;
• the tumor has clear clinical manifestations, and the woman is in menopause;
• fibroids have reached a size exceeding 12 weeks of pregnancy.

Endometriosis

Chronic growth of the endometrium (glandular tissue) outside the uterus is called endometriosis. The pathology is also common, and can be located inside or outside the reproductive system. The vast majority of diseases are due to the internal course of the disease. Laparoscopic removal of the overgrown epithelium is mainly used, which preserves the uterus and other organs. If there is an aggressive course of the disease, persistent failure of drug treatment, or a risk of malignant degeneration, then doctors may insist on performing a hysterectomy.

Cervical or ovarian cancer

Removing the uterus for cancer saves the patient's life. As a rule, in case of oncology, in addition to surgery, additional radiotherapy or chemotherapy is prescribed. For cancer, a radical hysterectomy is recommended, that is, not only the uterus is removed, but also the cervix, ovaries, upper part of the vagina, fallopian tubes and tissues with lymph nodes in this area. The early stage of oncology makes it possible to perform a more gentle operation while preserving the woman’s reproductive function: removal of 2/3 of the cervix while preserving the internal os and other organs, so that it is possible to become pregnant and give birth.

Necrosis of fibromatous nodes

The most serious complication of uterine fibroids is necrosis of the fibromatous node. The disease is a malnutrition of its tissues, which causes swelling and severe pain. When palpating the node painful sensations intensify, vomiting, irritation of the peritoneum appears, and the temperature rises. In case of infection general phenomena are intensifying. The indication for surgery is to establish a diagnosis. The extent of the operation is decided individually, depending on age and general condition sick.

Prolapse or prolapse of the uterus

Loss or prolapse of the genital organs in a woman occurs when the muscles of the pelvis or peritoneum are weakened. The pathology develops due to hard work, multiple births, endocrine disorders or chronic inflammation. At the initial stage of the disease, therapy is aimed at strengthening weak muscle groups. Hysterectomy is considered, although radical, but the most effective option solving the problem. There are two options: excision of the uterus and upper part of the vagina or partial removal vagina, which preserves the possibility of sexual activity.

Preparing for hysterectomy surgery

How to prepare for surgery? Since a hysterectomy is performed under anesthesia and takes a lot of time, removal of the uterus requires special preparation. Before performing an operation, the gynecologist must study the patient’s medical history, know about infectious and chronic diseases, allergies and the possibility of anesthesia. The entire complex of preparation for the operation includes medical examination, bowel cleansing, treatment of inflammation, taking medications and psychological correction.

Patient examination

Before performing a hysterectomy, a gynecological and general examination of the patient is performed. Laboratory diagnostics includes biochemical and clinical tests blood on:

• HIV antibodies;
• sexually transmitted diseases (chlamydia, syphilis);
• infectious hepatitis;
• levels of hormones, minerals, sugar;
• blood clotting;
• Rh factor and group.

ECG, spirography, tonometry, and chest radiography are also performed. If a pathology of the nervous system, kidneys, respiratory organs or heart is detected, the patient is referred for further examination to other specialists. Gynecological diagnostics includes examination of the vagina and uterus, ultrasound of the pelvis. If cancer is suspected, a woman is sent for MRI, biopsy and histology. It is important to timely identify infections in the urinary and genital tract before removing the uterus.

Bowel preparation

Before any surgical procedure, the intestines should be cleansed. To do this, three days before the operation, doctors prescribe special diet, which does not contain coarse fiber and toxins. Rye bread, legumes, fruits and vegetables should be excluded from the diet. On the evening before the hysterectomy, it is advisable not to eat; in extreme cases, you are allowed to have dinner with low-fat cottage cheese, yogurt or kefir 8 hours before hospitalization.

You should not cleanse the intestines yourself before removing the uterus, since active peristalsis can interfere with normal conduct operations. On the day of surgery, you should not eat or drink anything to avoid vomiting during anesthesia.

Medication preparation

If a woman does not have infections and pathologies of other organs, then she does not need medication preparation before removal of the uterus. Infections are treated and prescribed antibacterial drugs upon detection of the following diseases:

• colds and viral infections;
• endocrine pathologies (diabetes);
• neurological diseases;
• disturbances in the functioning of the kidneys, respiratory organs, and cardiovascular system.

An extremely important procedure before surgery is the preparation of the veins. Even if not varicose veins or chronic thrombophlebitis, blood stagnation may occur after surgery due to increased venous pressure. Such a process can result in serious complications, including the separation of a section of a blood clot and its entry into the vessels of the brain or lung. Before undergoing surgery to remove the uterus, the patient should definitely consult a phlebologist or vascular surgeon. During a hysterectomy, compression is applied to the veins using elastic bands.

Psychological support

Recovery after surgery is a long process, and hysterectomy is stressful for any woman. The younger the patient, the more psychological trauma. The role of the doctor in in this case– explain the need for such an intervention, why it cannot be avoided, talk about the course of the operation and the chosen option of excision.

Many women fear that after removal of the uterus they will have problems with their partner or will lose their health completely. sexual function. Practice shows that after rehabilitation a woman is only deprived of the function of childbearing, but she continues to experience a desire for sex. For reasons of medical ethics, the doctor will advise not to inform the man about the extent of the hysterectomy.

Progress of the operation

How is a hysterectomy performed? A hysterectomy begins with the surgeon choosing the scope and approach. As already mentioned, either the entire uterus with appendages is removed, or only part of it. Depending on the surgical approach, the following types of hysterectomy are distinguished:

1. Removal of the uterus through the vagina.
2. Supravaginal (subtotal).
3. Laparastoscopic with instruments.
4. Laparoscopic by da Vinci robot.
5. Open removal (abdominal surgery).

Surgery to remove the uterus begins with the administration of anesthesia. Anesthesia is used depending on the woman's body weight, age, general health and the duration of the operation. IN general anesthesia are administered to all patients, regardless of the chosen intervention technique, to completely relax the abdominal wall muscles.

Abdominal surgery

During abdominal surgery, a surgical incision is made in the lower abdomen to access the uterus. The incisions can be vertical and horizontal from 10 to 15 cm. The good thing about this technique is that the surgeon can clearly see the organs and determine the condition of the tissues. Abdominal hysterectomy is used when large adhesions or polyps appear, an enlarged uterus, endometriosis or cancer. The disadvantages of the technique are long recovery, serious condition after the intervention, and a scar from the incision.

Laparoscopic

Laparoscopic surgery is considered the most gentle type of hysterectomy. The intervention is performed without incisions on the abdomen - the doctor uses special instruments for punctures. First in abdominal cavity A cannula (tube) is inserted through which gas passes. This is necessary so that the abdominal wall is raised and the surgeon has free access to the uterus. Next, tubes are used that are inserted into the abdominal cavity through punctures, and then a video camera and surgical instruments are lowered through them to perform the removal. The advantage of the method is small incisions and a faster postoperative period.

Vaginal

The main feature of vaginal hysterectomy is that it is performed in a way convenient for the woman - after the operation there are no scars or stitches left on the body. After vaginal removal of the uterus, the patient recovers quickly, and rapid emotional rehabilitation occurs. Unfortunately, only a third of patients are operated on in this way, since there are many contraindications:

• large size of the uterus;
• C-section;
• malignant tumors;
• combined pathologies;
• acute inflammation of other organs and systems.

Duration

How long does a hysterectomy surgery take? The average duration of laparoscopic hysterectomy is 1.5 – 3.5 hours. Cavity removal surgery of the uterus lasts from 40 minutes to 2 hours, depending on the complexity of the surgical intervention. The duration of a vaginal hysterectomy is no more than two hours if the procedure goes without complications.

Postoperative period

Any surgical intervention is to varying degrees injuries caused by damage to tissues and blood vessels. After removal of the uterus, time is required for full recovery body. The scheme and duration of rehabilitation measures always depends on the severity of the disease, the characteristics of the female body, the type of operation, and postoperative complications. To correct health in the postoperative period, a whole range of rehabilitation measures has been developed. Its main components are physical therapy, proper nutrition, and hormonal support.

Recovery and rehabilitation

The postoperative recovery period after removal of the uterus includes the time period from surgery to full functionality and the beginning of sexual activity. Rehabilitation is divided into two stages: early and late. With a successful hysterectomy abdominal type early period lasts from 9 to 12 days, after which the patient’s stitches are removed and then discharged from the hospital.

After laparoscopic intervention, early rehabilitation is 3.5 – 5 days. During this period, bleeding and other symptoms, including possible infection, are eliminated. After a vaginal hysterectomy, if there were no complications during the operation, the patient is discharged from the hospital after a week. The late stage of recovery takes place at home with regular consultations with a doctor. On average, the stage lasts about a month. At this stage, the immune system is strengthened, the woman’s performance and psychological state are restored.

Nutrition after surgery

After surgery to remove the uterus, you should follow the recommendations aimed at improving the functioning of the gastrointestinal tract:

• Eat at least 6-7 meals in small portions.
• Drink two liters of plain water daily.
• Eat food in a liquid or semi-liquid state.

It is necessary to introduce porridge into the diet in crumbly form, and sea ​​fish and lean meat - only boiled. Low-fat meat broths are allowed to be consumed dairy products, vegetables (beans, potatoes and cabbage - carefully), vegetable salads with vegetable oil, vegetable puree. We recommend fresh herbs, dried fruits, walnuts. You can drink pomegranate juice, green tea.

Prohibited Products:

• liquid porridge;
• mushrooms;
• baked goods, white bread;
• confectionery;
• fried, fatty, spicy foods;
• semi-finished products;
• smoked meats;
• black tea, coffee;
• carbonated drinks;
• Limit salt intake to prevent fluid retention.

Physical exercise

After removal of the uterus, weights should not be lifted for 1.5 - 2 months. Sexual activity is not recommended for 6 weeks after a hysterectomy. Doctors advise playing sports, visiting the pool and sauna no earlier than six months after abdominal surgery when the scar is finally formed. Charge for recovery physical activity should be performed daily without straining. To avoid urinary problems to restore normal function genitourinary system Kegel exercises are shown.

Having a hysterectomy changes a woman's lifestyle. To successfully recover after hysterectomy, doctors recommend paying attention to the following points:

1. Bandage. Especially recommended for postmenopausal patients who have had multiple births.
2. Sex. Sexual life is prohibited for 4-6 weeks, since discharge continues during this period.
3. Special exercises. There is a perineal meter - a special simulator for strengthening the muscles of the pelvic floor and vagina. It ensures the effectiveness of intimate gymnastics.
4. Tampons. While there is discharge, pads should be used. Tampons are allowed only 2-2.5 months after hysterectomy.
5. Nutrition. Important has healthy food. Most meals should be consumed before 16:00.
6. Sick leave. The period of disability is 30-45 days for hysterectomy. In case of complications, sick leave is extended.

Possible postoperative complications and consequences

Complications after hysterectomy surgery are rare, but in order to seek help in time, you need to be aware of them. In the first days after a hysterectomy, the following deterioration of the condition is possible:

• suture dehiscence or inflammation of the scar with purulent discharge;
• difficulty urinating (soreness, pain) or urinary incontinence;
• varying intensity of bleeding (internal or external);
• thrombosis or thromboembolism pulmonary artery, leading to blockage of branches, which can be fatal;
• inflammation of the peritoneum (peritonitis), which can cause sepsis;
• hematomas in the suture area;
• discharge with an unpleasant odor and clots.

If the suture becomes infected, the patient’s temperature rises to 38 degrees. To stop this complication, antibiotics are sufficient. Peritonitis is more likely to develop if a woman has had an emergency hysterectomy. In this case pain syndrome pronounced, therefore antibiotic therapy and infusion of colloidal solutions are carried out. Repeat surgery may be required to remove the uterine stump and rinse the abdominal cavity with antiseptics.

In the following months, menopause sets in, which in such a situation is difficult. Most women experience burning and dryness in the vagina, hot flashes, discomfort in the genital area, and anxiety. This is due to hormonal changes when female body stops producing estrogens, as a result of which the vaginal mucosa becomes thinner and loses lubrication. Sexual intercourse in this condition can be painful, so a woman’s desire for sex decreases.

Cost of the operation

How much does a hysterectomy cost? The price of a hysterectomy depends on several factors: the level of the hospital, the skill of the surgeon, the extent of the operation, the region and the length of hospital stay. The cost of the operation is also affected by the method of surgical intervention. In private clinics in Moscow, laparoscopy will cost from 16 to 90 thousand rubles. Carrying out an abdominal or vaginal hysterectomy will cost from 20 to 80 thousand rubles. A similar operation to remove the uterus in Israel will cost from 12 thousand dollars.

Historically, medicine has established the opinion that the uterus is needed only for bearing a child. Therefore, if a woman does not plan to give birth, she can safely resort to surgery.

Is this really true or not? Why, for example, in March 2015, Angelina Jolie had both ovaries and fallopian tubes removed, but left an “unnecessary” uterus? Let's find out together whether hysterectomy is dangerous. And if it’s dangerous, then with what.

From a surgeon's point of view, radical surgery solves the issue “at its root”: no organ – no problem. But in fact, surgeons’ recommendations cannot always be perceived as objective. They often do not follow up with patients after discharge, do not conduct examinations six months, a year, 2 years after removal of the uterus, and do not record complaints. Surgeons only operate and rarely face the consequences of the operation, so they often have a false idea about the safety of this operation.

Meanwhile, scientists different countries independently conducted a series of observations. They found that within five years after hysterectomy, most women developed:

1. (previously absent) pelvic pain of varying intensity,

2. problems with the intestines,

3. urinary incontinence,

4. vaginal prolapse and prolapse,

5. depression and depression, up to serious mental disorders,

6. emotional and physiological problems in a relationship with a spouse,

7. Some women who were operated on for severe dysplasia or in situ cancer experienced a recurrence of the disease - damage to the stump area and vaginal vault.

8. fatigue,

9. steady increase blood pressure and other serious cardiovascular problems.

The problem is not invented, because according to the data Science Center obstetrics, gynecology and perinatology of the Russian Academy of Medical Sciences, various operations Removal of the uterus accounts for from 32 to 38.2% of all abdominal gynecological operations. In Russia, this is about 1,000,000 uterus removed annually!

The problem also has another side. Since all of these complications develop gradually, over the course of a year or several years after surgery, women do not associate the deterioration in their quality of life with the previous operation.

I am writing this material so that you can evaluate for yourselfall the pros and cons of the operation, weigh the pros and cons,and make your choice consciously.

My practice shows that extra organs can not be. Even in older women, removal of the uterus carries Negative consequences for health, and in the second part of the article I will dwell on them in detail.

Diagnoses that are no longer indications for hysterectomy

Thanks to the introduction of high-tech methods, some of the indications for genital removal have ceased to exist. absolute indications. Here is a list of diagnoses for which removal of the uterus in women can be replaced by other treatment methods and the organ can be saved.

1. Symptomatic, enlarged, rapidly growing uterine fibroids are today treated by embolization of the uterine arteries: the vessels feeding the fibroids are blocked. Subsequently, the fibroid gradually resolves.

2. Adenomyosis, or internal endometriosis, can be eliminated using a therapeutic method (PDT).

With endometriosis, cells in the inner lining of the uterus grow in unusual places. PDT specifically destroys these cells without affecting healthy tissue.

Photodynamic therapy is an organ-preserving treatment method that is part of federal standard providing medical care(see).

3. Precancerous condition of the endometrium -, – are also treatable using PDT. To date, I have successfully treated 2 patients with this pathology.

In cases where hyperplasia is predominantly viral in nature, treatment with PDT can eliminate the cause of the disease. In the treatment of cervical pathologies, the complete destruction of the human papillomavirus after one PDT session is confirmed in 94% of patients, and in 100% of patients after a second PDT session.

4. Precancerous conditions and oncological formations in the cervix. , and even microinvasive cancer can be completely cured using photodynamic therapy in 1 or 2 sessions.

The PDT method eliminates not only the disease itself, but also its cause – the human papillomavirus.

That's why correctly and completely performed photodynamic therapy is the only method that ensures lifelong recovery and minimal risk relapses (reinfection is possible only if reinfection HPV).

There is one more good news. Previously, a combination of age and several gynecological diagnoses was a compelling reason for organ removal. For example, a combination of cervical condylomas and uterine fibroids, or cervical dysplasia with adenomyosis against the background of a completed labor function.

To justify the removal of an organ, the surgeon usually does not give rational arguments, but refers to own experience or established opinion. But today (even if the attending physician tells you otherwise) a combination of several diagnoses is no longer a direct indication for removal of the uterus. Modern medicine considers each diagnosis as independent, and for each treatment tactics are determined individually.

For example, dysplasia and adenomyosis regress after photodynamic therapy. And the presence of multiple fibroids is not a reason for oncological alertness. Numerous observations in recent years show that fibroids are in no way associated with cancer, do not degenerate into a cancerous tumor, and are not even a risk factor.

In surgery, there is a concept of risks of therapeutic effects. The task of a good doctor is to minimize risks. When a doctor decides on treatment tactics, he is obliged to evaluate the indications, weigh the possible negative consequences of different treatment methods, and choose the most gentle and effective one.

By law, doctors must inform everyone possible methods treatment, but in practice this does not happen. Therefore, against the backdrop of the surgeon’s urgent recommendations for organ removal, I strongly advise you to consult several specialists or write me to evaluate the possibility of performing organ-conserving treatment that is suitable for you.

Unfortunately, not all diseases of the uterus can be treated with minimally invasive and therapeutic methods, and in some cases it is still better to remove the uterus. Such indications for removal are called absolute - that is, not requiring discussion.

Absolute indications for hysterectomy

1. Uterine fibroids with necrotic changes in the node. Preservation of an organ with such a diagnosis poses a threat to life.

2. Long lasting uterine bleeding that cannot be stopped by any other means. This condition is fraught with the loss of a large volume of blood and poses a serious danger to life.

3. Combination of large uterine fibroids and cicatricial deformation of the cervix.

4. Uterine prolapse.

5. Cancer, starting from stage I.

6. Giant size of tumors.

Depending on the indications, operations on the uterus are performed different methods and in different volumes. First, we will get acquainted with the types of surgical interventions. Then I will dwell in detail on the consequences that every woman will experience to one degree or another after the removal of this organ.

Types of hysterectomy operations

IN medical practice abdominal and endoscopic removal uterus.

• Cavity surgery(laparotomy) is performed through an incision on the anterior abdominal wall.
  The method is considered traumatic, but it provides great access and in some cases there is simply no alternative. For example, if the uterus has reached a large size due to fibroids.
• The second method is endoscopic surgery (laparoscopy). In this case, the surgeon removes the uterus through punctures in the anterior abdominal wall. Laparoscopic hysterectomy is much less traumatic and allows for faster recovery after surgery.
• Vaginal hysterectomy is the removal of the uterus through the vagina.

Consequences after abdominal hysterectomy surgery

Abdominal surgery to remove the uterus through a large incision is one of the most traumatic procedures. In addition to the complications caused directly by the removal of the uterus, such an operation has other negative consequences.

1. After the operation, a noticeable scar remains.

2. High probability formation of a hernia in the scar area.

3. Open surgery usually leads to the development of extensive adhesions in the pelvic area.

4. Rehabilitation and restoration (including performance) requires a lot of time, in some cases up to 45 days.

Removal of the uterus without the cervix. Consequences of supravaginal amputation of the uterus without appendages

Whether the cervix is ​​left or removed during a hysterectomy depends on the condition of the cervix and the risks associated with retaining it.

If the cervix is ​​left, this is the most favorable situation possible.

On the one hand, due to the preserved ovaries hormonal system continues to function more or less normally. But why do they leave the cervix when removing the uterus? Preserving the cervix allows you to maintain the length of the vagina, and after restoration the woman will be able to lead a full sex life.

Removal of the uterus without ovaries. Consequences of hysterectomy without appendages

Removal of the uterus without appendages, but with the cervix, is a more traumatic operation.

By leaving the ovaries, the surgeon allows the woman to maintain normal hormonal levels. If the operation is performed at a young age, the ovaries can avoid menopause and all associated health consequences.

But even after removal of the uterus without appendages, the anatomical relationship of the organs is disrupted. As a result, their function is impaired.

In addition, complete removal of the uterus, even with preservation of the ovaries, leads to shortening of the vagina. In many cases, this is not critical for sex life. But the anatomy of the organ is different for everyone, and not all women manage to adapt.

Removal of the uterus with appendages

This is the most traumatic operation that requires a lot of recovery time.

She needs serious hormonal correction and usually causes all the most severe consequences, especially if performed at the age of 40-50 years - that is, before the onset of natural menopause.

I will tell you more about the most common consequences of hysterectomy below. The most unpleasant thing is that all these consequences are irreversible and practically impossible to correct.

Meanwhile, a series of recent scientific research in this area says the opposite. Even if the ovaries are preserved, removal of the uterus is an operation with a high risk of endocrine disorders.

The reason is simple. The uterus is connected to the ovaries and tubes by a system of ligaments, nerve fibers and blood vessels. Any operation on the uterus leads to serious disruption of the blood supply to the ovaries, up to partial necrosis. Needless to say, in literally suffocating ovaries, the production of hormones is disrupted.

Hormonal imbalances manifest themselves in a whole string unpleasant symptoms, the most harmless of which is a decrease in libido.

In the vast majority of cases, the ovaries are not able to completely restore or compensate for normal blood supply. Accordingly, it is not restored and hormonal balance female body.

Consequence 2. Ovarian cysts after removal of the uterus

This is a fairly common complication in cases where the ovaries are preserved after removal of the uterus. This is how the negative impact of the operation itself manifests itself.

To understand the nature of the cyst, you must first understand how the ovaries work.

In fact, the cyst is natural process which occurs every month in the ovary under the influence of hormones and is called follicular cyst. If the egg is not fertilized, the cyst bursts and menstruation begins.

Now let's see what happens to the ovaries after removal of the uterus.

The uterus itself does not produce hormones. And many surgeons assure that after its removal the hormonal levels will not change. But they forget to say how closely the uterus is connected to other organs. When separating the ovaries from the uterus, the surgeon inevitably disrupts the blood supply and injures them. As a result, the functioning of the ovaries is disrupted, and their hormonal activity decreases.

Unlike the uterus, the ovaries produce hormones. Disturbances in the functioning of the ovaries lead to disruption of hormonal levels and the process of follicle maturation. The cyst does not resolve, but continues to grow.

It takes about 6 months to restore the full functioning of the ovaries and level out hormonal levels. But not always everything ends well, and the enlarged cyst resolves. Often, repeated surgery is required to remove an overgrown cyst - if large sizes formation there is a risk of rupture and bleeding.

If, several months after removal of the uterus, pain appears in the lower abdomen, which increases over time, you should visit a gynecologist. The most likely reason why the ovary hurts is an overgrown cyst.

The likelihood of developing this complication is only 50% dependent on the skill of the surgeon. Every woman's anatomy is unique. It is not possible to predict the location of the ovaries and their behavior before surgery, so no one can predict the development of a cyst after removal of the uterus.

Consequence 3. Adhesions after hysterectomy

Extensive adhesions after removal of the uterus often lead to the development of chronic pelvic pain. The characteristic symptoms of these pains are that they intensify with bloating, indigestion, peristalsis, sudden movements, and prolonged walking.

Adhesions after surgery to remove the uterus form gradually. Accordingly, pain appears only after some time.

At the initial stage postoperative adhesions in the small pelvis are treated conservatively; if ineffective, they resort to laparoscopic excision of adhesions.

Consequence 4. Weight after hysterectomy

Body weight after surgery can behave differently: some women gain weight, sometimes even gain weight, while others manage to lose weight.

The most common scenario after removal of reproductive organs is rapid weight gain, or a woman’s belly grows.

1. One of the reasons why women gain weight is due to metabolic disorders and the resulting fluid retention in the body. Therefore, strictly monitor how much water you drink and how much you excrete.

2. After removal of the uterus and ovaries, the hormonal levels change, which leads to a slowdown in the breakdown of fat, and the woman begins to gain excess weight.

In this case, a gentle diet will help to remove the belly. Meals should be fractional, small portions 6-7 times a day.

Should you worry if you have lost weight after having your hysterectomy? If the reason for the operation was a giant tumor or fibroid, there is no need to worry, you lost weight after removing the uterus.

If there was no mass formation, but you are losing weight, most likely it is a hormonal imbalance. To return your weight to normal, you will need hormone therapy.

Consequence 5. Sex after hysterectomy

Women who have undergone vaginal hysterectomy should observe sexual rest for at least 2 months until they heal. internal seams. In all other cases, sex can be had 1-1.5 months after the operation.

Sex life after removal of the uterus undergoes changes.

In general, women are concerned about vaginal dryness, burning after intercourse, discomfort, painful sensations. This occurs due to a drop in estrogen levels, which causes the genital mucosa to become thinner and begin to produce less lubricant. Hormonal imbalance reduces libido, decreases interest in sexual life.

• Removal of the uterus and appendages most strongly affects the intimate side of life, since the lack of female hormones leads to frigidity.
• Removal of the uterine body has little effect on intimate life. Vaginal dryness and decreased libido may occur.
• Removal of the uterus and cervix leads to shortening of the vagina, which makes sex difficult after surgery.

Consequence 6. Orgasm after hysterectomy

Does a woman have an orgasm after a hysterectomy?

On the one hand, all sensitive points - the G-spot and the clitoris - are preserved, and theoretically a woman retains the ability to experience orgasm even after removal of the organ.

But in reality, not every woman gets an orgasm after surgery.

Thus, when the ovaries are removed, the content of sex hormones in the body drops sharply, and many develop sexual coldness. A decrease in the production of sex hormones occurs even if the ovaries are preserved - for many reasons, after surgery, their activity is disrupted.

The best prognosis for orgasms is for those who still have a cervix.

The consequences after removal of the uterus and cervix are manifested in a shortening of the vagina by about a third. Full sexual intercourse often becomes impossible. Research conducted in this area has shown that the cervix is ​​of great importance in achieving vaginal orgasms, and when the cervix is ​​removed, achieving it becomes extremely difficult.

Consequence 7. Pain after hysterectomy

Pain is one of the main complaints after surgery.

1. B postoperative period pain in the lower abdomen may indicate a problem in the suture area or inflammation. In the first case, the stomach hurts along the seam. In the second case, the main symptom is joined heat.

2. If the lower abdomen hurts and swelling appears, you can suspect a hernia - a defect through which the peritoneum and intestinal loops extend under the skin.

3. Severe pain after surgery to remove the uterus, high fever, bad feeling signal pelvioperitonitis, hematoma or bleeding. Repeat surgery may be required to resolve the situation.

4. Pain in the heart indicates the possibility of development cardiovascular diseases.

A large Swedish study of 180,000 women found that hysterectomy significantly increases the risk of cardiovascular disease. coronary disease and stroke. Removing the ovaries further aggravates the situation.

5. If you are concerned about swelling of the legs or an increase in local skin temperature, you need to rule out thrombophlebitis of the veins of the pelvis or lower extremities.

6. Pain in the back, lower back, right side or left can be a symptom adhesive disease, cysts on the ovary and much more - it is better to consult a doctor.

Consequence 8. Prolapse after hysterectomy

After removal of the uterus, the anatomical location organs, muscles, nerves and blood vessels are injured, blood supply to the pelvic area is disrupted. The frame that supports the organs in a certain position ceases to perform its functions.

All this leads to displacement and omission internal organs– primarily the intestines and Bladder. Extensive adhesions aggravate the problem.

This is manifested by numerous increasing problems with the intestines and urinary incontinence with physical activity, coughing.

Consequence 9. Prolapse after hysterectomy

The same mechanisms cause the so-called genital prolapse - drooping of the vaginal walls and even their loss.

If in the postoperative period a woman begins to lift weights without waiting for full recovery, the situation worsens. Rising intra-abdominal pressure, the walls of the vagina are “pushed” out. For this reason, lifting weights is contraindicated even for healthy women.

When lowering, a woman has a feeling foreign object in the perineal area. Pain bothers me. Sex life becomes painful.

To reduce the symptoms of prolapse of the vaginal walls after removal of the uterus, special gymnastics are indicated. For example, Kegel exercises. Constipation also increases intra-abdominal pressure, so to prevent the process you will have to learn to monitor your intestinal function: bowel movements should be daily and stool should be soft.

Unfortunately, vaginal prolapse after hysterectomy cannot be treated.

Consequence 10. Intestines after hysterectomy

Intestinal problems after surgery are affected not only by the changed anatomy of the pelvis, but also by a massive adhesive process.

Intestinal function is disrupted, constipation, flatulence occur, various violations defecation, pain in the lower abdomen. To avoid intestinal problems, you must follow a diet.

You will have to learn to eat often, 6 - 8 times a day, in small portions.

What can you eat? Everything, with the exception of heavy food, products, causing bloating abdomen, stool retention.

Improves the condition of the pelvic organs and regular exercise.

Consequence 12. Urinary incontinence after hysterectomy

This syndrome develops in almost 100% of cases as a consequence of a violation of the integrity of the ligamentous and muscular framework during surgery. The bladder prolapses and the woman loses control of urination.

To restore bladder function, doctors recommend performing Kegel exercises, but even with exercise, the condition usually progresses.

Consequence 13. Relapse after hysterectomy

Uterine surgery is performed for various indications.

Unfortunately, the operation does not protect against relapse if the uterus was removed due to one of those diseases that are caused by the human papillomavirus, namely:

• leukoplakia of the cervix,
• stage 1A cervical or uterine cancer
• microinvasive cervical cancer, etc.

Regardless of the technique, surgery does not guarantee 100% recovery; it only removes the lesion. Traces of the human papillomavirus, which is the cause of all these diseases, remain in the vaginal mucosa. Once activated, the virus causes a relapse.

Of course, if there is no organ, then a relapse of the disease cannot occur either in the uterus or in its cervix. The cervical stump and the mucous membrane of the vaginal vault are subject to relapses - dysplasia of the vaginal stump develops.

Unfortunately, relapses are very difficult to treat classical methods. Medicine can only offer such patients traumatic methods. Removing the vagina is an extremely complex and traumatic operation, and the risks of radiation therapy are comparable to the risks of the disease itself.

According to various sources, relapses after surgery occur in 30 - 70% of cases. That is why, for the purpose of prevention, the Herzen Institute recommends performing photodynamic therapy of the vagina and cervical stump even after surgical removal uterus. Only eliminating the papilloma virus protects against the return of the disease.

This is the story of my patient Natalya, who faced a relapse of cancer of the vaginal stump after removal of the uterus.

“Well, I’ll start my sad story in order, with a happy ending. After giving birth at 38 years old and my daughter turning 1.5 years old, I had to go to work and I decided to see a gynecologist. In September 2012, there were no signs of sadness, but the tests were not reassuring - stage 1 cervical cancer. It was of course shock, panic, tears, sleepless nights. In oncology I passed all the tests, where the human papillomavirus genotype 16.18 was discovered.

The only thing our doctors offered me was expiration of the cervix and uterus, but I asked to leave the ovaries.

The postoperative period was very difficult both physically and mentally. In general, a vaginal stump remained, no matter how sad it may sound. In 2014, after 2 years, tests again show a not very good picture - then after six months, grade 2. They treated her with everything - all kinds of suppositories, antivirals, ointments.

In short, a lot of money was spent, and after a year and a half of treatment for this dysplasia, it went into the third stage and again cancer. What did our doctors offer me this time: photodynamics.

After reading about her, I was delighted and gave myself into their hands. And what do you think, what was the result of them? innovative technologies? And nothing has changed! Everything remained in its place. But I read so much about this method, studied various articles, I was especially attracted to the photodynamic method of Dr. Afanasyev M.S., and having compared the method and technology of treatment, I was surprised that everything that this doctor writes and tells was significantly different from how they did it me in our clinic. Starting from the ratio medicinal product per kilogram of my weight, the methodology itself, the questions they asked me. After photodynamics, I was forced to wear glasses for almost a month, sit at home with the curtains closed, and not lean out into the street. I had no doubt that they simply did not know how to do this procedure! I contacted Dr. Afanasyev M.S., bombarded him with questions, told my story and he offered his help. I thought and doubted for a long time.

My doctor suggested me radiation therapy, but knowing its consequences and the quality of life after this therapy, I still chose photodynamics again, but that Maxim Stanislavovich would give it to me.

Having gathered new strength, I flew to Moscow. The first impression of the clinic was, of course, pleasant, you feel like a person whom everyone cares about, attentiveness and responsiveness are the main qualities of these employees.

About the PDT procedure and recovery

The procedure itself took place under anesthesia, went away quickly, and in the evening I went to see my sister who was staying with me. I only wore glasses for three days. After 40 days I went for an initial examination to my clinic, but I had an eroded spot, apparently the healing was slow, but despite everything this - tests were good! The doctor prescribed healing suppositories. And when I came back after 3 weeks, the doctor gave me…….., everything healed, and I was very surprised - how did that happen! After all, during the entire practice of conducting photodynamics using their technology, there was not a single positive result! Now I will go for another examination in April. I am sure that everything will always be fine for me now!

This is my story. And I’m telling it to you so that you don’t give up, and during treatment choose the most gentle method of treatment, and not remove everything at once, apparently this is easier for our doctors. If I had found out about Maxim Stanislavovich earlier, I would have avoided these tears, a terrible operation, the consequences of which will strain my whole life! So think about it! No amount of money is worth our health! And most importantly, if you have the human papillomavirus of this particular genotype, which provokes cervical cancer under certain circumstances, you need to remove this cause. This is exactly what photodynamics does, but the technology and the doctor who does it must be masters of their craft. Who have extensive experience, scientific works and positive results in this area. And I think the only doctor who observes all this is Maxim Stanislavovich. Thank you very much Maxim Stanislavovich!!!”

The consequences described above after removal of the uterus concern different women to varying degrees. Young women of childbearing age have the hardest time undergoing hysterectomy.

Consequences of hysterectomy after 50 years

Surgery during menopause also does not greatly affect the health and well-being of a woman.

And if the operation was performed according to indications, then you made the right choice.

Consequences of hysterectomy after 40 years

If a woman did not have menopause before the operation, then during the recovery period it will be very difficult for her. Consequences of the operation in active childbearing age are tolerated much more acutely than at the age of natural menopause.

If the operation was caused by a huge fibroid or bleeding, removal of the uterus provides significant relief. Unfortunately, almost everything develops over time. long-term consequences, which we talked about above.

On medical language this condition is called post-hysterectomy and post-variectomy syndrome. It manifests itself as mood swings, hot flashes, arrhythmia, dizziness, weakness, and headache. The woman does not tolerate stress well and begins to get tired.

Within just a few months, sexual desire decreases and pain develops in the pelvic area. The skeletal system suffers - the level drops minerals, osteoporosis develops.

If hormonal levels are not corrected, aging will begin immediately after surgery: 5 years after hysterectomy, 55–69% of women operated on at the age of 39–46 years have a hormonal profile consistent with the postmenopausal one.

Surgery to remove uterine cancer is not necessary in its early stages

Uterine cancer is adenocarcinoma and carcinoma is a malignant process. The choice of treatment method and extent of intervention depends on the stage of the disease.

Previously, the initial stages of cancer (, microinvasive cancer) and precancerous diseases (,) were an indication for removal of the uterus. Unfortunately, cancer surgery does not eliminate the cause of the disease - the human papillomavirus - and therefore has a high rate of relapses.

Often, a person who learns about his diagnosis experiences real stress. Indeed, the word “cancer” frightens many and is a heavy blow, both for the cancer patient himself and for his loved ones.

It is no secret that any disease, not just cancer, is cured much faster if treatment is started in a timely manner, that is, at the first stage. Unfortunately, cancer is an insidious disease, and it is in its infancy that it cannot be detected. A person consults a doctor only when he feels severe pain when he rapidly loses weight, when he loses consciousness, or when he develops bleeding. Alas, cancer at the third and fourth stages is extremely rarely treatable, and the only thing a doctor can do is to alleviate suffering.

Yes, despite the fact that progress in medicine is obvious, it is not omnipotent... even the most talented doctor cannot help a person whose body is being destroyed before our eyes. In this case, the patient is discharged home to give him the opportunity to be with people close to him.

For terminally ill cancer patients, so-called symptomatic therapy is recommended, which is primarily patient care. The main goal of this therapy is not to prolong a person’s life, but to create the most comfortable conditions for him. A good solution would be to invite a professional nurse who can always provide the necessary assistance.

To care for a person suffering cancer, not only is required professional training, but also a lot of courage, since in the later stages of cancer a person often suffers from unbearable pain.

Painkillers should be given to cancer patients only as prescribed by a doctor; As a rule, the drug regimen is developed individually. Under no circumstances should you wait until the person is overcome by pain and only then give him the drug.

If the pain syndrome intensifies, you should give a one-time dose of the medicine additionally, and then return to the usual regimen.

Unfortunately, malignant tumor, formed in the uterus, is a real death sentence for many women, since uterine cancer can only be cured through surgery. But even in this case, no one can guarantee a complete recovery. “Sometimes after removal of uterine cancer they come back” - malignant cells can “make themselves known” again, which means that the woman will have to go under the surgeon’s scalpel again.

The danger of relapse lies in the fact that the undead enemy, the tumor, re-infects neighboring organs as well.

In the event of a relapse, oncologists try to do everything so that the woman can manage normal life. Preserving the ovaries, preserving the hormonal balance if possible - this is the main task, but, alas, for the second time the ovaries are often the object of attack of the insidious disease.

Of course, doctors try to immediately warn patients about the danger... but the fact of the matter is that cancer is an extremely unpredictable disease, and this is precisely the danger.
Perhaps the only recommendation for women is to take care of themselves and be attentive to their health. The phrase "all diseases develop on nervous soil"not just words.

Measured lifestyle balanced diet, and caution when walking are the basic safety requirements. In addition, there is no need to lift weights, and about smoking and alcoholic drinks should be completely forgotten forever. Nicotine and alcohol poison the body. And considering far from best condition ecology in modern cities, is it worth creating unnecessary problems for yourself?