How quickly does uterine cancer develop? Uterine cancer: symptoms at an early stage. How quickly does cervical cancer develop from a precancerous condition?

In the first days after birth, newborn girls may experience various vaginal discharges. Don't worry if you notice white or bloody discharge from the genitals of your newborn baby girl. Many mothers believe that a newborn girl should not have any discharge from the genitals. Hygiene for newborn girls should be sufficient, but not excessive.

Discharge in a tiny girl is one of the phenomena that mothers usually do not know how to properly assess. But they are always there, and in the first days a so-called sexual crisis occurs, and they can even become bloody, which is often frightening. In little girls, blood spots from the vagina are not profuse, last 2-3 days and completely stop.

Discharge in newborn girls

White accumulations may appear in the folds of the labia almost up to 3-4 weeks of life. Usually, whitish mucous accumulations in little girls stop on their own by the end of the first month and the genital slit clears. This is the so-called hormonal or sexual crisis. It may also occur in boys in the same manifestations. For new parents, hygiene of the child’s genital organs often becomes a certain difficulty when caring for a baby.

Thrush in newborns

They occur in both girls (the labia minora are fused) and boys (the foreskin and glans penis are fused). This can lead to difficulty urinating and infection. In girls, the occurrence of synechiae is associated with low levels of estrogens (female sex hormones), as well as with the presence of inflammation of the vulva. This sexual crisis is a normal phenomenon in girls in the first month of life, the cause of which is the mother’s hormones entering the child’s body through milk.

White discharge between the labia majora and minora in a girl: what to do?

If a girl worries or cries before she is about to pee, this is most often due to inflammation in the urethra or the canal itself. If you notice that your daughter’s labia are “glued together”, consult a doctor as soon as possible to avoid complications - an infection can easily develop in the accumulating secretions.

In case of incomplete fusion, if it does not interfere with urination, topical medications will be offered, which parents can use to treat the girl at home on their own. Prevention of synechiae and the inflammation that precedes it involves regular examination of the girl’s genitals, maintaining hygiene and monitoring food allergens. Girls, good day everyone!! The discharge may be in the form of a sticky secretion, similar to the vaginal discharge of pregnant women.

Mothers of daughters need to be especially careful, because due to the specific structure of the genital organs, they can easily become infected. A girl's intimate hygiene is carried out only by using baby soap. It is used only in cases of severe contamination.

When washing, you should not use washcloths, as this can injure the delicate skin of the genitals. However, there is no need to worry too much if we are talking about an infant in the first weeks of life. Discharge from the genital organs of a child at this age is caused by a sexual crisis. Normally, they can be white, yellowish, transparent and even bloody, similar to menstrual fluid.

Girls should be washed very carefully; the labia should be parted only for a significant reason, while acting very delicately. This is a secretion secreted by the glands of the labia. It is necessary to protect the genital tract of newborn girls from various types of infections; it should not be cleaned out. Time passes - the girl grows. A girl’s hygiene at 3 years old can be carried out under the supervision of her mother, but on her own, if from the age of 2 the baby was explained how to wash herself properly.

How to properly care for a girl's external genitalia

At this time, a creamy (beige) or light gray coating is noticeable on the labia of the newborn. This is smegma, vernix, and its presence is completely normal. This experience in caring for a newborn baby will be useful to you both during his infancy and in early childhood.

And the pediatrician from the district clinic looked at my daughter in the 3rd week and said that at least a couple of times a week you need to treat the lip and sponges with oil, such as Johnson... 1 time, after that the whitish layer of “plaque” became smaller, but curds appeared in the folds of the lip yellowish grains?

An infant cannot complain about anything; he can only respond to any discomfort by crying, which means you must be very attentive to any symptoms and changes in his condition. If you are expecting a girl, her reproductive system is already able to respond to the mother’s hormonal levels with appropriate changes.

There is no need to do anything about this other than normal care - this is the norm. The origin of these accumulations is the same as that of bloody ones. Their source is the vaginal walls, and they appear in response to stimulation by progesterone and prolactin, which come from the mother with milk.

Condition of the girl's genitals after birth

Another interesting phenomenon of the neonatal period of life is the uric acid crisis. At the same time, you may find yellow spots in the diaper, sometimes so bright that you can even call them orange. This happens regardless of the sex of the child in the first days after birth. These are just salts in the urine; they also do not require treatment and go away on their own.

Free delivery by courier in Moscow and St. Petersburg on the day of order. Sending orders to other regions by Russian Post and various transport companies. Let's try to figure out what this process does, how to properly wrap a baby in a diaper, and in general, whether it's worth doing. However, the granite of the science of child hygiene becomes pliable after mastering the theory and several practical sessions.

What's next? – After washing, you need to cover the child with a towel and carefully blot the moisture in the perineum. To do this, you need to rub a small amount of the product on the skin of the elbow and observe the reaction. The labia come into contact, and as the mucous membrane heals, conditions are created for their fusion. In boys (if there is no inflammation), it is recommended to separate synechiae after 5 years and later, since there is a possibility of their “self-destruction.”

However, at the time when they appeared, it should be remembered that she needs special intimate hygiene for a newborn girl. A newborn girl should have her own soap and towel. The intimate hygiene of a 2-year-old girl should be based on the same principles and rules as the hygiene of a newborn baby. No matter how it is! - the parents of a newborn girl can safely say when they struggle with a full diaper for the first time.

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

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

Cancer of the uterus in women

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

Cancer of the uterus in ICD-10

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

Causes of uterine cancer

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

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

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

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

History of the reproductive period.

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

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

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

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

Uterine cancer and pregnancy

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

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

What happens with uterine cancer

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

Symptoms and signs of uterine cancer

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

There are also less specific signs:

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

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

Signs before menopause

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

Manifestations in postmenopause

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

Stages

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

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

Stage 2. The tumor grows and invades the cervix.

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

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

Diagnosis of uterine cancer

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

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

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

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

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

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

Analyzes

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

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

Treatment of uterine cancer

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

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

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

Surgical treatment of uterine cancer

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

Radiation therapy for uterine cancer

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

Chemotherapyuterine cancer

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

Medicines and drugs

Most often used

• carboplatin
• cisplatin
• doxyrubicin
• paclitaxel.

Hormone therapy uterine cancer

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

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

Complications

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

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

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

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

Recurrence of uterine cancer

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

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

Urgent consultation with a doctor is needed if:

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

Rehabilitation after treatment

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

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

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

Patient survival prognosis

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

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

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

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

Prevention of uterine cancer

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

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

Uterine cancer affects older women, that is, from 55 to 65 years old, but in 40% of cases the disease occurs in young women. Among all malignant neoplasms of the female genital area, uterine cancer is given first place, and second place in female oncology (the championship belongs to).

Doctors note that the incidence of this pathology has increased in recent years, and explain this trend by an increase in life expectancy (extension of the postmenopausal period) and an increase in the frequency of “modern diseases”: chronic and anovulation, and others.

note

It is noted that the combination of these diseases with various disruptions in the endocrine system and metabolic disorders (excess weight, etc.) contributes to the development of dysfunctions in the reproductive, protective-adaptive and metabolic systems of the body and provokes the formation of endometrial cancer.

Classification, stages of uterine cancer

Uterine cancer refers to malignant degeneration of the endometrium, which is the inner lining of the uterus. Systematization of uterine cancer in gynecology is carried out according to the following criteria:

The degree of differentiation of malignant formation is an important prognostic sign. The more undifferentiated atypical cells a tumor contains, the more questionable the prognosis. An unfavorable option is poorly differentiated uterine cancer.

Etiology and pathogenesis

Sex hormones, which provide phase changes in the endometrium, leading either to the implantation of a fertilized egg and the further development of pregnancy or to its rejection (menstruation), select uterine cancer as their target, since it is a hormone-dependent tumor. Hormonal imbalance, which occurs as a result of changes in the hypothalamic-pituitary-ovarian system, leads to the development of proliferative processes in the endometrium, and then to its hyperplasia, which creates the background for the malignant degeneration of cells of the uterine mucosa. But the reason for the development of endometrial cancer against this background remains unknown to this day.

Risk factors:

• endocrine and metabolic disorders (diabetes, excess weight);
• hormonal-dependent reproductive disorders (anovulation, long-term infertility, hyperestrogenism);
• estrogen active;
• heredity (burdened family history of endometrial, breast and cancer);
• absence of pregnancy/birth;
• late cessation and onset of menstruation;
• treatment with hormones (tamoxifen).

The pathogenesis of uterine cancer is explained by three hypotheses:

• Hormonal (estrogenic). This hypothesis is based on a combination of excess estrogen, endocrine and metabolic disorders in 70% of confirmed endometrial cancer. Hyperestrogenism is manifested by anovulatory uterine bleeding, infertility and late (55 years or more) onset of menopause, tumors of the ovaries and/or uterus. Against the background of excess estrogen, highly differentiated uterine cancer develops, which slowly progresses and metastasizes. The course of this form of the disease is favorable, and the neoplasm is highly sensitive to gestagen therapy.
• Estrogen independent. In 30% of cases of uterine cancer, there are no endocrine and metabolic disruptions, and there are no ovulation disorders. Cancer forms against the background of atrophied uterine mucosa and is characterized by low differentiation, insensitivity to gestagenic drugs, and a tendency to rapid metastasis. This variant of pathology is less favorable in prognostic terms.
• Genetic. Explains the mechanism of disease formation by genetic factors.

During its development, uterine cancer goes through several stages:

• functional disorders (excess estrogen, lack of ovulation);
• the appearance of background morphohistological changes (polyposis or endometrial hyperplasia);
• the occurrence of precancerous changes (atypical and/or dysplasia);
• formation of malignant neoplasia (degeneration).

Pathways of uterine cancer metastasis:

• lymphogenous - malignant cells spread with the lymph flow and affect near and distant lymph nodes;
• hematogenous - cancer cells spread through the bloodstream to internal organs (mainly lung and liver tissue and bones);
• implantation - the tumor grows into the uterine wall and spreads throughout the peritoneum, into the peri-uterine tissue and appendages.

Signs of uterine cancer

The first signs of uterine cancer include the appearance of acyclic bleeding - intermenstrual, before the onset of menstruation or after its end. can last quite a long time and be abundant. This symptom occurs in 90% or more of cases of endometrial cancer. However, this symptom also appears in many other gynecological diseases (endometrial hyperplasia, uterine fibroids, endometriosis) in women of childbearing age, which often leads to an error in diagnosis and delays diagnostic and therapeutic measures for uterine cancer. Bleeding from the uterus is a pathognomic symptom for endometrial cancer only in postmenopausal women. The intensity of bleeding in this case may vary - from scanty to heavy.

Elderly patients complain of copious watery discharge (tumor decay). During a gynecological examination, there are no characteristic signs of inflammation (,). Watery discharge is considered a specific manifestation of endometrial cancer. When a secondary infection attaches to the site of tumor necrosis, the discharge becomes purulent or takes on the appearance of meat slop with a putrid odor. When purulent discharge accumulates in the uterine cavity, pyometra is formed, which is accompanied by signs of intoxication (fever, chills, weakness and malaise, loss of appetite).

A later sign of uterine cancer is pain, which manifests itself at stages 3–4 of the disease.. The pain is caused by tumor growth into the periuterine tissue and compression of the nerve endings in it, into the walls of the pelvis, large intestine and bladder. The pain is described by patients as constant, aching, and of sufficient intensity. Localized in the lumbar and sacral regions, they can occur during coitus or natural sexual intercourse. When the rectum and bladder are affected, urination and defecation are impaired.

note

In 70% of cases, uterine cancer is diagnosed at the first stage, which leads to a favorable prognosis for life and almost never leads to death. Self-healing of endometrial cancer is impossible, and the use of traditional methods is unacceptable; only timely consultation with a doctor is the key to a positive outcome and recovery.

Diagnostics

Diagnosis of uterine cancer consists of collecting anamnesis and complaints, conducting a general and gynecological examination, and prescribing additional research methods:

• Gynecological examination. When examined in the speculum, there are no signs of damage to the vagina and cervix; bimanual palpation makes it possible to determine the size of the uterus and its consistency, mobility, and palpate the ovaries and fallopian tubes.
• M-echo values ​​(endometrial thickness) equal to 12 mm or more in women of childbearing age (normally from 10 to 16 mm) and 4 mm or more in postmenopausal patients should raise suspicion of a malignant tumor of the uterus. In this case, the patient is required to undergo endometrial aspiration. Ultrasound also makes it possible to clarify the size and contours of the uterus, the depth of tumor growth into the uterine wall and its location, the condition of the internal os, regional lymph nodes, appendages and parametrium.
• Cytogram. A smear from the cervical canal and material obtained by aspiration of the endometrium are subjected to cytological examination in order to identify atypical cells.
• Hysteroscopy. Allows you to examine the uterine cavity and cervical canal, perform a targeted biopsy of the endometrium and determine the feasibility of separate curettage. If necessary, curettage is performed first of the cervical canal and then of the uterine cavity. The resulting material is sent for histological examination.

In order to exclude/confirm metastases to distant and nearby organs, chest, cystoscopy, and urinary system and abdominal cavity are prescribed. Comparative diagnosis of uterine cancer is carried out with endometrial hyperplasia, adenomatosis and submucous

Treatment of uterine cancer

Treatment of uterine cancer is complex and includes surgery, radiation, hormonal and drug therapy (cytostatics).. The sequence of treatment methods and their intensity are determined by the stage of the disease, the size and histotype of the tumor, the degree of differentiation and the depth of penetration of the tumor into the myometrium. The extent of the tumor beyond the uterus, the presence/absence of distant metastases, the patient’s age, and concomitant diseases are also taken into account.

The main direction in the treatment of this pathology is surgical intervention.. The extent of the operation depends on certain prognostic factors. In the presence of favorable factors (stage 1 cancer, highly differentiated, myometrial growth by no more than a third), extirpation of the uterus and appendages is performed. In the case of unfavorable factors (cancer stages 3–4, poorly differentiated, invasion into the myometrium by more than a third, tumor spread to neighboring organs), an extended extirpation of the uterus and appendages is performed (removal of the upper third of the vagina, parametrium and regional lymph nodes). But in the case of severe extragenital diseases (hypertension, diabetes, overweight), they are limited to simple extirpation of the uterus and appendages, combined with pelvic lymphadenectomy.

note

In the case of the first stage of cancer in women of childbearing age, it is possible to perform endometrial ablation using a hysteroresectoscope (complete destruction of the basal layer of the mucosa and 3–4 mm of the myometrium).

In the postoperative period, in case of myometrial growth and tumor spread, irradiation of the vaginal area, pelvis and regional lymph nodes is performed. Additionally, treatment with cytostatics (cyclophosphamide, doxorubicin) is prescribed, and if the cancer is sensitive to hormone therapy, antiestrogens, gestagens and combined estrogen-gestagen drugs are prescribed.

Prognosis for uterine cancer

Success in the fight against uterine cancer depends on the stage of the process, the age of the patient, the presence of distant and near metastases, cancer differentiation, its prevalence and pathogenetic course. The five-year survival rate among women under 50 years of age and with hormone-dependent uterine cancer without metastases is 90%. An unfavorable prognosis is expected in patients over 70 with estrogen-dependent uterine cancer, in which case the five-year survival rate is 60% or less.

Relapse of the disease in 75% of patients is observed during the first 3 years after primary therapy. If cancer has metastasized to the lymph nodes, the risk of disease progression increases 6 times. In 42% the tumor recurs in the vagina, in 30% in the pelvic lymph nodes, in 28% in distant organs.

Sozinova Anna Vladimirovna, obstetrician-gynecologist

The uterus is one of the most important organs of the female reproductive system. And, like other female organs, the uterus can be affected by a malignant neoplasm. This pathology ranks first among all cases of cancer of the female genital organs. And therefore, it is important for any representative of the fair sex to know the main signs of this formidable and life-threatening disease.

Description of the disease

The uterus is a muscular sac designed for the development of the fetus. Organ dimensions – 8/4/3 cm (length/width/thickness). The lower part of the uterus, facing the vagina, is called the cervix. The rest forms the body of the uterus. The upper part of the body of the uterus, adjacent to the peritoneum, is called the fundus of the uterus.

The walls of this organ have several layers. The inner layer is called the endometrium, and the fertilized egg attaches to this layer. This layer is necessary to supply the embryo with everything it needs. The middle layer of the uterus is relatively thick. It is made up of muscle tissue and is called the myometrium. The outer layer is thin and is called the parametrium.

According to histological parameters, uterine cancer is divided into the following types:

• adenocarcinoma,
• clear cell,
• squamous,
• serous,
• glandular-squamous,
• mucinous,
• undifferentiated.

In most cases, the tumor is localized in the fundus of the uterus, less often in the lower part of the uterus.

Practice shows that malignant tumors can develop both in the endometrium and myometrium, as well as in the cervix. However, cervical cancer has its own characteristics and is therefore classified as a separate disease in gynecological oncology. In this article we will not dwell on it, but will consider only uterine cancer.

Who is most likely to get uterine cancer?

Every year in Russia, many women (approximately 16,000) are diagnosed with this terrible diagnosis - uterine cancer. It can affect both older women who have reached menopause and young women of childbearing age. Although the proportion of elderly patients, over 45 years of age, still prevails. In addition, the incidence of the disease is increased in those women who entered menopause late.

Causes of the disease

There are two main types of the disease. This is uterine cancer associated with the level of female hormones, and uterine cancer that occurs regardless of this factor. Doctors have long noticed that women with elevated levels of estrogen in the body and insufficient levels of progesterone are at increased risk of developing the disease. Uterine cancer caused by these abnormalities is called hormone-dependent. It accounts for 70% of all cases of uterine cancer. This type of disease usually begins with excessive growth of the endometrium. At the same time, processes occur in the woman’s endometrium that most likely lead to the formation of a tumor.

What other factors influence the occurrence of uterine cancer:

• long-term use of estrogen,
• hypertonic disease,
• taking certain medications for breast tumors,
• heredity (cases of uterine, breast or ovarian cancer in close relatives),
• immune disorders,
• absence of pregnancies,
• ovarian tumors,
• endometritis,
• scars after birth trauma,
• multiple abortions,
• irradiation of the pelvic organs,
• diseases of the liver and adrenal glands.

As can be seen from this list, many of these factors also indicate that the incidence of uterine cancer is often associated with hormonal imbalances in the female body. For example, adipose tissue also plays the role of a kind of endocrine organ that produces female hormones. According to studies, exceeding the normal body weight in women by 10-25 kg increases the risk of malignant tumors of the uterus three times, and by more than 25 kg – by 9 times.

Many drugs for the treatment of breast tumors also contain estrogens. With ovarian tumors, there is also often an increased release of estrogen. Diseases such as adenoma or adrenal hyperplasia, hepatitis, and cirrhosis also affect the level of hormones in the body.

However, many tumors arise regardless of the level of hormones in a woman’s body. This type of cancer is called autonomous, and, as a rule, it is much more severe than hormone-dependent. This type of cancer most often occurs in older women. Risk factors here are immune disorders and cases of uterine bleeding after menopause.

Stages of uterine cancer

The success of treatment of the disease depends on the stage at which it was started. The more developed the disease, the less chance of defeating it. Uterine cancer, like most types of malignant tumors, is dangerous because in the later stages it damages surrounding organs and spreads its metastases everywhere, including to distant organs. In such cases, doctors, despite all their efforts to treat the disease, may not save the patient’s life.

There are two types of classification of stages of uterine cancer. One of them is proposed by the International Association of Obstetricians and Gynecologists FIGO. The other, the so-called TNM classification, takes into account not only the size of the tumor itself, but also the degree of damage to the lymph nodes, as well as the spread of metastases to distant organs.

Let us first consider the FIGO staging system suitable for describing endometrial cancer. This classification contains the following stages:

• IIIA,
• IIIB,
• IIIC,

What do these stages mean? Stage zero is usually designated as the stage when there is no cancer as such, but atypical endometrial hyperplasia is observed, which with a high, almost 100% probability, turns into cancer.

In stage I, the tumor is located exclusively within the uterus. In stage IA, the tumor has not spread beyond the endometrium. At stage IB, the tumor begins to penetrate the muscle layer, at stage IC it comes close to the outer lining of the uterus.

At stage II, the tumor spreads to the cervix. In stage IIA, the tumor is observed only in the area of ​​the cervical glands, and in stage IIB, it also spreads to the stromal cells.

Stage III is diagnosed when the tumor extends beyond the uterus, but the pathological process does not leave the pelvis. In stage IIIA, the tumor affects the appendages, in stage IIIA, in the vagina, and in stage IIIC, metastases are detected in the nearest lymph nodes. Stage IVA indicates tumor invasion into the bladder or rectum. Stage IVB is the last stage, with metastases forming outside the pelvis.

Let us now consider the TNM staging system. It takes into account three parameters - T (tumor size), N (damage to lymph node metastases), M (presence of metastases).

Here are the phenomena that correspond to different values ​​on the T scale:

• T_IS – precancer;
• T1A – the tumor is located within the uterus, less than 8 cm in diameter;
• T1B – tumor within the uterus, more than 8 cm in diameter;
• T2 – tumor is found in the cervix;
• T3 – the tumor extends beyond the uterus, but does not leave the pelvis;
• T4 – The tumor has spread to the rectum or bladder, or has spread beyond the pelvis.

Parameters N and M can take the following values:

• N0 – no signs of lymph node involvement,
• N1 – lymph nodes affected,
• M0 – no evidence of distant metastases,
• M1 – distant metastases.

The G index is also sometimes used, indicating the degree of differentiation of tumor cells. An index value of 1 means a high degree of differentiation, 2 – average, 3 – low.

Symptoms

Making an accurate diagnosis in the case of uterine cancer is not an easy task. This is due to the fact that the signs of this disease may resemble the symptoms of other pathologies of the female genital organs. And it often takes precious time to establish the correct diagnosis, during which the tumor develops unhindered.

The main symptom that many women with uterine cancer experience is vaginal bleeding that is not associated with menstruation. Such phenomena should be alarming, although, of course, they do not always mean the presence of a malignant tumor. However, they must necessarily be a reason to consult a doctor.

The second symptom is profuse vaginal discharge, often of an unusual appearance. They may be purulent and watery and have an unpleasant odor.

The first signs of uterine cancer usually do not include severe pain. Pain in the early stages of uterine cancer is usually mild or not observed at all. A woman may only be bothered by nagging pain in the lower abdomen. Severe and disturbing pain can appear only after the spread of the pathological process in the pelvic area. Also, if a tumor develops and compresses the ureter, pain may occur when urinating and a frequent urge to urinate. Signs such as pain during defecation and false urge to defecate may appear. Sexual intimacy is also usually uncomfortable.

In adult women after menopause, when menstruation stops, there should normally be no bloody discharge from the vaginal area. This phenomenon very often indicates a malignant tumor.

It should be remembered that in 8% of cases, uterine cancer at an early stage develops completely asymptomatically.

Diagnostics

If during a gynecological examination the doctor suspects uterine cancer, the doctor will refer the patient to a number of additional diagnostic procedures. First of all, this is an ultrasound. With ultrasound diagnostics, it is easy to determine the thickness of the endometrium, and its increased thickness is a cause for concern. In elderly women after menopause, it should not exceed 4 mm, in elderly women during menopause - 7 mm, in women of childbearing age - 12 mm. Ultrasound also allows you to determine in which direction the tumor is growing - inside the uterine cavity or outside it. The disadvantage of the ultrasound procedure is the impossibility of examining nearby lymph nodes for damage.

There are also more informative research methods - MRI and computed tomography. However, the biopsy method has the greatest accuracy. If a suspicious formation is found, a tissue sample is taken from it using a special needle for analysis. A biopsy of nearby lymph nodes may also be performed. An endoscopic examination method is also performed - hysteroscopy. This method can be combined with taking tissue samples for analysis using a biopsy. In addition, during hysteroscopy, diagnostic material can be collected by scraping the surface of the endometrium.

Another common method is analysis of the contents of the uterus (aspiration biopsy). Collection of contents for analysis can be carried out in women and on an outpatient basis. Unfortunately, in the early stages of cancer the method is not very informative. In any case, the appropriate method is selected by a specialist.

In addition, your doctor may prescribe the following diagnostic tests:

• general blood analysis,
• blood chemistry,
• Analysis of urine,
• coagulogram.

When diagnosing, it is important to differentiate a malignant neoplasm of the uterus from other diseases of the genital organs - fibroids, endometriosis, polyps, adenomatosis, tumors of the vagina and cervix. Only after the diagnosis has been accurately established can treatment of the disease begin.

Statistics say that in most cases, uterine cancer is diagnosed at the first stage of the disease (72% of cases). The shares of stages 2, 3 and 4 account for 13%, 12% and 3%, respectively.

Treatment

Therapy of any malignant tumor is not an easy and lengthy process. Uterine cancer is no exception to this rule. The choice of treatment methods largely depends on the location of the tumor, the type of cancer cells (differentiated or not), and the stage of the disease. In addition, the patient’s age and her concomitant diseases are also taken into account. The last factor is also important, because uterine cancer is rarely diagnosed in otherwise completely healthy women. As noted above, the development of the disease is often facilitated by diabetes, obesity, and hormonal imbalance in the body.

In most cases, the main treatment is surgical. The usual practice is to completely remove the uterus (total hysterectomy). Often it is carried out together with the appendages, especially in cases where the woman is in menopause. The extent of tumor spread is also taken into account. There are two types of hysterectomy surgery – amputation and extirpation. During amputation, the uterus is separated from the cervix, and during extirpation, it is removed along with the cervix. Practice shows that amputation is tolerated more easily by patients than extirpation. In addition, it leads to fewer complications. However, here it is also necessary to take into account how much the tumor has grown and whether it affects the neck of the organ.

Typically, this operation also removes the appendages - the ovaries and fallopian tubes. Of course, after the operation, the amount of female hormones produced by the body decreases, but not much, since part of the function of hormone synthesis is taken over by other internal secretion organs, for example, the adrenal glands.

The operation to remove the organ can be carried out either by the classic abdominal method (using an incision in the abdomen), or by the vaginal method, in which the uterus is removed through an incision in the posterior wall of the vagina. A similar procedure today is usually performed using laparoscopic technology.

In some cases, instead of removing the entire organ, surgery may be performed to ablate (remove) the endometrium. This operation is performed only if the tumor is small - no more than 3 mm. After this operation, as well as after the removal of an organ, the woman loses her ability to bear children.

Treatment may also include chemotherapy and radiation therapy. These types of treatments are usually used as adjuncts to surgical ones. With their help, it is possible to achieve a significant reduction in the tumor, which makes the operation to remove it easier. In cases where surgery is impossible for one reason or another, for example, due to the patient’s health, radiation therapy and chemotherapy become the main methods of treatment.

Cytostatic drugs are used to treat the tumor as part of chemotherapy. The principle of their action is based on blocking the proliferation of pathological tumor cells. The most commonly used drugs are cisplatin, doxorubicin, and cyclophosphamide.

The disease is often treated with radiation therapy. In this case, two methods are possible. With one, the radiation source is introduced inside the organ, and with the second, it is located outside.

If the cancer is hormone-dependent, then treatment with hormones - antiestrogens and gestagens - is often used. In the initial stages of cancer, hormone therapy can stop the progression of the disease, and in the case of atypical endometrial hyperplasia, it can even achieve a complete cure.

Forecast

The prognosis for the development of the disease depends on factors such as the stage of the disease, the type of tumor, the age of the patient, and her state of health. It has been noted that hormone-dependent cancer is usually less severe and easier to treat than hormone-independent (autonomous) cancer.

In addition, in old age the disease is more severe than in young people.

The degree of differentiation of cancer cells also matters. If it is low, then the disease usually develops faster and is difficult to treat.

The prognosis for the disease largely depends on factors such as the formation of metastases. This factor is influenced by the woman’s age, the degree of differentiation of tumor cells, its location, and the type of cancer - hormone-dependent or autonomous. With an autonomous type of cancer, the probability of metastases is 13%, with a hormone-dependent type - 9%. With highly differentiated cancer, metastases form in 4% of cases, with poorly differentiated cancer - in 26% of cases. In patients under the age of 30, metastases are extremely rare, in patients 30-60 years old - in 6% of cases, in patients over 60 years old - in 15% of cases.

After treatment is completed, recurrence of the disease cannot be ruled out. In the first three years, relapses occur in every fourth patient, and in subsequent years, relapses occur in only every tenth patient.

On average, for all categories of patients, the five-year survival rate is 86-98% for those who began treatment at the first stage of the disease, 70% at the second, 30% at the third, and 5% at the fourth.

Prevention

Of course, there is no one hundred percent guarantee that uterine cancer will not occur. However, it is worth remembering that a number of factors contribute to the occurrence of this disease. These are excess weight, uncontrolled use of hormonal drugs, diabetes. In addition, a woman needs to visit a gynecologist regularly, at least once a year. This is especially true for those ladies who have entered menopause. If feminizing benign tumors are detected, they must be promptly removed. Any suspicious phenomena occurring in the genital organs, primarily bleeding from them, may be harbingers of malignant tumors. This should be remembered. You should also eat right, eat more plant fiber, which reduces the risk of any type of cancer, and avoid bad habits - smoking and drinking alcohol.

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

This common disease ranks 4th after breast cancer, skin cancer and gastrointestinal cancer. They form in women over 45 years of age, and the type of oncology depends on its location, because the uterus is a multilayered organ. Think about it: hundreds of thousands of women face this diagnosis every year.

Causes of oncology

The causes of uterine cancer are not precisely determined; there are factors that aggravate the risk of the occurrence and development of the disease. Research results show that the disease is caused by:

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

Obesity remains a significant influencing factor. If a woman's weight is 15 kilograms more than normal, 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 can intensify the occurrence of 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?

The nature of the epithelium determines the division into squamous cell carcinoma and glandular carcinoma (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 canal - this is a sarcoma.

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

Stages of development of uterine cancer:

1. In the first stage, the tumor is located in the body of the uterus.
2. The second cancer process produces further damage to the cervix.
3. The third stage is characterized by the transition of the tumor to tissue, 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 are a woman complaining of bleeding, pain and discomfort, and the appearance of leucorrhoea.

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

In the early stages, purulent mucous masses may appear, which cause irritation and itching. The first symptoms appear after physical activity, defecation or shaking.

Then there is the manifestation of bloody discharge, it doesn’t even matter what nature. A similar process occurs periodically (constantly) and the discharge can be abundant or scanty.

Menstrual irregularities indicate that pathology is developing. The duration of menstruation may be reduced or increased, and pain during urination is characteristic, indicating that the tumor is growing into the bladder.

What are the main symptoms of uterine cancer? Oncologists say that 80% have uterine bleeding; such symptoms of uterine cancer do not relate to menstruation.

In later stages, uterine cancer has signs and symptoms:

• A pulling pain develops in the lumbar region, abdomen and perineal area.
• There is pain during and after sexual intercourse.
• Disturbances in the process of bowel movement - diarrhea or constipation.
• Unreasonable weight loss.
• Loss of appetite.
• Nausea and vomiting.
• Decreased performance, rapid fatigue.
• Hyperthermia (increased body temperature, heat accumulation).

Cancer of the uterus before menopause has the following symptoms:

• No characteristic decrease in the amount of bleeding.
• Bloody discharge appears frequently.
• There is an abundance of discharge (instead of proper weakening and impoverishment).

During the postmenopausal period, there are no periods, so vaginal discharge should at least alert a woman. It does not matter what the intensity, duration and frequency of bleeding is. Symptoms of uterine cancer should be suspected in women who are concerned about their health.

If you notice the slightest symptoms of uterine cancer, consult a doctor immediately! After all, uterine cancer can have terrible consequences. A timely visit to the doctor will allow you not to worsen the situation and cope with oncology in a timely manner.

Diagnostic methods

Diagnosis is an important stage; treatment of uterine cancer depends on it. First, the patient’s complaints are examined and determined. Suspicious cases of the disease occur during observation by a gynecologist; without examining patients, it is impossible to cure the disease.

Diagnosis is made by vaginal examination, rectal examination and examination using speculum.

A vaginal examination of endometrial cancer of the uterus helps to determine changes in a pronounced process of tumor development. The study is characterized by bleeding due to damage to the tumor with a finger. If uterine cancer is widespread, then 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. An inspection method using mirrors is used. A biopsy or cytological examination helps 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 curetted for diagnosis and histology.

The manipulations are carried out in a clinic by a doctor with the necessary equipment. Biopsy remains the accurate method; here, cases of errors are rare. In half of the cases diagnosed during 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, shape and stage of tumor development. The main treatment is surgical, which involves extirpation (removal) of the uterus, and in some cases the lymph nodes of the pelvic area have to be removed.

At a late stage, a combined treatment method is used, in which surgery is performed, followed by remote irradiation of the vagina (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 surgery. As a stand-alone method, radiation therapy is effective when the tumor is localized, as well as when there are contraindications for surgery. At the third and fourth stages of development, antitumor drugs are effective.

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

Five-year survival rates range from 80 to 40% after surgery.

Metastases in uterine cancer

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

Prevention methods

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

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

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

Diseases in the cervix need to be treated radically using electrocoagulation, electroexcision or complete removal of the cervix.

Diagnosis carried out on time and the treatment process 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. Monitor your health and visit your doctor promptly.