Symptoms of cancer of the female uterus. Blood for tumor markers. Causes and mechanisms of development of uterine cancer

Uterine cancer is a malignant neoplasm that develops from the endometrium (cylindrical epithelium that covers the internal cavity of the reproductive organ).

In recent decades, there has been a steady increase in the incidence of cancer pathologies of the female genital area throughout the world, including such common ones as uterine cancer.

Among malignant neoplasms in women, this pathology ranks second, second only to breast cancer. According to statistics, today about 2-3% of women develop endometrial cancer during their lifetime.

Cancer of the uterine body can develop at any age, but it mainly affects women over 45 years of age (the average age of patients who first consulted a doctor about symptoms of endometrial cancer is 60 years).

To understand the causes and mechanisms of development of uterine cancer, consider the anatomy and physiology of the female reproductive organ.

Anatomy and physiology of the uterus

In front of the uterus, located deep in the pelvis, is the bladder, and behind is the rectum. This proximity causes the occurrence of urination and defecation disorders in the presence of pronounced pathological processes in the uterus.

The normal dimensions of the non-pregnant uterus are relatively small (length about 8 cm, width 4 cm and thickness up to 3 cm). The reproductive organ is pear-shaped; its structure consists of a fundus, a body and a neck.

From above, in the area of ​​the expanded fundus of the uterus, the fallopian tubes flow into the right and left, through which the egg enters the organ cavity from the ovary (as a rule, the process of fertilization occurs in the fallopian tube).
Downwards, the body of the uterus narrows and passes into a narrow canal - the cervix.

The uterus is pear-shaped and consists of three layers, such as:

• endometrium (inner epithelial layer);
• myometrium (the muscular lining of the uterus, the contractions of which ensure the birth of a child);
• parametrium (superficial shell).

The growth, flourishing and rejection of the functional layer of the endometrium are associated with cyclical changes in the level of female hormones in the blood, which are secreted by the female sex glands - the ovaries.

The production of hormones is controlled by a complex neuro-endocrine regulation system, therefore any nervous or endocrine disorders in the female body have a detrimental effect on the functioning of the endometrium and can cause serious diseases, including uterine cancer.

What factors increase the risk of developing uterine cancer?

• unfavorable heredity (presence of endometrial cancer, ovarian cancer, breast or colon cancer in close relatives);
• late menopause;
• no history of pregnancy;
• ovarian tumors that produce estrogen;
• treatment of breast cancer with tamoxifen;
• long-term oral contraception using dimethisterone;
• estrogen replacement therapy;
• irradiation of the pelvic organs.

Causes and mechanisms of development of uterine cancer

Hormone-dependent endometrial cancer– the most common form of the disease (about 70% of all cases of diagnosed pathology), which develops due to increased stimulation of the epithelium of the uterine cavity by female sex hormones - estrogens.

An increased content of estrogen is often observed in metabolic and neuroendocrine disorders, therefore, risk factors for the development of hormone-dependent endometrial cancer include diabetes mellitus, obesity and hypertension (the combination of these pathologies is especially dangerous).

Clinically, hyperestrogenism is manifested by the following symptoms:

• menstrual irregularities with uterine bleeding;
• hyperplastic processes in the ovaries (follicular cysts, stromal hyperplasia, etc.);
• infertility;
• late onset of menopause.

In addition, significant hyperestrogenism is observed with hormone-producing ovarian tumors, hyperplasia or adenoma of the adrenal cortex, as well as with the artificial introduction of estrogens into the body (treatment of malignant breast tumors with tamoxifen, estrogen replacement therapy in postmenopause, etc.).

As a rule, hormone-dependent malignant endometrial tumors are highly differentiated and therefore characterized by slow growth and a relatively low tendency to metastasize. Primary multiple development of malignant tumors (in the ovaries, in the mammary gland, in the rectum) often occurs.
The development of hormone-dependent endometrial cancer can be divided into several stages:

• functional disorders associated with hyperestrogenism (menstrual irregularities, uterine bleeding);
• benign hyperplasia (growth) of the endometrium;
• precancerous conditions (atypical hyperplasia with stage III epithelial dysplasia);
• development of a malignant tumor.

The mechanisms of development of autonomous endometrial cancer are still not fully understood. Today, many experts associate the occurrence of pathology with profound disorders in the immune system.

Autonomous cancer of the uterine body is often represented by poorly differentiated and undifferentiated tumors. Therefore, the course of this pathogenetic variant is less favorable: such tumors are characterized by faster growth and metastasize earlier.

How is the stage of uterine cancer determined?

Stage zero (0) is considered to be atypical endometrial hyperplasia, which, as has already been proven, will inevitably lead to the development of a malignant tumor.

The first stage (IA-C) is said to occur when the tumor is limited to the body of the uterus. In such cases there are:

• Stage IA – the tumor does not grow deep into the myometrium, being limited to the epithelial layer;
• Stage IV – the tumor penetrates the muscular layer of the uterus, but does not reach the middle of its thickness;
• Stage ІС – carcinoma grows through half of the muscular layer or more, but does not reach the serous membrane.

At the second stage, endometrial cancer grows into the cervix, but does not spread beyond the organ. In this case they share:

• Stage ІІА, when only the glands of the cervix are involved in the process;
• Stage II, when the stroma of the cervix is ​​affected.

• Stage III, when carcinoma grows into the outer serosa of the uterus and/or affects the uterine appendages;
• Stage III, when there are metastases in the vagina;
• Stage III, when metastases have occurred in nearby lymph nodes.

In addition, there is still a generally accepted International classification system TNM, which allows you to simultaneously reflect in the diagnosis the size of the primary tumor (T), tumor involvement of the lymph nodes (N) and the presence of distant metastases (M).

The size of the primary tumor can be characterized by the following indicators:

• T is - corresponds to the zero stage of FIGO;
• T 0 – the tumor is not detected (completely removed during the diagnostic study);
• T 1a – carcinoma is limited to the body of the uterus, with the uterine cavity not exceeding 8 cm in length;
• T 1b – carcinoma is limited to the body of the uterus, but the uterine cavity exceeds 8 cm in length;
• T 2 – the tumor spreads to the cervix, but does not extend beyond the organ;
• T 3 – the tumor extends beyond the organ, but does not grow into the bladder or rectum and remains within the pelvis;
• T 4 – the tumor grows into the rectum or bladder and/or extends beyond the pelvis.

• M 0 (N 0) – no signs of metastases (damage to lymph nodes);
• M 1 (N 1) – metastases detected (affected lymph nodes detected);
• M x (N x) – there is not enough data to judge metastases (tumor damage to the lymph nodes).

N 0 M 0 - means that we are talking about a tumor limited to the body of the uterus, the uterine cavity does not exceed 8 cm in length, the lymph nodes are not affected, there are no distant metastases (stage I according to FIGO).

In addition to the above classifications, the G index is often given, characterizing the degree of tumor differentiation:

• G 1 – high degree of differentiation;
• G 2 – moderate degree of differentiation;
• G 3 – low degree of differentiation.

How does uterine cancer metastasize?

As a rule, metastases of uterine cancer appear in the lymph nodes first. The fact is that lymph nodes are a kind of filters through which interstitial fluid passes.

Thus, the lymph nodes act as a barrier to tumor spread. However, if the “filter” is significantly contaminated, the tumor cells settled in the lymph nodes begin to multiply, forming metastases.
In the future, it is possible for malignant cells to spread from the affected lymph node to more distant parts of the lymphatic system (inguinal lymph nodes, lymph nodes near the aorta, etc.).

Cancer of the uterine body begins to spread hematogenously, when the tumor grows into the blood vessels of the organ. In such cases, individual malignant cells are transported through the bloodstream to distant organs and tissues.

Most often, hematogenous metastases in uterine cancer are found in the lungs (more than 25% of all types of metastases), ovaries (7.5%) and bone tissue (4%). Less commonly, foci of malignant tumors are found in the liver, kidneys and brain.

The uterine cavity communicates with the abdominal cavity through the fallopian tubes, so the appearance of implantation metastases is possible even before the primary tumor invades the serous membrane of the uterus. The detection of malignant cells in the abdominal cavity is an unfavorable prognostic sign.

What factors influence the ability of uterine cancer to metastasize?

• localization of the tumor in the uterine cavity (the risk of developing metastases ranges from 2% when localized in the upper-posterior part of the uterus to 20% when localized in the infero-posterior part);
• age of the patient (in patients under 30 years of age, metastases practically do not occur; at the age of 40-50 years, the probability of developing metastases is about 6%, and in women over 70 years old - 15.4%);
• pathogenetic variant of uterine cancer (with a hormone-dependent tumor - less than 9%, with an autonomous tumor - more than 13%);
• degree of differentiation of a malignant tumor (for highly differentiated tumors - about 4%, for poorly differentiated tumors - up to 26%).

What are the symptoms of uterine cancer?

The clinical picture of uterine cancer differs between women of reproductive and non-reproductive age. The fact is that acyclic bleeding of varying degrees of severity (scanty, spotting, copious) occurs in approximately 90% of cases of this pathology.

If the patient has not yet reached menopause, then the initial stages of the pathology can be diagnosed by suspecting the presence of a malignant process due to menstrual irregularities.

However, acyclic uterine bleeding in women of reproductive age is nonspecific and occurs in various diseases (ovarian pathology, disorders of neuroendocrine regulation, etc.), so the correct diagnosis is often made late.

Uterine bleeding.
The appearance of uterine bleeding in postmenopausal women is a classic symptom of uterine cancer, so in such cases, as a rule, the disease can be detected at relatively early stages of development.

Beli
These discharges characterize another characteristic symptom of uterine cancer, which most often appears when the primary tumor is of significant size. In some cases, the discharge may be heavy (leukorrhea). The accumulation of leucorrhoea in the uterine cavity causes nagging pain in the lower abdomen, reminiscent of pain during menstruation.

Purulent discharge
With cervical stenosis, suppuration of leucorrhoea can occur with the formation of pyometra (accumulation of pus in the uterine cavity). In such cases, a characteristic picture develops (bursting pain, increased body temperature with chills, deterioration in the patient’s general condition).

Watery discharge
Abundant watery leucorrhoea is most specific for uterine cancer; however, as clinical experience shows, a malignant tumor can also manifest itself as bloody, bloody-purulent or purulent discharge, which, as a rule, indicates a secondary infection. As the tumor disintegrates, the leucorrhoea takes on the appearance of meat slop and an unpleasant odor. Pain unrelated to bleeding and leukorrhea appears already in the later stages of development of uterine cancer. When a tumor grows into the serous membrane of the genital organ, a pain syndrome of a gnawing nature occurs; in such cases, as a rule, the pain often bothers patients at night.

Pain
Often, pain syndrome appears in a widespread process with multiple infiltrates in the pelvis. If the tumor compresses the ureter, lower back pain appears, and attacks of renal colic may develop.

With a significant size of the primary tumor, pain is combined with disturbances in urination and defecation, such as:

• pain when urinating or defecating;
• frequent painful urge to urinate, which is often of an orderly nature;
• tenesmus (painful urge to defecate, usually not resulting in the release of feces).

What diagnostic procedures are necessary to undergo if uterine cancer is suspected?

• establishing a diagnosis of malignant neoplasm;
• determining the exact location of the primary tumor;
• assessment of the stage of disease development (prevalence of the tumor process, the presence of tumor-affected lymph nodes and distant metastases);
• determining the degree of differentiation of tumor tissue;
• study of the general condition of the body (the presence of complications and concomitant diseases that may be contraindications to one or another type of treatment).

Gynecological examination
The doctor then conducts an examination on a gynecological chair using mirrors. Such an examination allows us to exclude the presence of malignant neoplasms of the cervix and vagina, which often have similar symptoms (spotting, leucorrhoea, aching pain in the lower abdomen).

After conducting a two-manual vaginal-abdominal wall examination, it will be possible to judge the size of the uterus, the condition of the fallopian tubes and ovaries, and the presence of pathological infiltrates (seals) in the pelvis. It should be noted that this examination will not detect pathology in the early stages of the disease.

Aspiration biopsy
The presence of a malignant neoplasm in the uterine cavity can be confirmed using aspiration biopsy, which is performed on an outpatient basis.

In women of reproductive age, manipulation is performed on the 25-26th day of the menstrual cycle, and in postmenopausal women - on any day. Aspiration is performed without dilating the uterine canal. This is a minimally invasive (low-traumatic) and absolutely painless technique.

Using a special tip, a catheter is inserted into the uterine cavity, through which the contents of the uterus are aspirated (sucked in with a syringe) into a Brown syringe.

Unfortunately, the method is not sensitive enough for the early stages of uterine cancer (it detects pathology in only 37% of cases), but with common processes this figure is much higher (more than 90%).

Ultrasound
The leading method in diagnosing uterine cancer today is ultrasonography, which detects malignant neoplasms in the early stages of development and allows you to determine:

• precise localization of the tumor in the uterine cavity;
• type of tumor growth (exophytic - into the uterine cavity or endophytic - germination into the wall of the organ);
• the depth of tumor growth into the muscular layer of the uterus;
• the spread of the process to the cervix and surrounding tissue;
• defeat by the tumor process of the uterine appendages.

Therefore, if a common process is suspected, ultrasound data are supplemented with the results computer or magnetic resonance imaging, which allow us to judge with extreme accuracy the condition of the organs and structures of the pelvis.

Hysteroscopy
The list of mandatory tests for suspected uterine cancer includes hysteroscopy with targeted biopsy. Using an endoscope, the doctor examines the inner surface of the uterus and collects tumor tissue for histological examination. The accuracy of such a study reaches 100%, in contrast to other methods of obtaining material to determine tumor differentiation.

In the early stages of the disease, such a new promising method of endoscopic diagnosis as fluorescence study using tumor-tropic photosensitizers or their metabolites (aminolevulinic acid, etc.). This method makes it possible to detect microscopic neoplasms up to 1 mm in size using the preliminary introduction of photosensitizers that accumulate in tumor cells.

Hysteroscopy is usually accompanied by separate gynecological curettage of the uterus. First, the epithelium of the cervical canal is scraped, and then fractional curettage of the uterine cavity is performed. Such a study makes it possible to obtain data on the state of the epithelium of various parts of the uterine cavity and cervical canal and has a fairly high diagnostic accuracy.

All patients with suspected uterine cancer undergo general examination of the body, to obtain information about contraindications to a particular method of treating a malignant tumor. The examination plan is drawn up individually and depends on the presence of concomitant pathologies.

If the presence of distant metastases is suspected, additional studies are performed (ultrasound of the kidneys, x-ray of the chest organs, etc.).

When is surgical treatment of uterine cancer indicated?

The surgical method is the main method in the treatment of uterine cancer in the early stages of development, with the exception of cases of severe concomitant pathology, when such intervention is contraindicated. According to statistics, about 13% of patients suffering from uterine cancer have contraindications to surgery.

The scope and method of surgical intervention for uterine cancer is determined by the following main factors:

• stage of tumor development;
• degree of differentiation of tumor cells;
• patient's age;
• presence of concomitant diseases.

Are organ-conserving surgeries performed for uterine cancer?

In young women with atypical endometrial aplasia (FIGO stage zero), endometrial ablation.

In addition, this manipulation may be indicated in selected cases of stage 1A disease (endometrial tumor that does not spread beyond the mucous membrane) and in elderly patients with severe concomitant diseases that prevent a more traumatic intervention.
Endometrial ablation is the total removal of the uterine mucosa along with its basal germinal layer and the adjacent surface of the muscular layer (3-4 mm of myometrium) using controlled thermal, electrical or laser effects.

The removed uterine mucosa is not restored, therefore, after endometrial ablation, secondary amenorrhea (absence of menstrual bleeding) is observed, and the woman loses her ability to bear children.

Also in young women in the early stages of developing uterine cancer During hysterectomy surgery, the ovaries can be preserved(only the uterus with fallopian tubes is removed). In such cases, the female reproductive glands are preserved to prevent the early development of menopausal disorders.

What is hysterectomy surgery and how does it differ from hysterectomy?

• the operation is more easily tolerated by patients;
• ligamentous material is preserved, which prevents prolapse of the internal pelvic organs;
• lower likelihood of developing complications from the urinary system;
• Violations in the sexual sphere are less common.

Hysterectomy
Hysterectomy or total hysterectomy is the removal of the uterus along with the cervix. The standard scope of surgery for stage I uterine cancer according to FIGO (the tumor is limited to the body of the uterus) is removal of the uterus along with the cervix and appendages.

At the second stage of the disease, when the likelihood of malignant cells spreading through the lymphatic vessels is increased, the operation is supplemented with bilateral lymphadenectomy (removal of the pelvic lymph nodes) with a biopsy of the para-aortic lymph nodes (to exclude the presence of metastases in the lymph nodes located near the aorta).

What is open (classical, abdominal), vaginal and laparoscopic hysterectomy?

Abdominal access allows surgical interventions of varying volumes (from supravaginal amputation of the uterus to total hysterectomy with removal of the uterine appendages and lymph nodes).
The disadvantage of the classical technique is the increased traumatic nature of the operation for the patient and a fairly large scar on the abdomen.

A vaginal hysterectomy is the removal of the uterus through the back wall of the vagina. Such access is possible in women who have given birth and with small tumor sizes.

Vaginal hysterectomy is much easier to tolerate by the patient, but a significant disadvantage of the method is that the surgeon is forced to act almost blindly.

This disadvantage is completely eliminated with the laparoscopic method. In such cases, the operation is performed using special equipment. First, gas is injected into the abdominal cavity so that the surgeon can gain normal access to the uterus, then laparoscopic instruments to remove the uterus and a video camera are inserted into the abdominal cavity through small incisions.

Doctors monitor the entire course of the operation on a monitor, which ensures maximum accuracy of their actions and safety of the operation. The uterus is removed through the vagina or through a small incision in the front wall of the abdomen.

Using the laparoscopic method, any volume of surgery can be performed. This method is optimal because it is best tolerated by patients. In addition, complications are significantly less common with laparoscopic hysterectomy.

When is radiation therapy for uterine cancer indicated?

Indications for radiation therapy may include the following conditions:

• transition of the tumor to the cervix, vagina or surrounding tissue;
• malignant tumors with a low degree of differentiation;
• tumors with deep damage to the myometrium and/or with spread of the process to the uterine appendages.

How is radiation therapy performed for uterine cancer?

Internal irradiation is carried out in a hospital, in which special granules are inserted into the vagina, which are fixed with an applicator and become a source of radiation.

According to indications, combined internal and external irradiation is possible.

What side effects occur during radiation therapy for uterine cancer?

However, some patients do experience some side effects, such as:

• diarrhea;
• frequent urination;
• pain during urination;
• weakness, increased fatigue.

When is hormone therapy for uterine cancer indicated?

In such cases, antiestrogens (substances that somehow suppress the activity of female sex hormones - estrogens), gestagens (analogs of female sex hormones - estrogen antagonists) or a combination of antiestrogens and gestagens are prescribed.

As an independent treatment method, hormone therapy is prescribed to young women in the initial stages of highly differentiated hormone-sensitive uterine cancer, as well as in the case of atypical endometrial hyperplasia.

In such situations, hormone therapy is carried out in several stages. The goal of the first stage is to achieve complete healing from oncological pathology, which must be confirmed endoscopically (endometrial atrophy).
At the second stage, using combined oral contraceptives, menstrual function is restored. In the future, they achieve complete rehabilitation of ovarian function and restoration of fertility (ability to bear children) according to an individual scheme.

In addition, hormone therapy is combined with other methods of treating uterine cancer for common forms of hormone-sensitive uterine cancer.

What side effects can occur during hormone therapy for uterine cancer?

Hormonal changes can cause dysfunction of the central nervous system, in particular sleep disturbances, headaches, increased fatigue, and decreased emotional levels. For this reason, this type of treatment is prescribed with great caution to patients who are prone to depression.

Sometimes, during hormone therapy, signs of pathology of the digestive tract appear (nausea, vomiting). In addition, metabolic disorders are possible (feeling of hot flashes, swelling, acne).

Unpleasant symptoms from the cardiovascular system such as increased blood pressure, palpitations and shortness of breath appear less frequently.

It should be noted that high blood pressure is not a contraindication to hormone therapy, but it should be remembered that some drugs (for example, oxyprogesterone capronate) enhance the effect of antihypertensive drugs.

The occurrence of any side effects should be reported to your doctor; tactics for dealing with unpleasant symptoms are selected individually.

When is chemotherapy indicated for uterine cancer?

In such cases, the CAP regimen (cisplastin, doxorubicin, cyclophosphamide) is most often used for maintenance therapy.

What complications can develop during chemotherapy for uterine cancer?

The most dangerous complication of chemotherapy is the inhibition of proliferation of blood cells in the bone marrow. Therefore, this method of treating oncological diseases is always carried out under laboratory monitoring of blood conditions.

The effect of anticancer drugs on the epithelial cells of the digestive tract often manifests itself in such unpleasant symptoms as nausea, vomiting and diarrhea, and the effect on the epithelium of the hair follicles results in hair loss.

These symptoms are reversible and completely disappear some time after stopping the drugs.
In addition, each drug from the group of antitumor drugs has its own side effects, which the doctor informs patients about when prescribing a course of treatment.

How effective is treatment for uterine cancer?

Cancer of the uterine body recurs mainly in the vagina (more than 40% of all relapses) and in the pelvic lymph nodes (about 30%). Tumor foci often occur in distant organs and tissues (28%).

What is the prognosis for uterine cancer?

Recently, it has been possible to achieve a fairly high five-year survival rate in patients with uterine cancer. However, this only applies to women who sought help in the first and second stages of the disease. In such cases, the five-year survival rate is 86-98% and 70-71%, respectively.

The survival rate of patients in the later stages of the disease remains stable (about 32% in the third stage, and about 5% in the fourth).

All things being equal, the prognosis is better in young patients with highly differentiated hormone-dependent tumors. Of course, severe concomitant pathology significantly worsens the prognosis.

How can you protect yourself from uterine cancer?

In cases where benign endometrial dysplasia does not respond to conservative treatment, doctors advise turning to surgical methods (endometrial ablation or hysterectomy).

Since the prognosis for uterine cancer largely depends on the stage of the disease, so-called secondary prevention, aimed at timely diagnosis of a malignant tumor and precancerous conditions, is of great importance.

Tumor diseases of the genital organs in women account for about a quarter of all cases of cancer.

In recent years, there has been a rejuvenation of cancer in this location.

At the current level of development of medicine, a neoplasm detected at stages 0 and 1 of development can be treated in 80-100% of cases. It is not possible to achieve a significant reduction in the mortality rate from malignant tumors of the uterus due to the reluctance of women at risk to undergo regular examinations.

Faced with this pathology, many ask questions regarding life expectancy. We will try to answer the question of how long people live with uterine cancer in this article.

Influence of factors on life expectancy

The development of the clinical picture in cancer is like an iceberg; ¾ of the time from the division of the first pathological cell to death from a disintegrating tumor occurs during the latent period of tumor growth.

When we discover a 2-centimeter tumor at the age of 40, we must realize that it began to develop at least 10 years ago, but was overlooked due to its small size and lack of symptoms. It is the stage at which the process is diagnosed that is the prognosis for the life and health of the patient.

The principles of staging are based on the morphology and size of the tumor, its location, its invasion of neighboring organs and structures, the degree of damage to the lymphatic system, and the presence of distant metastases.

Even with a detailed study of the patient’s process and classification according to modern standards, it will not be possible to accurately determine his life expectancy due to the individuality of each person. In addition to the histological structure and position of the cancer in relation to surrounding tissues, the following factors are of great importance:

• age (the younger the body, the greater the chance of overcoming the disease);
• state of health before diagnosis (immunodeficiency states reduce resistance and suggest the addition of infections, which aggravates the condition and shortens life);
• the presence of chronic diseases (for diseases of the cardiovascular and respiratory systems at the stage of decompensation, it is impossible to carry out surgical procedures even to a limited extent, which makes even the initial forms of cancer incurable);
• allergic diseases (may limit the possibilities of both surgical and chemotherapy treatment).

The totality of all the above points determines how long a particular person will live.

Prognosis depending on the type of cancer

Uterine cancer changes the life expectancy of any person differently, depending on the level of damage and morphology. Cervical cancer has a positive prognosis compared to endometrial cancer, which is more favorable in the case of the hormone-dependent variant.

Neoplasms of the cervix are visual localizations, which simplifies their detection, and the introduction of a Pap test (screening to detect atypical cells) into the mandatory examination list at the gynecological chair allows you to diagnose this type of cancer at stage T0.

If cancer is recognized locally, a cone biopsy, which is performed for the purpose of histological examination, leads to a complete recovery of the patient, the survival rate reaches 90-100%. In stages I and II, there is already a need for hysterectomy with adnexa, and about 30-60% recover. Only about 10% of patients manage to survive more than 5 years when cervical cancer is detected at stage T4.

Endometrial cancer (adenocarcinoma), due to improved detection and treatment of cervical cancer, is overtaking it in the number of patients. Its two main forms (hormone-dependent and autonomous) differ morphologically, require a different therapeutic approach and have a different prognosis.

Hormone-dependent tumors cause a clear clinical picture with uterine bleeding and general disturbances of endocrine metabolism, which forces women to seek help. This point is in some sense positive, since an autonomous variant of adenocarcinoma can develop and disseminate to other tissues with minimal symptoms.

Due to the low aggressiveness of hormone-dependent neoplasms, they do not metastasize for a long time and respond well to treatment with an integrated approach (surgery, chemotherapy, radiation therapy and hormone therapy). The five-year survival rate is up to 90% when diagnosed at stages T0 and T1, 70% at stage T2 and decreases to 50% at stages T3, T4.

Autonomous cancer

Autonomous cancer is usually found in advanced stages and in women under 50 years of age. Low histological differentiation of the tumor makes it malignant and worsens the prognosis.

Hormones help in treating the disease, and the immunosuppression characteristic of this form provokes the addition of various infections. Prognostically unfavorable is the spread of endometrial cancer to the cervix and detection of the process during pregnancy.

Leiomyosarcoma is considered relatively rare, but malignant, and can metastasize beyond the pelvis. Lethal outcomes are caused by cancer intoxication and distant metastases to organs. The mortality rate in the first 5 years reaches 80% of cases.

How to prolong life with uterine cancer?

In order to maintain the quality of life at a decent level for as long as possible and extend its life, you should:

1. Follow the recommendations and prescriptions of your doctor.
2. Lead a healthy lifestyle as much as possible (give up bad habits, stick to a balanced diet, follow a daily routine).
3. Sanitize chronic foci of infection, which will reduce the risk of infectious diseases.
4. Maintain a positive mindset. Internal harmony and balance extend life.

The support of loved ones is of great importance, without which the patient cannot cope. A sufficient amount of attention and empathy will help you avoid depression and maintain the meaning of existence.

Palliative care in the final stages of the tumor process comes down to the treatment of infectious and non-infectious complications, adequate pain relief, care for the patient if he is unable to care for himself, and the same psychological support from friends and relatives.

You should not trust traditional methods of treatment; any traditional therapy can only supplement the main list of prescriptions. Wanting to try all the delights of alternative medicine on yourself, the condition not only does not get better, but may even worsen. If at least one of the folk methods could really cure cancer, then it would have long ago entered practical medicine.

Those who are faced with pathology should be reminded that life expectancy also depends on you; you should not give up, because this is a century in which every new day can become the day of the discovery of a cure for cancer.

And for people who are not urgently interested in this problem, the advice would be relevant not to avoid preventive gynecological examinations and to seek help from specialists if they detect the slightest changes in themselves that are suspected of malignancy.

When diagnosed with uterine cancer, a woman does not always notice the first signs and symptoms. She feels painful sensations in the lower abdomen, observes blood discharge after douching or sexual intercourse.

The disease is very often asymptomatic and is determined by a gynecologist during a routine examination. As the disease progresses, bleeding appears between menstruation or after sexual intercourse or douching. Bloody discharge from the vagina indicates a pathology in the body, and consultation with a specialist is necessary.

Causes and signs of manifestation of a malignant tumor

The most common causes of malignant pathology are:

• Diabetes mellitus, hypertensive disorders.
• Infectious, sexually transmitted diseases – HIV, human papillomavirus.
• Cigarette abuse.
• Disorders of menstruation.
• Use of oral contraception.
• Numerous sexual partners.
• Early pregnancy, late menopause.
• Very early sexual intercourse.
• Decreased immune system.

Excess weight is also an important factor. A precancerous condition can develop into a malignant formation due to erosion, polyps, scars after childbirth, and chronic inflammation.

One of the main causes of the disease is considered to be hormonal disorders in the body, which leads to the growth of the uterine mucosa.

Genital endometriosis can lead to cancer. With this disease, neoplasms appear on the mucous membrane, growths on the genital organs - ovaries, bladder, fallopian tubes.

The first signs of uterine cancer are bloody discharge from the vagina. If there is blood after sexual intercourse or the menstrual cycle is disrupted, you should consult a gynecologist.

If a woman has not had a period for more than a year, and then there is a discharge with blood, she needs to undergo a full examination for uterine cancer. Only an experienced specialist can recognize uterine cancer after examination and a complete examination.

In the early stages, the disease may not manifest itself, but if the disease progresses, the following symptoms are observed:

• Menstruation is painful, it becomes heavy and lasts for a long time.
• Heavy or spotting discharge appears between menstrual cycles.
• Blood after sexual intercourse, douching, physical exertion.
• Pain in the lower abdomen during sexual intercourse.

These symptoms are also typical for other gynecological diseases. But in order to determine pathological changes in the body, it is necessary to undergo an examination by a gynecologist.

During the examination, the doctor collects anamnesis, listens to all the patient’s complaints, finds out all the symptoms and the woman’s genetic inheritance.

It is important not to ignore such conditions:

• Discharge between periods can alert a girl. They may be transparent, yellowish, or mixed with blood. An oncological tumor can cause contact discharge, which appears during fast walking, physical activity, after sexual intercourse, even constipation causes spotting from the vagina. At an advanced stage, an unpleasant odor appears. The blood may flow profusely or lightly.
• The pathology causes anemia, fatigue and weakness of the entire body. Body temperature rises to 38% for no particular reason. These symptoms indicate cancer.
• Pain occurs when other organs are affected. In the later stages, pain appears in the lower back, rectum, and thigh; it is long-lasting and often repeated.
• The functioning of the urinary system is impaired. In the early stages, the tumor does not affect the bladder, but advanced disease causes frequent urge to urinate. This leads to the development of cystitis, the growth of a malignant formation contributes to the appearance of urinary retention and uremia.
• The neglect of cancer leads to constant constipation, and fistulas form in the intestines.

It is difficult to diagnose cancer in the early stages on your own. Only an experienced specialist can determine cancer after proper examination of the patient. Timely treatment saves 90% of women from death.

Diagnosis and treatment of pathology

To determine a gynecological disease, the gynecologist listens to the patient’s complaints and conducts an examination on a gynecological chair with mirrors. The doctor determines the condition of the vagina, the wall of the cervix, and determines the cause of bleeding, which is the main symptom of uterine cancer.

If there are any changes in the organs, the doctor takes a smear for further examination and takes part of the tissue for a biopsy. After histological examination, an accurate diagnosis can be made.

If uterine cancer is diagnosed, the patient undergoes vaginal curettage, then additional examination is performed. A woman is recommended to undergo ultrasound, computed tomography and magnetic resonance imaging.

All diagnostic methods are very important for prescribing the correct combined or radiation treatment for the tumor. Treatment for malignant disease depends on the severity of the disease, age and general condition of the woman.

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

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

Features of the anatomy and physiology of the uterus

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

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

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

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

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

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

Risk factors for endometrial tumors

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

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

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

causes of endometrial cancer of the uterus

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

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

Precancerous changes and causes of endometrial tumors

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

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

There are several types of hyperplasia:

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

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

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

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

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

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

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

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

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

Features of classification and staging of uterine cancer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Metastasis of endometrial cancer

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

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

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

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

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

How to suspect cancer?

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

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

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

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

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

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

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

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

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

How to detect cancer?

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

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

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

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

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

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

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

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

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

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

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

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

From timely diagnosis to successful treatment

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

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

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

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

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

Radiation therapy

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

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

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

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

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

Prognosis and prevention

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

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

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

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

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

Video: uterine cancer in the program “Live Healthy”

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

Uterine cancer is a malignant tumor caused by the uncontrolled growth of endometrial cells in the uterus. This disease is also called uterine cancer or endometrial cancer, since tumor growth begins in the tissue lining the uterus from the inside, i.e. in the endometrium. This type of cancer is considered the most common among tumor diseases of the female reproductive system.

Another type of uterine cancer is uterine sarcoma. It occurs when a tumor affects muscle or connective tissue. Sarcoma is rare, accounting for about 8% of all uterine tumors.

Cancer of the uterus in women

Endometrial cancer mainly affects postmenopausal women, that is, from 45 to 74 years old. Before age 45, this disease is extremely rare, occurring in less than 1% of women. Uterine cancer ranks 4th among all cancers in women. Fortunately, it is often detected in the early stages, when treatment is possible.

Cancer of the uterus in ICD-10

According to the international classification of diseases, pathology is classified in section C54 - “Malignant formation of the uterine body. There are cancers of the uterine isthmus - C54.0, endometrium - C54.1, myometrium - C54.2, fundus of the uterus - C54.3, lesions extending beyond one localization - C54.8, and unspecified C54.9.

Causes of uterine cancer

The causes of uterine cancer are still not completely clear. However, risk factors have been identified.

Hormone imbalance. Disruption of hormone production plays a major role in the occurrence of the disease. Before menopause, estrogen and progesterone levels are in a balanced state. After menopause, a woman's body stops producing progesterone, but small amounts of estrogen continue to be produced. Estrogen stimulates the proliferation of endometrial cells, the restraining influence of progesterone disappears, which increases the risk of developing cancer.

Another cause of hormonal disorders occurs if a woman receives hormone replacement therapy with only estrogen, without a progesterone component.

Overweight. The risk of uterine cancer increases with excess body weight, since the fat tissue itself can produce estrogens. Overweight women are three times more likely to develop endometrial cancer than women of normal weight. In women with severe obesity, the risk of getting the disease increases 6 times.

History of the reproductive period.

Taking tamoxifen. The risk of illness will arise if a woman takes tamoxifen. This medicine is used to treat breast cancer.

Diabetes. The disease doubles the risk of uterine cancer. This is due to an increase in insulin levels in the body, which in turn increases estrogen levels. Diabetes is often associated with obesity, which makes the situation worse.

Diseases of the genital organs. PCOS (polycystic ovary syndrome) also predisposes to the disease because estrogen levels are elevated in this condition. Endometrial hyperplasia is considered a precancerous condition, i.e. thickening of the uterine mucosa.

Family history. Women whose relatives (mother, sister, daughter) have uterine cancer are at risk. Also, the chances of getting the disease increase when there is a family history of a hereditary type of colorectal cancer (Lynch syndrome).

Uterine cancer and pregnancy

Women who have not given birth are more likely to have uterine cancer. During pregnancy, progesterone levels increase and estrogen levels decrease. This hormonal balance has a protective effect on the endometrium.

Also at risk are women who began menstruating before age 12 and/or menopause occurred after age 55.

What happens with uterine cancer

The process begins with a mutation in the DNA structure of endometrial cells. As a result, cells begin to multiply and grow uncontrollably, causing the tumor itself to appear. Without treatment, the tumor can extend beyond the inner lining of the uterus and grow into the muscle layer and further into the pelvic organs. In addition, cancer cells can spread throughout the body through the blood or lymph. This is called metastasis.

Symptoms and signs of uterine cancer

The most common manifestation of endometrial cancer is bloody vaginal discharge. The discharge can be either scanty, in the form of streaks of blood, or in the form of heavy uterine bleeding.

There are also less specific signs:

• discomfort when urinating
• pain or discomfort during sex
• lower abdominal pain.

If the disease has caused damage to organs near the uterus, then you may experience pain in the legs and back, and general weakness.

Signs before menopause

Before the onset of menopause, the disease can be suspected if menstruation becomes heavier than usual, or if there is bleeding during the intermenstrual period.

Manifestations in postmenopause

After menopause, any bleeding from the genital tract is considered pathological. Regardless of the amount of bleeding, if present, you should visit a gynecologist.

Stages

There are several stages of uterine cancer. At stage zero, atypical cells are found only on the surface of the inner lining of the uterus. This stage is determined very rarely.

Stage 1. Cancer cells grow through the thickness of the endometrium.

Stage 2. The tumor grows and invades the cervix.

Stage 3. The cancer grows into nearby organs, such as the vagina or lymph nodes.

Stage 4. The tumor affects the bladder and/or intestines. Or cancer cells, forming metastases, affect organs located outside the pelvis - the liver, lungs or bones.

Diagnosis of uterine cancer

During a routine gynecological examination, the doctor can determine changes in the shape, density, size of the uterus, and suspect a disease.

Ultrasound examination (ultrasound) of the pelvic organs performed through vaginal access is considered more accurate: the doctor inserts a sensor into the vagina and examines the endometrium in detail. If there is a change in its thickness, the next stage of diagnosis is a biopsy - a small fragment of the uterine mucosa is studied in the laboratory. There are two ways to perform a biopsy:

· Aspiration biopsy, when using a thin flexible probe inserted through the vagina, a piece of the mucous membrane is taken.

· Hysteroscopy, in which a flexible optical system (hysteroscope) is inserted into the uterine cavity, which allows you to examine the entire surface of the uterus from the inside. Then the doctor can perform a diagnostic curettage, after which a fragment of the endometrium is also sent for examination. The procedure is performed under general anesthesia.

If cancer cells are detected during the biopsy, then additional examination is carried out to understand how much the cancer has spread. For this use:

• X-rays of light
• Magnetic resonance imaging (MRI), which provides a detailed image of the pelvic organs
• computed tomography (CT), which can also detect metastases outside the uterus.

Analyzes

The study of tumor markers in blood serum is not considered a reliable way to diagnose uterine cancer, although the level of the CA-125 marker may be elevated during the disease.

The test used to diagnose cervical cancer (Pap test or smear) will not help detect endometrial cancer in the early stages. However, if the cancer has spread from the uterus to the cervix, the test may be positive.

Treatment of uterine cancer

A gynecologist-oncologist, a chemotherapist, and a radiologist may be involved in helping the patient. For effective treatment, doctors take into account:

• stage of the disease
• general health
• the possibility of pregnancy is relatively rare, since this type of cancer is typical for older women.

The treatment plan may involve using several methods at the same time.

Surgical treatment of uterine cancer

At stage 1 of the process, a hysterectomy is performed, i.e. removal of the uterus along with the ovaries and fallopian tubes. If necessary, nearby lymph nodes are removed. The operation is performed through a wide incision in the abdomen or laparoscopically. At stages 2-3, a radical hysterectomy is performed, additionally removing the cervix and upper part of the vagina. At stage 4, as much of the affected tissue as possible is removed. Sometimes, when cancer has extensively spread to other organs, it is impossible to remove the tumor completely. In this case, surgery is done to relieve symptoms.

Radiation therapy for uterine cancer

This method is used to prevent relapse of the disease. It is carried out in two ways: internal (brachytherapy) and external. During internal surgery, a special plastic tube containing a radioactive substance is inserted into the uterus. For external treatment, irradiation is used using radiation therapy devices. In rare cases, both options are used: internal and external irradiation at the same time.

Chemotherapyuterine cancer

It can complement surgical treatment in stages 3-4 of the disease, or can be used independently. The drugs are usually administered intravenously.

Medicines and drugs

Most often used

• carboplatin
• cisplatin
• doxyrubicin
• paclitaxel.

Hormone therapy uterine cancer

Some types of uterine cancer are hormone dependent, i.e. the tumor depends on the level of hormones. This type of formation in the uterus has receptors for estrogen, progesterone, or both hormones. In this case, the introduction of hormones or hormone-blocking substances suppresses tumor growth. Typically used:

• gestagens (medroxyprogesterone acetate, megestrol acetate)
• tamoxifen
• gonadotropin releasing hormone analogues (goserelin, leuprolide)
• aromatase inhibitors (letrozole, anastrozole, exemestane).

Complications

During radiation therapy, ulcerations, redness, and pain may occur at the site of irradiation. There is also diarrhea and damage to the colon with bleeding from it.

During chemotherapy, hair loss, nausea, vomiting, and weakness are not excluded.

Hormone treatment may cause nausea, muscle cramps, and weight gain.

In 5% of women, fatigue and malaise persist even after treatment.

Recurrence of uterine cancer

If the disease returns (relapse), the tactics will depend on the state of health and the treatment already performed. A combination of surgery, radiation and chemotherapy, as well as targeted and immune therapies in various combinations are usually used.

After the treatment has been carried out for the first time, the patient is monitored.

Urgent consultation with a doctor is needed if:

• bleeding from the uterus or rectum occurs
• the size of the abdomen has increased sharply or swelling of the legs has appeared
• there was pain in any part of the abdomen
• cough or shortness of breath bothers you
• Appetite disappears for no reason and weight loss occurs.

Rehabilitation after treatment

Uterine cancer, both at the stage of diagnosis and at the stage of treatment, disrupts the usual way of life. To combat the disease more effectively, you should try to communicate with women who have the same disease, ask relatives for support, try to learn as much as possible about your condition and, if necessary, get a second opinion on treatment methods.

Your diet should provide enough calories and protein to avoid weight loss. Chemotherapy can cause nausea, vomiting, and weakness, in which case a nutritionist can help.

After successful treatment, follow-up visits to the doctor and examinations are necessary to ensure that the disease has not returned.

Patient survival prognosis

With stage 1, 95% of women recover and live five years or more.

At stage 2, the five-year survival rate is 75%.

In stage 3, 40 out of 100 women live more than 5 years.

At stage 4, the 5-year survival rate is 15%. The outcome depends on how quickly the tumor spreads to other organs.

Prevention of uterine cancer

Since the exact cause has not been identified, it is impossible to completely prevent uterine cancer. However, to reduce the risk you need to:

• maintain normal weight. It is important to know your body mass index (BMI). Its value between 25 and 30 indicates overweight, and above 30 indicates obesity. It is recommended to keep your BMI below 25.
• do not use hormone replacement therapy containing only an estrogen component. This type of HRT is only safe in women who have already had a hysterectomy, i.e. the uterus was removed.
• use oral contraceptives as recommended by your doctor.
• Visit your doctor immediately if you experience spotting after menopause or during treatment with hormones for breast cancer.