Cancer of the body of the uterus, endometrial cancer - Causes, symptoms and treatment. MF.

Cancer of the uterus body is one of the most common cancer diseases, accounting for 30% of all oncogynecologic diseases, and is on the 3-4th place among cancerous diseases in women after breast, large intestine and lung cancer. According to various data, the cancer of the uterus body affects up to 3% of all women. On average, the disease occurs in people older than 60 years.

To date, we can distinguish two pathological variants of the cancer of the body of the uterus:

1. In young women, against a background of hyperestrogenia, developing against a background of hyperplasia of the endometrium. As a rule, highly differentiated, has a favorable outlook.
2. In elderly patients - against the background of endometrial atrophy. In this case, the tumor, as a rule, is poorly differentiated and is characterized by a less favorable prognosis.

Causes of uterus cancer

Among the risk factors, we can single out:

• The absence of births - 2-3 times higher than the cancer of the uterus body in women who did not give birth.

• Infertility, menstrual irregularity, anovulation.
• Late menopause. It is believed that this is due to an increase in anovulatory menstrual cycles after 45 years.
• Obesity. If the weight exceeds the norm by 20 kg or more, the risk of developing a cancer of the uterus body is 10 times higher.
• Replacement hormone therapy in postmenopause without progesterone.
• Use of tamoxifen in breast cancer.
• Diabetes mellitus

Symptoms of uterine body cancer

Main clinical manifestations:

1. Bleeding and spotting from the genital tract outside of menstruation or in postmenopausal women. The most characteristic symptom, especially for the elderly, in which menstrual bleeding appears against the backdrop of prolonged menopause. In addition to endometrial cancer, this can also be associated with damage to the genital tract, uterine myoma, endometrial polyp.

2. Complaints of pain in the lower abdomen - a more rare symptom, appears with an increase in the uterus and compression of neighboring organs.

3. A hematometer or pyometra is a collection of blood in the uterine cavity, in view of the occlusion of the cervical canal, with possible suppuration. It is typical for the elderly, worsens the prognosis.

4. Constipation, trouble with urination - when the body increases in size, it squeezes nearby the rectum and bladder.

Examination for suspected uterine body cancer

Diagnosis and necessary examination methods:
1. Anamnesis collection, palpation and examination in
mirrors 2. Acquisition of smears
3. Clinical and biochemical blood tests. At the same time, sometimes the level of CA-125 is seen, becauseat late stages of the disease, it can be higher. However, this indicator is most pathognomonic for a tumor of the ovaries, and for cancer of the uterus body it is still used much less often.
4. Ultrasound and vaginal ultrasound is one of the main types of diagnosis of uterine body cancer.
5. Necessarily, if there is a suspicion of uterine body cancer, especially if there are complaints about spotting from the genital tract, taking biapsy material is either a separate diagnostic curettage of the uterine cavity, or taking an aspirate from the cavity if it is impossible to perform the currettage. It is possible to perform hysteroscopy before scraping.
6. Chest X-ray - for diagnosis of metastases to the lungs.
7. Cystoscopy, sigmoidoscopy, irrigosokpi, CT and MRI of the abdominal cavity and small pelvis - according to the indications and the doctor's prescription.

Stages of cancer of the uterus body( substantially simplified):

Stage 0 - cancer in situ
Stage I - tumor is confined to the uterus body
Stage II - with transition to the cervix, without going beyond the uterus
Stage III - the tumor spreads within the pelvis
Stage IV - the tumor sprouts the bladder or rectal mucosa, or there are distant metastases.

Treatment of uterus cancer of the uterus

1. Surgical treatment is the first stage of treatment. The removal of the body of the uterus, cervix and appendages. This tactic of treatment is applicable for cancer of the uterus body of the I-II stage. According to the indications, the operation can be expanded, up to removal of deep pelvic and iliac lymph nodes and removal of the omentum.
In the absence of lesions of the lymph nodes, with the initial stages of the disease operation may be the only necessary treatment.

2. Radiation therapy - at the initial stages is used as the second method, the next after the operative removal of the uterus. As a rule, both intracavitary and remote radiation therapy are used.

3. Chemotherapy - is actively used in our country, often with long-term treatment courses. It is possible to use neoadjuvant( previous operation and precise staging) chemotherapy, for patients with later forms of the disease.

4. Hormone therapy - progestogens are used. Efficiency is not proven.

Forecast

The prognosis for cancer of the uterus body depends on the stage at which the treatment was started, the degree of differentiation, the condition of the patient. In patients with the first stage and a highly differentiated tumor, survival is 96%, in patients with a fourth and a low-grade tumor, only 18%.Five-year survival at all stages is 73%.It is important to emphasize that the higher the survival, the higher the differentiation of the tumor( its affinity for the primary tissue, from which it "occurred").For example, as mentioned above, in the fourth stage of the disease with low differentiation, survival is only 18%, whereas a highly differentiated tumor at the same stage gives a five-year survival rate of 36%!

It should be noted that adequate treatment of patients with any cancer disease is possible only in conditions of an oncological hospital, or in the presence of a specialized specialist in general hospitals. Patients who are diagnosed with cancer of the uterus should be hospitalized in the shortest possible time. Treatment is more effective the earlier it is started.

Progression of the disease occurs in a quarter of patients who have been treated for cancer of the uterus. In 50% of cases, this occurs in the first 2 years, 75% - 3. To diagnose the deterioration of the condition is necessary after treatment, the first 2-3 years to examine patients every 6 months. Gynecological examination, ultrasound of the small pelvis, radiography of the lungs( once a year).

Doctor gynecologist Kupatadze D.D.