Uterine cancer - what causes it, how to recognize the disease, modern methods of treatment, prevention. Uterine cancer: early symptoms

Uterine cancer (or endometrial cancer of the uterus) is a malignant tumor that develops from the tissues of the uterus, which can spread throughout the body.

This common disease ranks 4th after breast cancer, skin cancer and cancer of the gastrointestinal tract. They are formed in women over 45 years old, and the type of oncology depends on its location, because the uterus is a multilayer organ. Think about it: hundreds of thousands of women every year are faced with this diagnosis.

Causes of oncology

Causes of uterine cancer are not precisely defined, there are factors that aggravate the risk of occurrence and development of the disease. The results of studies show that the causes contribute to the disease:

• diabetes;
• hypertonic disease;
• HIV infection;
• smoking;
• human infection with the papilloma virus;
• violation of the cycle of menstruation;
• late menopause;
• infertility;
• active sex life with several partners, its early onset;
• diseases of a venereal nature;
• oral contraceptives;
• early childbirth.

Obesity remains a significant factor. If a woman's weight is 15 kilograms more than her norm, then the risk of the disease increases. And if more than 30 kilograms, then 10 times.

Causes such as precancerous conditions that affect the formation of oncology are capable of strengthening emerging uterine cancer. Among them are scars, ulcers, erosions after childbirth, leukoplakia, polyps, condylomas and chronic inflammatory processes, such as endometritis and endocervicitis.

How does uterine cancer develop?

From the nature of the epithelium, there is a division into squamous cell carcinoma and glandular cancer (adenocarcinoma) in the uterine cavity. Glandular cancer is the most common and accounts for about 70%. There is a rare tumor that affects the uterine passage - it is a sarcoma.

There are three tumor differentiations: highly differentiated tumors, moderately differentiated tumors, and undifferentiated.

Stages of development of uterine cancer:

1. In the first stage, the tumor is located in the body of the uterus.
2. On the second cancerous process produces further damage to the cervix.
3. The third stage is characterized by the transition of the tumor to fiber, and metastases occur in the vagina.
4. The fourth degree is characterized by the spread of the tumor beyond the pelvic area, and its further germination to the rectum or neighboring organs.

Symptoms of the disease

With uterine cancer, the symptoms of this disease develop. The first signs of uterine cancer - a woman complains of bleeding, pain and discomfort, the appearance of leucorrhoea.

Symptoms and signs appear when the tumor decays, which means that uterine cancer may not manifest itself for a long time.

In the early stages, purulent-mucous masses may appear that cause irritation and itching. The first symptoms appear after exercise, defecation or shaking.

Then there is a manifestation of bloody discharge, it does not even matter what nature. A similar process occurs periodically (constantly) and the discharge is abundant or scarce.

Violations of the menstrual cycle indicate that there is a development of pathology. The duration of menstruation can be reduced or increased, pain is characteristic during urination, indicating that the tumor grows into the bladder.

What are the main symptoms of uterine cancer? Oncologists say that 80% of uterine bleeding are detected, such symptoms of uterine cancer do not apply to menstruation.

In advanced stages, uterine cancer has signs and symptoms:

• In the lumbar region, abdomen and in the perineal region, pain of a pulling nature is formed.
• During intercourse and after it - pain.
• Disturbances in the process of emptying the intestines - diarrhea or constipation.
• Unreasonable weight loss.
• Loss of appetite.
• Nausea and vomiting.
• Decrease in working capacity, rapid achievement of fatigue.
• Hyperthermia (increase in body temperature, accumulation of heat).

Pre-menopausal uterine cancer has the following symptoms:

• Absence of a characteristic decrease in the amount of bleeding.
• Bleeding appears frequently.
• There is an abundance of secretions (instead of due weakening and impoverishment).

In the postmenopausal period, menstruation is absent, so vaginal discharge should at least alert the woman. No matter what the intensity, duration and frequency of bleeding. Uterine cancer symptoms should be suspected in women who are concerned about their health.

If the slightest symptoms of uterine cancer are found, consult a doctor immediately! After all, uterine cancer can have terrible consequences. A timely appeal to the doctor will allow not to aggravate the situation, and to cope with oncology in time.

Diagnostic methods

Diagnosis is an important stage, the treatment of uterine cancer depends on it. First, there is an examination and determination of the patient's complaints. Suspicious cases of the course of the disease occur when observed by a gynecologist; without examining patients, it is impossible to cure the disease.

Diagnosis occurs by methods of vaginal examination, rectal examination and examination using mirrors.

Vaginal examination of uterine endometrial cancer helps to determine changes in the pronounced process of tumor development. The study is characterized by bleeding due to harm to the tumor with a finger. If uterine cancer is common, then an additional examination of the rectum is performed to determine the tumor on the walls of the pelvis, in the area between the uterus and the sacrum.

To detect cervical cancer at an early stage, a vaginal examination will not be enough. Connect the inspection method using mirrors. A biopsy or cytological examination helps to determine the initial stage of cervical cancer, after which a smear sample is taken from the surface. If doctors suspect cancer of the cervical canal, or cavity, then the canal is scraped for diagnosis and histology.

Manipulations are carried out in the clinic by a doctor with the necessary equipment. Biopsy remains an accurate method, here cases of errors are rare. In half of the cases diagnosed with vaginal examination, cervical cancer is not detected. Diagnosis using mirrors leaves about ten percent of cancer cases unrecognized.

Treatment of uterine cancer

Can uterine cancer be cured? It all depends on the general condition of the patient, age, form and stage of tumor development. The main treatment is surgical, in which the uterus is extirpated (removed), and in some cases the lymph nodes of the pelvic zone have to be removed.

At a late stage, a combined method of treatment is used, in which an operation occurs, and then vaginal irradiation remotely (radiotherapy, radiation therapy) and the use of drugs (chemotherapy).

Combined treatment of uterine cancer involves intracavitary therapy. If the development of a cancerous tumor has reached the third stage, then radiation therapy is performed before the operation. As a stand-alone method, radiation therapy is effective in the localized location of the tumor, as well as in the presence of contraindications for surgery. At the third and fourth stages of development, anticancer drugs are effective.

After treatment for uterine cancer, you need to visit a gynecologist for examination and additional tests. Do procedures for intravenous pyelography, chest x-ray, ultrasound. For the first year after treatment, the doctor must be visited four times, and for the next five years - once every six months, but then the control does not stop - the patient visits the doctor annually. With the development of relapses, pelvic exenteration is performed (partial or complete removal of the pelvic organs).

The five-year survival rate is 80 to 40% after surgery.

Metastases in uterine cancer

Distant metastases are curable by chemotherapy. Metastases occur in the lymph nodes of the pelvis, less often in the inguinal. With distant metastases, the prognosis is not favorable, they occur more often in the lungs, kidneys or liver. A quarter of patients from recurrence saves radiation therapy. With recurrence of metastases, a cure for cancer is unlikely, and the effect obtained from the treatment is short-lived.

Prevention methods

For preventive purposes, all women over 30 years of age are recommended to undergo examinations by a doctor, to do this systematically twice a year.

To identify possible precancerous diseases, the signs of which do not manifest themselves, will help regular examinations, which should be started with the advent of sexual activity. Cytological examination and ultrasound tomography should be added to such examination methods.

Common signs are the presence of symptoms, their chronic and long-term type, and the lack of results of anti-inflammatory treatment.

Diseases in the cervix should be treated radically by methods of electrocoagulation, electroexcision or complete removal of the cervix.

Diagnosis, carried out on time and the process of treatment - give a positive prognosis for survival. If a malignant tumor of the uterus is detected at an early stage, then the chances of a favorable outcome are greater. Take care of your health and visit your doctor in a timely manner.

Cancer of the body of the uterus is one of the main oncological diseases of the female reproductive system. The disease is widespread and is in second place in the incidence of malignant neoplasms among women.

Despite the high prevalence, this disease is considered one of the favorable forms among malignant neoplasms.

Cancer of the body of the uterus is a malignant neoplasm that develops in the area of ​​the body of the uterus from its various layers. The most common variant is cancer of the endometrial layer - the innermost.

The tumor can be of varying degrees of malignancy, which determines the degree of its growth and invasiveness. Malignancy depends on the degree of differentiation of cellular elements: highly differentiated, moderately differentiated, poorly differentiated cancer of the uterine body.

There are two variants of tumor growth: endophytic - inside the uterine cavity, and exophytic - outside. The early stages of the oncological process are:

• 0 - cancer in place;
• 1A- the tumor is limited to the endometrium;
• 1B- the tumor grows into the myometrium for ½ of its thickness.

This video shows what uterine cancer looks like on ultrasound:

Symptoms

Cancer of the body of the uterus is considered the most favorable oncological process in terms of prognosis, since the five-year survival rate for it is more than 75%.

This is largely due to the early diagnosis of the disease and the rapid development of the clinical picture and symptoms already in the initial stages of endometrial cancer, which allows timely identification of the malignant process, its form and treatment.

Allocations

Discharge from the external genital tract is one of the first and valuable symptoms of incipient endometrial cancer. Allocations can be of a very different nature, but most often - bloody (uterine bleeding) outside the menstrual cycle.

Acyclic spotting is the first sign to look out for. and go to the antenatal clinic. The cause of uterine bleeding in cancer of the uterine body can be foci of ulceration of the endometrial mucosa, as well as adenomyosis.

Often, uterine bleeding from cancer is confused with dysfunctional uterine bleeding if the woman is still in her reproductive age group.

In postmenopausal age, the discharge as a result of the development and progression of a malignant neoplasm is more often serous in nature. The so-called odorless whites and other inflammatory signs are a characteristic sign of a malignant process in the uterus.

In rare cases, the disease is accompanied by a profuse flow of serous discharge from the uterine cavity, which is called leukorrhea.

Discomfort

The second characteristic sign of the development of cancer is a gradually increasing feeling of discomfort in the womb. In the earliest stages, discomfort may appear irregularly over long periods of time.

As the tumor grows, the discomfort manifests itself more and more often, and the intensity increases until the onset of pain. Discomfort often occurs in combination with discharge. In stage 1 cancer, discomfort is difficult to associate with any oncological process, so this symptom becomes pathognomic in stages 1A and 1B.

Itching and burning

In addition to discomfort, a sick woman is very often worried about a burning sensation and itching in the area of ​​​​the vagina and pubic joint.

Itching and burning are one of the first signs of cancer. The cause of this symptom is the production of toxic components by oncological cells and local irritation of the sensitive nerve receptors of the internal and external genital organs of a woman, which leads to such an unpleasant symptom.

When establishing complaints about the symptom of itching and burning in a biochemical blood test, the following biologically active substances are often found: bradykin, serotonin, enkephalin, histamine. All of these substances are pro-inflammatory agents and irritate sensitive nerve fibers.

Blood during intercourse

Bloody discharge during sexual intercourse is another of the signs characteristic of the early stage of the oncological process. Bloody discharge during intercourse is scarce and may be accompanied by pain (daspareunia).

The release of blood from the external genital organs during sexual intercourse occurs as a result of a rush to the internal genital organs, in particular to the uterus - blood. Significant blood flow and expansion of the uterine vessels can provoke bleeding from the tumor growth zone.

The tumor can be ulcerated due to rapid growth or grow into a local uterine vessel. With an increase in blood flow, as well as in combination with intense physical activity, these factors can provoke uterine bleeding in endometrial cancer. Bleeding passes on its own as a result of contraction of the uterine myometrium and narrowing of the diameter of the vessels.

Scarlet blood during menstruation

This symptom occurs in women of reproductive age from 20 to 45 years. Scarlet blood indicates a high concentration of oxygen in it, which means that the blood flows from the arterial bed.

If scarlet blood is detected during menstruation, it is necessary to urgently contact the emergency gynecology department, since scarlet blood indicates the onset of uterine bleeding, which in some cases cannot be stopped on its own.

Difficulty diagnosing pain during menstrual bleeding, since in cancer, the scarlet blood released from the external genital tract is not accompanied by pain.

In any case, if red blood is detected during menstruation, it is necessary to contact the gynecology department and carry out a series of diagnostic procedures to identify the cause of bleeding. And also eliminate it, since bleeding can lead to significant blood loss and anemic syndrome.

Cycle failures

Violation of the menstrual cycle is not a pathognomic symptom, but is part of the clinical picture of uterine cancer. Acyclic bleeding is most often accompanied by an arterial type of bleeding and is not accompanied by pain.

When examining a woman for hormonal status, a violation of the hormonal background and the ratio of progesterone and estrogen can be detected. Hormonal imbalance contributes to the development of a precancerous condition and malignancy of the hyperplastic process in the endometrium.

Violation of the menstrual cycle occurs due to damage to the endometrium and replacement of the latter with atypical tumor cells. As a rule, the condition preceding cancer - complex or simple adenomatous hyperplasia contributes to the disruption of the cycle. Cycle failure is most often observed in women with severe excess body weight and other concomitant hormonal disorders.

pain

Pain syndrome manifests itself later than all of the above. Women begin to notice pain at stage 1B, in the future, the pain syndrome only progresses and has a permanent character. Pain may occur during intercourse or be unrelated to any other symptoms.

Characteristic for cancer of the body of the uterus is the absence of pain at the time of uterine bleeding outside the cycle, which provides good reasons for conducting a full diagnostic study for the presence of a malignant neoplasm of the endometrium.

As for the intensity of pain, this is a subjective sign and for each woman this symptom is individual, since the pain threshold is different for everyone. The intensity of pain may depend on the rate of progression of the oncological process and the degree of invasiveness.

Pain occurs due to compression or destruction of the nerve sensitive fibers of the uterus by atypical cells. Often a woman cannot establish a clear localization of pain sensations, since visceral sensitivity is poorly developed and the innervation of internal organs by sensitive nerve endings does not make it possible to determine the exact localization of pain.

Usually, complaints relate to pain in the lower abdomen, in which case the pain syndrome should be considered in conjunction with other manifestations of the disease.

General manifestations

In the development of endometrial cancer, the cellular composition of the tumor, the form of growth and the degree of differentiation of atypical tumor cells play an important role in the clinical picture and the timing of its formation.

The more invasive the malignant process is, the more pronounced the cellular atypia and the rate of cell proliferation, the faster the symptoms will appear, and the clinical picture will become bright and characteristic.

The general signs of the oncological process in the early stages include the whole range of factors preceding the development of a malignant neoplasm. Metabolic syndrome associated with overweight or obesity, dyslepidemia, hormonal imbalance are additional criteria in establishing a clinical diagnosis of uterine cancer.

Specific oncological markers can be detected in blood plasma, which can confirm the progression of the tumor.

Timely contacting a specialist with the above symptoms allows you to quickly carry out a number of diagnostic procedures, refer the patient to the gynecological oncology department for hysteroscopy and taking material for a biopsy for absolute certainty in the presence of endometrial cancer.

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Content

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

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

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

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

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

Myometrium in the structure of the uterine body performs several important functions. Due to the muscular layer, the uterus increases in size during pregnancy, shrinks during menstruation and childbirth.

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

With the progression of cervical cancer at an early stage, all layers are gradually involved in the malignant process. Then the tumor moves to the cervix and surrounding tissues. Over time, distant organs can be affected due to the occurrence of metastases.

The reasons

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

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

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

However, under the influence of some unfavorable factors, this balance is disturbed. There are functional, and then structural disorders. The endometrium may overgrow. Over time, the first signs and symptoms of atypia often occur.

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

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

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

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

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

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

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

Some scholars are of the view that according to which the transformation of cells is embedded in DNA. This is the so-called genetic theory of the development of uterine cancer.

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

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

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

Stages and types

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

Early stage uterine cancer is called preinvasive cancer. In another way, such a pathology is defined as cancer of the zero stage. As a rule, there are no signs and symptoms at this early stage of the cancer process. It is possible to identify the disease through the use of laboratory and instrumental diagnostic methods.

Gynecologists distinguish four stages of uterine cancer.

• Stage 1 is characterized by damage to the endometrium (A). As part of the early first stage, the myometrium may be affected up to half of the layer (B) or the entire muscular layer (C).
• Stage 2 is characterized by involvement in the pathological process of the cervix. If the tumor is present exclusively in the glandular layer - A, with the penetration of the neoplasm into the deep layers - B.
• Stage 3 includes the penetration of malignant cells into the serosa and appendages (A). Sometimes there is a lesion of the vagina (B). In the most severe cases, metastasis occurs to surrounding lymph nodes (C).
• Stage 4 means the appearance of metastases. If metastases develop only in the bladder and intestine - A. If metastases occur in the lungs, liver and bones - B.

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

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

• high;
• average;
• low.

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

There are the following morphological varieties of uterine cancer:

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

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

Symptoms and signs

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

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

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

Early first signs usually include abnormal discharge, which can be observed in the second or third stage. Early stages, such as pre-invasive and first, are usually asymptomatic. The appearance of the first signs is associated with the spread of cancer and tumor growth.

In advanced stages, the first signs are:

• pain of varying intensity;
• puffiness;
• deterioration in general well-being, which can be manifested by weakness, dizziness, subfebrile temperature.

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

Methods of diagnosis and treatment

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

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

To detect metastases, it is necessary to perform MRI, CT and X-ray of the lungs. Evaluation of the functions of the bladder and intestines, which are often affected in uterine cancer, is carried out through cystoscopy and rectoscopy.

Treatment involves a combination of several methods:

• surgical intervention;
• radiotherapy;
• chemotherapy.

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

Irradiation is more often performed after surgery to remove the remaining malignant cells. As an independent method, it is practically not used.

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

• What is uterine cancer
• What causes uterine cancer
• Symptoms of uterine cancer
• Diagnosis of uterine cancer
• Treatment for uterine cancer
• Prevention of uterine cancer
• Which Doctors Should You See If You Have Uterine Cancer?

What is uterine cancer

What causes uterine cancer

Risk factors for uterine cancer- diabetes, hypertension, smoking, human papillomavirus infection, HIV, early onset of sexual activity, late menopause and menstrual irregularities, infertility, a large number of sexual partners, early first birth, sexually transmitted diseases, oral contraceptives.

One of the risk factors is obesity: in women with a body weight exceeding the norm by 10-25 kg, the risk of developing endometrial cancer is 3 times greater than with normal body weight, and in women with an excess body weight of more than 25 kg, the risk of the disease 9 times higher.

Widely known precancerous conditions that play a significant role in the occurrence of cancer. These are erosions, ulcers, scars after a birth injury, proliferation of the epithelium (warts, polyps) and leukoplakia, as well as chronic inflammatory processes - endocervicitis and endometritis.

Pathogenesis (what happens?) during Uterine Cancer

According to the nature of the epithelium of various parts of the uterus, squamous cell carcinoma of the cervix and glandular cancer (adenocarcinoma) of the cervical canal and uterine cavity are distinguished. Adenocarcinoma is the main morphological variant (up to 70%). It should be pointed out that a relatively rare tumor affecting the uterus is a sarcoma. There are three degrees of tumor differentiation (highly differentiated, moderately differentiated and undifferentiated).

With uterine cancer, 4 stages of its development are distinguished: stage 1 - the location of the tumor in the body of the uterus, stage II - damage to the body and cervix, stage III - spread to the parametric fiber or metastases in the vagina, stage IV - spread beyond the pelvis, germination of the bladder or rectum.

Symptoms of uterine cancer

Clinical symptoms of uterine cancer consists of complaints of leucorrhea, bleeding and pain. However, all these three symptoms occur already during the decay of the tumor and the time of their appearance depends on the time of onset of ulceration. Therefore, in some cases, uterine cancer may not give any symptoms for a long period.

The early stages of uterine cancer are usually accompanied by mucopurulent discharge that causes itching and irritation, which may occur after exercise, shaking, defecation, and spotting, which may be scanty or profuse, constant or intermittent. Signs of the disease can be a violation of the menstrual cycle, an increase or decrease in the duration of menstruation, frequent urination and pain when urinating (this means that the tumor has begun to grow into the bladder).

Leucorrhea is of a different nature: watery, mucous, stained with blood, odorless and fetid. The admixture of blood gives the whites the appearance of meat slops. The retention of discharge in the vagina and the joining infection leads to the appearance of purulent leucorrhea with a smell. In stage III and IV cancer, discharge from the genital tract is putrefactive. Bleeding can be in the nature of small spotting, as well as single or multiple heavy blood loss. For cervical cancer, so-called contact bleeding is very typical (during sexual intercourse, douching, vaginal examination, or after heavy lifting). If a woman has already stopped menstruating, then the appearance of bloody discharge from the vagina in most cases is a sign of a malignant tumor.

Pain is a late symptom, indicating the involvement of the lymph nodes and pelvic tissue in the cancerous process with the formation of infiltrates that compress the nerve trunks and plexuses. General symptoms and, in particular, cachexia (weight loss) occur very late, in very advanced stages, and usually women suffering from uterine cancer retain a blooming, healthy appearance.

Diagnosis of uterine cancer

Recognition of uterine cancer begin with the study of the patient's complaints and the course of the disease. In all suspicious cases according to the anamnesis, patients are subject to immediate examination by a gynecologist. It is absolutely unacceptable to prescribe any treatment for such patients without a detailed examination.

The examination includes a vaginal two-handed examination, a rectal two-handed examination, and examination with speculums.

At vaginal examination in cases of a sufficiently pronounced tumor process, it is possible to determine certain changes in the neck, depending on the type of tumor growth (exophytic, endophytic and mixed). As a rule, the study is accompanied by bleeding as a result of trauma to the tumor with the examining finger. With advanced uterine cancer, an additional study is performed through the rectum to clarify the transition of the tumor to the pelvic walls and sacro-uterine ligaments.

To detect the initial stages of cervical cancer, one should not be limited only to a vaginal examination; mandatory inspection with mirrors. To detect early forms of cancer in all cases of certain changes in the cervix, they take swabs for cytology or biopsy. If cancer of the cervical canal or uterine cavity is suspected, diagnostic separate curettage of the cervical canal and uterine cavity is performed and subsequent histological examination.

All these studies can be carried out already in the clinic if you have the necessary tools and follow the rules of asepsis. To illustrate the importance of a comprehensive examination, it suffices to point out that cervical cancer remains unrecognized in more than half of the patients whose examination consisted only of a two-handed vaginal examination. At the same time, when examining with the help of mirrors, the number of errors in the diagnosis decreases by almost 5 times, and when using a biopsy, they are observed only in isolated cases.

Recently, it has become widespread and of great importance. ultrasound diagnostics(ultrasound), which allows to detect changes in the uterus that are inaccessible to other research methods and has become a mandatory research method in case of suspicion of any benign and malignant tumors in the uterus.

To establish the defeat of the lymph nodes and metastases, which very often accompanies cervical cancer, they resort to x-ray methods - lymphography and ileocavagraphy. For the same purpose, chest x-ray, intravenous pyelography, irrigography, cystoscopy and sigmoidoscopy. It is possible to perform CT, MRI, lymphangiography, biopsy of the tumor with a thin needle.

These studies are very important in uterine cancer to develop a plan for radiation or combined treatment.

Treatment for uterine cancer

Uterine cancer treatment tactics depends on the patient's age, general condition and clinical stage of cancer. Treatment is mainly surgical (extirpation of the uterus with appendages and sometimes removal of the pelvic lymph nodes). Combined treatment is possible - surgery, and then remote irradiation on the vaginal stump area, intracavitary gamma therapy. Preoperative radiation therapy is also carried out, mainly in stage III. Radiation therapy as an independent method is used for local spread of the tumor process, with contraindications to surgery. Anticancer drugs are effective in highly differentiated tumors, in stages III and IV of the disease.

In case of cervical cancer, treatment is carried out with equal success both by combined radiation therapy and surgically (extended extirpation of the uterus with appendages). Treatment depends on the stage of the disease. At stage Ia (microinvasive cancer), the uterus is extirpated with appendages. At stage Ib (cancer is limited to the cervix), remote or intracavitary irradiation is indicated, followed by extended extirpation of the uterus with appendages, or, conversely, an operation is performed first, and then remote gamma therapy. In stage II (involvement of the upper part of the vagina, it is possible to pass to the body of the uterus and infiltration of the parametrium without passing to the walls of the pelvis), the main method of treatment is radiation, surgical intervention is rarely used. At stage III (transition to the lower part of the vagina, infiltration of the parametrium with the transition to the pelvic bones), radiation treatment is indicated. Finally, in stage IV (transition to the bladder, rectum or distant metastasis), only palliative radiation is used. In the later stages, symptomatic treatment is carried out, it is possible to use chemotherapeutic treatment.

After treatment, periodic visits to the doctor are required to examine the pelvic organs and take a smear. Investigations also include chest x-ray, ultrasound, and intravenous pyelography. During the first year of visiting a doctor every 3 months, then for 5 years - every 6 months. After 5 years, control is carried out annually.

In case of relapses, if the process is localized, a partial or total pelvic exenteration is performed (removal of the uterus, cervix, vagina, parametrium, bladder and rectum as a single block). In the presence of distant metastases, patients usually receive chemotherapy. Radiation therapy can be used to palliatively treat painful metastases.

Metastasis.
Most often, uterine cancer metastasizes to the pelvic lymph nodes, less often to the inguinal. Distant metastases are more often in the kidneys, liver, lungs, have a poor prognosis.

Prognosis for uterine cancer.
In uterine cancer, the 5-year survival after surgical treatment is from 84 to 45%, depending on the stage of the disease. In case of recurrence, 25% of patients who initially underwent surgical treatment can be saved from recurrence of the disease with the help of radiation therapy of the pelvic organs. With metastatic relapses, cases of cure are extremely rare, and the therapeutic effect is individual and short-lived. In stage IV of the disease, the 5-year survival rate is up to 9%.

Prevention of uterine cancer

Early diagnosis and prevention of uterine cancer are possible only through systematic preventive examinations of all women over 30 years of age (at least 2 times a year). It is advisable to start regular examinations with the onset of sexual activity. Regular examinations, ultrasound tomography and cytological examination (once every 2 years) contribute to the detection of precancerous diseases, and their treatment - cancer prevention.

Equally important is the timely and correct treatment of precancerous diseases of the cervix. There are no especially characteristic signs inherent only in precancerous diseases of the cervix, they proceed like ordinary inflammatory diseases. Common signs of precancerous diseases are a long chronic course, persistence of symptoms, and most importantly, the lack of effect from conservative (anti-inflammatory) treatment. Treatment of precancerous diseases of the cervix should be radical and consists in electroexcision, electrocoagulation of the affected areas, or even amputation of the cervix. They also resort to the radiation method of treatment in the form of application radium therapy. Among patients radically treated for various precancerous lesions, mortality from cervical cancer decreased by 6 times.

What are the characteristic symptoms and signs of uterine cancer? Very often, oncological diseases in the early stages are asymptomatic: the neoplasm makes itself felt only when the process has already gone far. However, this does not apply to malignant tumors of the endometrium. With cancer of the body of the uterus, the first symptoms occur almost immediately, which in the vast majority of cases provides the possibility of a radical solution to the problem and a favorable prognosis.

That is why, if any suspicious signs appear, it is necessary to consult a gynecologist. There is no need to put off seeing a doctor "for later": if the cancer spreads to other parts of your body, its treatment will become more difficult, and the prognosis will worsen.

The first symptoms of uterine cancer

A cancerous tumor developing in the endometrium manifests itself as abnormal vaginal bleeding. In patients with cancer of the body of the uterus, these symptoms are almost always present, but may vary depending on the functional state of the female reproductive system.

Due to the fact that the disease is directly related to the imbalance of female sex hormones, it usually occurs during the period of hormonal changes, that is, during menopause. In this case, the symptoms of uterine cancer depend on the phase of the extinction of sexual function:

• If a woman has not yet gone through menopause, bleeding between periods, as well as regular hypermenorrhea - heavy and prolonged periods (more than 7 days), may indicate the occurrence of a malignant neoplasm.
• After the onset of menopause (the duration of the absence of menstruation for 1 year or more), any vaginal bleeding is abnormal and should be a signal for immediate medical attention. Sometimes, the first symptoms of uterine cancer and pronounced signs are watery discharge mixed with blood. As the tumor grows, uterine bleeding intensifies and becomes permanent.

It should be added that only in 1 out of 10 cases, the above disorders are a consequence of the development of cancer. The same manifestations are characteristic of endometriosis, fibroids (benign neoplasms), mucosal polyposis, etc. Therefore, their appearance is a reason for examination, and not for panic.

Other signs and symptoms of uterine cancer:

• Pain in the pelvic area. Pain in the small pelvis occur constantly, differ in duration and intensity, intensify during menstruation and during sexual intercourse. If the cause of their appearance is a cancerous focus in the endometrium, this indicates the prevalence of the process.
• Anemia. If left untreated, persistent blood loss contributes to the development of anemia. A woman's hemoglobin decreases, which is accompanied by the appearance of weakness, dizziness and shortness of breath, even with minor physical exertion.
• Cancer intoxication. Any oncological disease eventually leads to a general deterioration in well-being, due to the toxic effect of the waste products of malignant cells. In patients with advanced stages of uterine cancer, these signs and symptoms of uterine cancer are manifested by increased irritability, loss of appetite, nausea, and fatigue.

As the disease progresses, pain in the back, legs, pelvic region and other disorders associated with the growth of the neoplasm into neighboring organs and tissues and the appearance of distant metastases join the symptoms described above.