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The main clinical symptom of uterine cancer. How to promptly detect signs of uterine cancer in the early stages

The first place in incidence among gynecological cancers is uterine cancer, or endometrial cancer. In Russia, up to 16 thousand new cases of the disease are detected every year, and the number of cases is constantly increasing.

The pathology mainly affects women after 60 years of age, but can also occur at a younger age. About 40% of patients become ill before menopause. In the last decade, the incidence rate has increased most rapidly in women under 29 years of age.

The tumor is accompanied by the rapid onset of symptoms, which force the woman to see a doctor. This results in up to 90% of uterine cancer cases being diagnosed at an early stage, which significantly improves the prognosis.

Causes and risk factors

For many cancer pathologies, the exact cause of their occurrence is unknown. This also applies to uterine cancer. Pathology is considered a “disease of civilization” that occurs under the influence of unfavorable external conditions, dietary habits and lifestyle.

Factors predisposing to uterine cancer:

late first menstruation;
only after 55 years;
long;
and hormonally active tumor of these organs (Brenner's cancer);
obesity;
diabetes mellitus;
long-term use of estrogen hormones without combination with gestagens;
treatment with antiestrogenic drugs (Tamoxifen);
lack of sexual activity or pregnancy;
cases of illness in close relatives.

Endometrial cancer of the uterus occurs against the background of a complex of disturbances in hormonal balance, metabolism of fats and carbohydrates.

The main pathogenetic types of the disease:

hormonal-dependent (in 70% of patients);
autonomous.

In the first option, ovulation disorders in combination with obesity or diabetes lead to increased production of estrogen. Acting on the inner uterine layer - the endometrium, estrogens cause increased proliferation of its cells and their increase in size and change in properties. Gradually, hyperplasia becomes malignant, developing into precancer and uterine cancer.

Hormone-dependent uterine cancer is often combined with a tumor of the intestine, breast or ovary, as well as with ovarian sclerocystosis (Stein-Leventhal syndrome). This tumor grows slowly. It is sensitive to progestogens and has a relatively favorable course.

Signs that increase the risk of hormone-dependent cancer:

infertility, late menopause, anovulatory bleeding;
ovaries and hyperplastic processes in them (thecomatosis);
obesity;
improper treatment with estrogen, adrenal adenoma or cirrhosis of the liver, causing hormonal changes.

The autonomous variant often develops in postmenopausal women against the background of ovarian and endometrial atrophy. There is no hormonal dependence. The tumor is characterized by a malignant course, quickly spreading deep into the tissues and through the lymphatic vessels.

There is a genetic theory of cancer, according to which cell mutations are programmed into DNA.

The main stages of the formation of a malignant tumor of the uterus:

lack of ovulation and increased estrogen levels under the influence of provoking factors;
development of background processes - polyps and endometrial hyperplasia;
precancerous disorders - atypia with hyperplasia of epithelial cells;
preinvasive cancer that does not penetrate beyond the mucous membrane;
minimal penetration into the myometrium;
pronounced form.

Classification

Cancer of the uterine body is classified depending on the size of the tumor, its penetration into the muscle layer, growth in surrounding organs, damage to the lymph nodes and the presence of distant metastases. Both the TNM staging system and the International Federation of Obstetricians and Gynecologists (FIGO) staging are used.

A tumor that does not extend beyond the endometrium is called preinvasive. It is designated as carcinoma in situ, Tis, or stage 0.

There are 4 stages of uterine cancer

1. The tumor affects only the body of the uterus:

endometrium (T1a or IA);
myometrium to half depth (T1b or IB);
more than half the depth of the myometrium (T1c or IC).

2. Malignant cells are found in the cervix:

only in the glandular layer (T2a or IIA);
the tumor penetrates into the deep layers of the cervix (T2b or IIB).

3. The tumor spreads to the vagina, appendages or lymph nodes:

damage to the outer serous layer of the uterus and/or appendages (T3a or IIIA);
spread to the vagina (T3b or IIIB);
there are metastases to the pelvic or peri-aortic lymph nodes (N1 or IIIC).

4. Stage 4 uterine cancer with metastases:

into the bladder or rectum (T4 or IVA);
to the lungs, liver, bones, distant lymph nodes (M1 or IVB).

In addition, different degrees of differentiation of tumor cells are distinguished: from G1 (high degree of cell maturity) to 3 (poorly differentiated tumor). The more pronounced the differentiation, the slower the tumor grows and the less likely it is to metastasize. With poorly differentiated cancer, the prognosis worsens.

Depending on the microscopic structure, the following morphological types of cancer are distinguished:

adenocarcinoma;
light cell;
squamous;
glandular squamous;
serous;
mucinous;
undifferentiated.

The morphological type largely determines malignancy. Thus, the course of undifferentiated cancer is unfavorable, but with a squamous cell tumor the likelihood of recovery is quite high.

The neoplasm can grow exophytically (into the lumen of the uterus), endophytically (into the thickness of the muscle wall) or have a mixed nature.

Cancer is localized in the area of the fundus and body of the uterus; tumors are found less frequently in its lower segment.

Symptoms

Often, a patient consults a doctor when she experiences the first signs of uterine cancer in the early stages. First of all, this is irregular bleeding in young women that does not coincide with the menstrual cycle. Postmenopausal women experience uterine bleeding. Young patients develop light leucorrhoea.

Bleeding occurs not only with endometrial cancer, but also with many other diseases. This may cause difficulties in early diagnosis of the disease, especially in young women. They can be observed for a long time about.

Other symptoms of uterine cancer appear in later stages. When blood accumulates in the organ cavity, pain appears in the lower abdomen. Long-term pain syndrome occurs when the tumor grows on the appendages and spreads throughout the peritoneum.

Copious watery or mucous discharge due to uterine cancer is typical for older women.

If the bladder is damaged, frequent painful urination may occur. If the rectum is involved, constipation, pain during bowel movements, and blood in the stool appear.

General signs of cancer pathology are weakness, deterioration in performance, nausea, lack of appetite, weight loss.

How quickly does uterine cancer develop?

With a high degree of differentiation, the tumor grows slowly over several years. Poorly differentiated forms have a high rate of proliferation of malignant cells. In this case, a clinically significant tumor can develop within several months.

Metastasis

The spread of cancer cells is possible through the lymphatic tract, blood vessels and peritoneum.

Lymphogenic metastasis occurs in the nearest (regional) pelvic lymph nodes. At an early stage and high differentiation (G1-G2), the probability of lymph node involvement does not exceed 1%. If cancer cells invade the myometrium, the risk of metastasis increases to 6%. If the tumor affects a large area, penetrates deep into the uterine wall or spreads to the cervix, metastases in the lymph nodes are found in 25% of patients.

Hematogenous metastasis occurs later. Tumor cells travel through blood vessels to the lungs, bones and liver.

Implantation metastases occur on the peritoneum and omentum when the outer layer of the uterus grows and the fallopian tubes are damaged.

Diagnostics

Screening studies for early detection of formation are not carried out. It is believed that for timely recognition you only need to be observed annually by a gynecologist.

Analysis for tumor markers, the most common of which is CA-125, is usually not performed. It is considered an additional method for assessing the effectiveness of treatment and early detection of relapses.

The simplest diagnostic method is aspiration of the contents of the uterus with a special syringe and histological examination (). At an early stage, the information content of this method does not exceed 36%; with a widespread tumor, its signs can be detected in 90% of patients. To increase the accuracy of the study, it can be carried out repeatedly. Aspiration biopsy does not require dilation of the cervical canal and is performed on an outpatient basis.

Instrumental diagnosis of uterine cancer:

: The thickness of the endometrium in postmenopausal women should not exceed 4 mm.
with a biopsy of a suspicious area of the endometrium and its microscopic examination.

To determine the extent of the tumor and damage to the lymph nodes, it is carried out. Unlike ultrasound, the method helps to clarify the condition of the lymph nodes in 82% of patients.

An X-ray of the lungs is required to exclude metastases in them.

Is uterine cancer visible on ultrasound?

The doctor should be alerted to ultrasound data of the uterus if an increase in M-echo (endometrial thickness) of more than 4 mm in elderly women or 10-16 mm in patients before menopause is recorded.

If the M-echo value is more than 12 mm in young women, aspiration biopsy is prescribed. If this value is 5-12 mm, hysteroscopy and targeted biopsy are performed (taking material from a suspicious area).

If a tumor is detected on ultrasound, you can determine:

size and contours of the uterus;
myometrial structure;
tumor location;
depth of germination into the myometrium;
damage to the internal pharynx, ovaries and lymph nodes.

Additional information is provided by color Doppler mapping - ultrasound examination of blood vessels, which allows one to assess the speed and intensity of blood flow in the vessels of the uterus and the tumor focus.

Hysteroscopy is the most important diagnostic method, allowing one to assess the severity and extent of the tumor and take material for histological analysis.

If uterine cancer is suspected, it is necessary to perform the walls of the cervical canal and endometrium.

How to detect uterine cancer with minimal lesion size?

A modern method for detecting the early stages of endometrial cancer is fluorescent diagnostics. Special substances are introduced into the body that selectively accumulate in cancer cells. When the inner surface of the uterus is irradiated with a laser, these substances begin to glow. This allows you to see tumor foci up to 1 mm and take a targeted biopsy. At an early stage, the sensitivity of such diagnostics reaches 80%.

The diagnosis is finally confirmed by uterine curettage. If the tumor is located in the upper part of the organ, it is recognized in 78% of cases, and with widespread lesions - in 100% of cases.

Uterine cancer must be differentiated from the following diseases:

endometrial hyperplasia;

Treatment

If a woman is diagnosed with a malignant tumor of the reproductive system, the patient should be observed by a gynecological oncologist.

Treatment of uterine cancer is based on various combinations of three methods:

Operation.
Irradiation.
Drug therapy.

The main method of treatment performed at any stage of the disease is removal of the uterus and appendages. If there is a poorly differentiated tumor or it penetrates deeply into the muscular layer of the organ, the pelvic lymph nodes, which may contain metastases, are additionally removed.

The operation is performed in 90% of women with an early stage of the disease. For others, it is contraindicated due to severe concomitant diseases. The development of new methods of surgical intervention makes it possible to expand the possibilities of surgical treatment.

If the tumor does not penetrate deeper than 3 mm, it can be removed by ablation (“cauterization”) during hysteroscopy. This way you can save the organ. However, the likelihood of incomplete removal of the lesion is quite high, therefore, after such treatment, regular monitoring by an oncologist in a specialized institution is necessary.

Radiation therapy for uterine cancer as an independent method of treatment is rarely used, only when it is impossible to remove the organ. Most often, radiation is given after surgery (adjuvant radiotherapy) to destroy any remaining cancer cells.

This combination is indicated in the following cases:

deep germination of the neoplasm into the myometrium;
spread to the cervical canal and cervix;
metastases to lymph nodes;
poorly differentiated or non-endometrioid tumor.

Modern treatment methods: radiotherapy – IMRT and brachytherapy. The IMRT method involves targeted irradiation of the tumor with minimal damage to surrounding tissue. Brachytherapy is the introduction of special radioactive substances into the tumor site that act directly on cancer cells.

For endometrial precancer in young women, hormonal therapy with progestins is possible. These hormones block the activating effect of estrogen on the tumor, preventing its further growth. Hormones are used for advanced (disseminated) cancer, as well as for its recurrence. Their efficiency does not exceed 25%.

At an early stage, taking hormones according to a certain scheme lasts about a year. The effectiveness of therapy is monitored using a biopsy. If the result is favorable, the normal menstrual cycle is restored over the next 6 months. Subsequently, a normal pregnancy is possible.

Chemotherapy is prescribed for poorly differentiated uterine cancer and non-endometrioid tumors, disseminated and recurrent cancer, if the tumor does not respond to the influence of gestagens. It is palliative in nature, that is, it is aimed at reducing severe symptoms caused by the tumor, but does not cure the disease. Drugs from the groups of anthracyclines, taxanes, and platinum derivatives are used. Postoperative (adjuvant) chemotherapy is not prescribed.

At home, a woman needs to rest more. Those around her should protect her from emotional stress. Nutrition for uterine cancer is complete and varied, excluding refined carbohydrates (sugar), limiting animal fats, fried and canned foods, spices, chocolate and other irritating foods. Dairy products and plant foods are very healthy.

It is believed that some plants help cope with the tumor or improve the patient’s well-being:

green tea;
turmeric;
beet;
tomatoes;

Treatment tactics depending on stage

The question of how to cure uterine cancer is decided by the doctor after a thorough analysis of all the diagnostic information received. This largely depends on the stage of the tumor.

For stage 1 cancer, complete removal of the uterus and appendages is used (total hysterectomy and).

This operation is carried out if all of the following conditions are met:

moderate and high tumor differentiation;
the formation occupies less than half of the organ cavity;
the depth of myometrial growth is less than 50%;
there are no signs of tumor spread throughout the peritoneum (no cancer cells were found in peritoneal washings).

If the depth of penetration into the muscle layer is more than half its thickness, intravaginal radiation therapy is prescribed after surgery.

In all other cases, removal of the genital organs is complemented by excision of the pelvic and, in some cases, para-aortic lymph nodes. Nodes located near the aorta are punctured during surgery and an urgent histological examination is performed. Based on its results, a decision is made to remove these formations.

After surgery, radiation is used. If surgery is not possible, only radiation therapy is used, but the effectiveness of such treatment is lower.

Hormonal therapy is not used at stage 1.

For stage 2 cancer, patients are advised to remove the uterus, appendages, pelvic (sometimes para-aortic) lymph nodes and postoperative radiation therapy. Irradiation is carried out according to a combined scheme: intravaginally and remotely.

For stage 3 cancer, combined surgical and radiation treatment is performed. If the tumor has grown into the walls of the pelvis, its complete removal is impossible. In this case, radiation therapy is prescribed through the vagina and remotely.

If radiotherapy and surgery are contraindicated, treatment depends on the hormonal sensitivity of the tumor: either progestins or chemotherapy are prescribed.

For stage 4 tumors, palliative chemotherapy in combination with hormones is used. These substances help destroy distant metastases of cancer in other organs.

Recurrence of the tumor is also treated with hormones and chemotherapy. For recurrent lesions located in the pelvis, palliative radiotherapy is performed. Relapses most often occur during the first 3 years after treatment. They are localized mainly in the vagina, lymph nodes and distant organs.

Uterine cancer and pregnancy

During pregnancy, pathological changes are almost impossible to recognize. Tumor growth during pregnancy is most often not observed. However, uterine cancer during pregnancy can be accompanied by miscarriage, placental abruption, fetal death and severe bleeding. In these cases, emergency delivery is performed followed by hysterectomy.

If a young woman has completed the full course of treatment with good results, she may become pregnant in the future. To restore fertility, doctors prescribe courses of hormonal therapy that restore normal reproductive function.

How long do they live with uterine cancer?

This depends on the stage of detection of the disease and sensitivity to hormones. With the hormone-dependent variant, 85-90% of patients live for 5 years or more. In the autonomous form in elderly women, this figure is 60-70%. However, in the 3rd stage of any form, life expectancy of more than 5 years is recorded in a third of patients, and in the 4th stage - only in 5% of cases.

Unfortunately, the number of cancer diseases is only growing every year. In women, one of the leading causes is uterine cancer. has now increased, the female half of the population has a longer period of menopause, and doctors attribute the increase in incidence to this. The risk group most often includes women 40-60 years old.

What is uterine cancer

The uterus in women, like any other organ, has a three-layer structure. The inner one is epithelial tissue, the middle one is smooth muscle tissue and the outer one is connective tissue. As the disease develops, a tumor forms on the walls of the uterus, and then, if no treatment measures are taken, it will begin to spread throughout the body.

Due to the multilayered structure of the uterus, the tumor comes in different types and differs in location.

Reasons for the development of the disease

Doctors came to the conclusion that uterine cancer begins to develop to a greater extent if this organ has been repeatedly exposed to many factors, among which I would especially like to highlight the following:

Frequent abortions and ruptures during childbirth.
Inflammatory processes, especially of a chronic nature.
Dystrophic and degenerative changes in epithelial tissue that can occur as a result of hormonal effects.
Hereditary predisposition.
The presence of human papillomavirus or genital herpes in the body.
Long-term use of hormonal contraceptives.
Early onset of sexual activity, that is, before the age of 18.
Having a large number of sexual partners.
Having bad habits, especially smoking.
Lack of personal hygiene.

Despite the fact that there are many reasons that can provoke uterine cancer, life expectancy with such a diagnosis will depend on many factors. If you consult a doctor in time, then this disease can be easily managed.

Diagnosis of the disease

Making any diagnosis begins with a conversation between the doctor and the patient. A woman must be examined by a gynecologist; without a thorough examination, there can be no talk of any treatment or diagnosis.

The examination begins with an examination of the vagina and cervix using gynecological speculum. In the presence of a disease, it is usually possible to detect changes in tissues. Often, during examination, slight bleeding may begin as the tumor is injured.

If necessary, they may prescribe an examination through the rectum to clarify how much the pelvic walls are affected.

All these manipulations can be carried out if you have all the necessary equipment. It often happens that cancer at an early stage is not recognized due to incomplete examination. With the development of ultrasound diagnostics, this method began to be used to detect cancer tumors.

Since the development of cancer occurs in the lymph nodes, an X-ray examination is also prescribed. In some cases, MRI and CT are prescribed.

All examinations are very important to establish the correct diagnosis and prescribe adequate treatment, because if a woman has uterine cancer, life expectancy will depend on the effectiveness of therapy.

A timely visit to the doctor will allow you to identify the disease at an early stage. This guarantees a high cure rate.

Uterine cancer: symptoms and signs

Women need to monitor their health more carefully throughout their lives, and even more so after the age of 40, because it is at this age that the risk of developing cancer increases. Eae and all diseases, uterine cancer has symptoms and signs, so it is necessary to pay attention to all deviations from the norm in the functioning of the body. The trouble is that we are in no hurry to rush to the hospital as soon as we notice suspicious symptoms. It’s a pity, not only the quality of our life, but also its duration completely depends on this.

Most cancer diseases are dangerous because they begin to show their symptoms only in later stages, so it often happens that when a person asks for help, nothing can be done to help him.

It turns out that uterine cancer manifests itself differently at different periods of a woman’s life. Let's try to figure this out.

Signs before menopause

If a woman is not yet at the stage of menopause, then the following manifestations of this disease can be diagnosed:

Periodic bleeding from the vagina.
Menstruation becomes either more rare and scanty, or, on the contrary, it can come more often and abundantly.
Pain in the lower abdomen.

Nagging pain in the lower back.
Pain during sexual intercourse.
Purulent vaginal discharge.
Frequent urge to urinate.

Symptoms during menopause

When a woman goes through menopause, her periods stop completely. At this time, the following symptoms should alert you:

Any bleeding.
Sudden bleeding from the vagina.
Drawing pain in the perineal area.
Fatigue.
Weight loss for no apparent reason.

If you find yourself with any of these symptoms, then you should not hope that everything will go away on its own. This is a rather insidious disease - uterine cancer, photos confirm this.

Uterine cancer also occurs in pregnant women, but it is rare. This is quite dangerous for a woman's life. In this case, if the diagnosis of uterine cancer is confirmed, surgery is inevitable. You will have to terminate the pregnancy and begin treatment.

Stages of development of uterine cancer

Most often, any disease goes through certain stages, this can be said about a malignant tumor in the uterus. Oncologists distinguish the following stages of uterine cancer:

Zero. At this time, it is already possible to diagnose endometrial hyperplasia, which will certainly lead to the development of malignancy. It's just a matter of time, how quickly it will happen.
First stage. The tumor develops only in the body of the uterus itself, but the localization can be different:

Cancer cells affect only the epithelial cell layer.
The tumor begins to penetrate into the muscle layer.
Carcinoma grows into half of the myometrium.

3. Second stage. The cancer begins to affect the cervix, but does not spread beyond the organ. But there are also varieties:

Only the glands of the cervix are involved in the process.
The tumor affects the stroma of the cervix.

4. Third stage of the disease. Uterine cancer is already spreading beyond the organ, photos confirm this, but again there are its own divisions:

Carcinoma damages the serosa of the uterus and can spread to the ovaries.
Metastases appear in the vagina.
Metastases occur in nearby lymph nodes.

5. The fourth stage is the most serious. The tumor is already affecting the bladder and rectum. Metastases appear outside the pelvis.

When diagnosed with uterine cancer, the degrees also vary. This affects the prognosis of the disease:

High degree of differentiation.
Moderate.
Low.

Doctors note that the greater the degree of differentiation, the better the prognosis. Tumors with low grade metastasize quickly and are characterized by accelerated growth.

If you are diagnosed with uterine cancer, your life expectancy will depend on the stage and extent of the disease.

Cervical cancer

A malignant tumor can begin to develop not only in the uterine cavity, but also in the cervix, then they speak of cervical cancer. This disease also has its own stages of development:

First stage. The tumor develops only in the cervix.
Second. It has its own development options:

Penetration into the parametrium without moving to the pelvic wall.
Vaginal variant, when the tumor affects its walls.
The tumor develops endocervically. It can even affect the body of the uterus.

3. The third stage is also characterized by the presence of three options:

Infiltration of the pelvic wall occurs on one or both sides.
In the vaginal variant, the tumor extends to the lower part of the vagina.
Pelvic metastases appear.

4. Fourth stage. The following development options can be distinguished:

The tumor spreads to the bladder.
Cancer cells affect the rectum.
The tumor extends beyond the pelvis.

Different types of stages and development of the tumor help doctors give a clear idea of treatment methods and its effectiveness.

Treatment of uterine cancer

Currently, given the level of development of medicine, we can say that most cancer diseases are not a death sentence for the patient. But this is only if the person seeks medical help in a timely manner.

Treatment of malignant tumors is carried out taking into account the stage of the disease and its location. Most often the main methods are:

If treatment is started on time, then there is a high probability that you will have a successful cervical cancer; the photos clearly demonstrate the full life of women after surgery.

When a woman seeks medical help too late, the success rate of treatment is significantly reduced.

Disease prevention

Only if you regularly visit a gynecologist and undergo an annual physical examination, then you can be sure that cancer will be detected at an early stage.

As soon as a woman begins to be sexually active, she should make it a rule to visit a gynecologist every year. Regular examination, smear examination, and ultrasound of the pelvic organs can identify precancerous conditions. If they are treated in time, the development of tumors can be prevented.

This is how you can prevent it. Photos confirm that identifying such pathologies is quite simple if you undergo regular examinations. It is impossible to recognize the disease on your own and prescribe medications correctly; this should only be done by a doctor.

Most often, if inflammatory diseases of the pelvic organs are not treated, then over time they can easily develop into cancer. Our health is only in our hands, and no one except ourselves will take care of it.

Treatment effectiveness

The effectiveness of cancer treatment can be judged by repeated cases of the disease. Relapse usually occurs in the first three years after therapy. For many, when diagnosed with cervical cancer, after surgery the vital functions of the body are normalized, the woman recovers and returns to her usual way of life.

If more than three years have passed since the operation and everything is fine with you, then we can guarantee with great confidence that a relapse is unlikely for you.

Prognosis for uterine cancer

Unfortunately, it is impossible to give a 100% guarantee that after treatment the tumor will no longer bother you. If the disease is detected in the first stages of its development, then about 90% of patients recover almost completely.

Considering that the quality of medical examination has now improved, a lot of work is being done on early detection of the disease, it can be guaranteed that the survival rate when cancer is detected will further increase.

Even if you have stage 3 or 4 uterine cancer, your life expectancy increases significantly with proper treatment. Survival rates can be improved by combining radiation with chemotherapy.

If a woman seeks medical help when metastases involve not only the uterus or cervix, but also neighboring organs, then the prognosis is not very good. In this case, it is much more difficult to influence cancer cells.

We can conclude that the quality and duration of our lives depends only on ourselves. Don’t be afraid to visit clinics; if a disease is detected in time, it can be treated much faster and more effectively.

What is uterine cancer
What causes uterine cancer
Symptoms of Uterine Cancer
Diagnosis of uterine cancer
Uterine Cancer Treatment
Prevention of uterine cancer
Which doctors should you contact if you have uterine cancer?

What is uterine cancer

Uterine cancer is very common, currently occupying fourth place in women after breast, skin and gastrointestinal cancer. This form of malignant tumors is usually observed between the ages of 40 and 60 years.

What causes uterine cancer

Risk factors for developing uterine cancer- diabetes, hypertension, smoking, infection with the human papillomavirus, HIV, early onset of sexual activity, late menopause and menstrual irregularities, infertility, a large number of sexual partners, early first birth, sexually transmitted diseases, taking 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 a body weight exceeding the norm by more than 25 kg, the risk of the disease 9 times higher.

Precancerous conditions are widely known to play a significant role in the development of cancer. These are erosions, ulcers, scars after birth trauma, epithelial proliferation (condylomas, 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 noted that a relatively rare tumor affecting the uterus is sarcoma. There are three degrees of tumor differentiation (well differentiated, moderately differentiated and undifferentiated).

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

Symptoms of Uterine Cancer

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

The early stages of the development of uterine cancer are usually accompanied by mucopurulent discharge, causing itching and irritation, which can appear after exercise, shaking, defecation, as well as spotting, which can be scanty or abundant, constant or intermittent. Signs of the disease may include irregular menstruation, an increase or decrease in the duration of menstruation, frequent urination and pain during urination (this means that the tumor has begun to grow into the bladder).

Leucorrhoea can be of various types: watery, mucous, blood-stained, odorless and foul-smelling. The admixture of blood gives the leucorrhoea the appearance of meat slop. Retention of vaginal discharge and associated infection leads to the appearance of purulent leucorrhoea with an odor. In cancer stages III and IV, discharge from the genital tract is putrid in nature. Bleeding can be in the form of small spotting, as well as single or multiple heavy blood losses. For cervical cancer, so-called contact bleeding is very typical (during sexual intercourse, during douching, vaginal examination or after lifting something heavy). 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 cancer process with the formation of infiltrates that compress the nerve trunks and plexuses. General symptoms and, in particular, cachexia (weight loss) occur extremely late, in very advanced stages, and usually women suffering from uterine cancer retain an outwardly blooming, healthy appearance.

Diagnosis of uterine cancer

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

The examination includes a bimanual vaginal examination, a bimanual rectal examination, and a speculum examination.

At vaginal examination in cases of a fairly pronounced tumor process, it is possible to determine certain changes in the cervix depending on the type of tumor growth (exophytic, endophytic and mixed). As a rule, the examination is accompanied by bleeding as a result of trauma to the tumor with the examining finger. In case of advanced uterine cancer, an additional examination is carried out through the rectum to clarify the transition of the tumor to the pelvic walls and uterosacral ligaments.

To detect the initial stages of cervical cancer, one cannot limit oneself only to a vaginal examination; mandatory inspection using mirrors. To detect early forms of cancer, in all cases of certain changes in the cervix, they take smears for cytological examination or biopsy. If cancer of the cervical canal or uterine cavity is suspected, diagnostic separate curettage of the cervical canal and uterine cavity and subsequent histological examination are performed.

All these studies can be carried out in the clinic if the necessary instruments are available and aseptic rules are observed. To illustrate the importance of a comprehensive examination, it is enough to point out that cervical cancer remains unrecognized in more than half of the patients whose examination consisted only of a two-manual vaginal examination. At the same time, when examining with the help of mirrors, the number of errors in diagnosis is reduced 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 makes it possible to detect changes in the uterus that are inaccessible to other research methods and has become a mandatory research method if any benign or malignant formations in the uterus are suspected.

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

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

Uterine Cancer Treatment

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

For cervical cancer, treatment with equal success is carried out using both combined radiation therapy and surgery (extended extirpation of the uterus and appendages). Treatment depends on the stage of the disease. At stage Ia (microinvasive cancer), the uterus and appendages are removed. 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, surgery is performed first, and then remote gamma therapy. In stage II (involvement of the upper part of the vagina, possible transition to the body of the uterus and infiltration of the parametrium without transition to the pelvic walls), 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 transfer 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 later stages, symptomatic treatment is carried out, and chemotherapy may be used.

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

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

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

Prognosis for uterine cancer.
For uterine cancer, the 5-year survival rate after surgical treatment is from 84 to 45%, depending on the stage of the disease. In case of relapses, 25% of patients who initially underwent surgical treatment can be spared from recurrent disease using radiation therapy to 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) help identify precancerous diseases, and their treatment helps prevent cancer.

Equally important is the timely and correct treatment of precancerous diseases of the cervix. There are no particularly characteristic signs unique to precancerous diseases of the cervix; they proceed like ordinary inflammatory diseases. Common signs of precancer 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 must be radical and consist of electroexcision, electrocoagulation of the affected areas, or even amputation of the cervix. They also resort to radiation treatment in the form of application radium therapy. Among patients radically treated for various precancerous lesions, mortality from cervical cancer decreased by 6 times.

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

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

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

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

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

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

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

Reasons

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stages and types

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

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

Gynecologists distinguish four stages of uterine cancer.

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

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

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

high;
average;
low.

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

There are the following morphological types of uterine cancer:

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

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

Symptoms and signs

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

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

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

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

In advanced stages, the first signs are:

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

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

Diagnostic and treatment methods

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

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

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

Treatment involves a combination of several techniques:

surgical intervention;
radiotherapy;
chemotherapy.

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

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

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

Content

Among all oncological diseases, cervical cancer ranks fifth; among gynecological oncological pathologies, the disease ranks second after breast cancer. Signs of uterine cancer in women in the initial stages are mild, making diagnosis difficult. In Russia, 17 women out of every hundred thousand suffer from the disease. Survival prognosis depends directly on the stage at which the patient is diagnosed.

The internal cavity of the organ is lined with a special epithelial layer - the endometrium. Cervical cancer is a malignant tumor process that develops from the endometrium. As a rule, the pathology affects women after 45 years of age, but in recent years the number of cases (up to 40%) among younger women has been increasing. There are two types of uterine oncology: autonomous (in which the etiology is unknown, accounting for a third of all cases of uterine oncology) and hormonal (characterized by endocrine metabolic disorders).

The autonomous variety develops as a result of increased estrogen synthesis - the hormone acts on the endometrium, causing increased cell proliferation, changes in their size and properties (hyperplasia). The hormonal type of oncology is often combined with diseases of the endocrine system. In this case, the malignant lesion develops gradually and has a more favorable prognosis.

Endometrial cancer is considered a “disease of civilization”; the exact causes of the tumor are unknown. The following risk factors exist:

late menopause at the age of 55 years;
lack of ovulation for a long time;
late menarche (first menstruation);
hormonal infertility;
diabetes mellitus, obesity;
polycystic ovary syndrome;
long-term treatment with estrogen-based drugs (without gestagen) or anti-estrogenic drugs;
lack of pregnancy experience;
heredity.

Early symptoms

In most cases, there are no symptoms when a tumor forms. Signs of uterine cancer in the early stages include uterine bleeding that is in no way related to menstrual bleeding. This symptom is observed in most women. Young girls may be bothered by light leucorrhoea. It should be noted that discharge is not always a symptom of cancer; it accompanies many pathologies of the genital area. This significantly affects the diagnosis of the disease. The following discharge is observed:

plentiful;
scanty;
one-time;
repetitive;
periodic.

Symptoms of early stage uterine cancer are usually mild. Pain in the lower abdomen may be observed, mucous (or watery) discharge bothers elderly patients. If the lesion affects the bladder, pain may occur when urinating.

Signs in later stages

Some signs of uterine oncology in women are not accompanied by a clear clinical picture, but are detected during a gynecological examination without special studies. The following symptoms are identified:

refusal to eat, weight loss;
increased fatigue, weakness, decreased performance;
bloody or purulent (at stages 3 and 4 - putrefactive) discharge (including after sexual intercourse);
pain in the pelvic area (in the abdomen, lower back, sacral area);
swelling in the legs;
intermenstrual discharge;
low-grade fever;
vomiting, nausea;
abdominal ascites (fluid accumulation);
pyometra (inflammation of the uterus);
spread of metastases to lymph nodes, liver, bones (leading to fragility, brittleness, fractures);
stenosis (fusion) of the cervix;
gastrointestinal disorders (constipation or diarrhea).