Uterine Cancer Symptoms
Uterine Cancer - is the growth of malignant cells in the uterus.In recent years, the continued and steady increase in the incidence of uterine body cancer and is the second-third of all cancers in women, second only to breast cancer and ovarian cancer.In spite of the existing opinion about the slow nature of the growth and spread of endometrial cancer, mortality from this disease remains very significant.
term uterine cancer is often used instead of the term "endometrial cancer", as the malignancy of the uterus most often develop in the endometrium - tissue lining the uterus.Malignant tumors may also develop in the muscular wall of the uterus (uterine sarcoma), although this is relatively rare.
Cervical cancer is the most common cancer of the female reproductive organs of the pelvic;it most commonly affects postmenopausal women, aged 50 to 70 years.Younger women whose ovaries produce estrogen, but ovulation does not occur, as well as women with polycystic ovaries are also likely to develop cancer o
• The cause of uterine cancer is unknown.
• Obesity, high blood pressure, diabetes, endometrial hyperplasia, endometrial polyps, polycystic ovaries, and late menopause with severe bleeding is associated with an increased risk of uterine cancer.
• Long-term use of estrogen replacement therapy (without a progestin agent) in postmenopausal women is associated with a higher likelihood of developing uterine cancer.
• Tamoxifen, a drug used in the treatment of breast cancer increases the risk of uterine cancer.
• Cervical cancer is more common in women who have had few or no children;it is less common among those who have used oral contraceptives.
Increased detection rate of endometrial cancer is found mainly in countries with high economic standard of living.
increased incidence of uterine body cancer, many associated with the increase in material living standards, changes in the principles of food (increase in the use of meat and animal fats), extensive uncontrolled use of contraceptives and hormone replacement medicines nature.Others see the cause of the increase in total life expectancy of women.
High incidence noted in the risk groups, which include women with accompanying endocrine and metabolic diseases, dysfunction of the ovaries.
Women young age the risk of endometrial cancer associated with prior genital pathology: myoma of the uterus in the 1.6-8%;Endometrial polyposis - 5.3-25%;dysfunction, polycystic ovary amid - 25%;various forms of endometrial hyperplasia - 81.3%.
• Bleeding from the vagina after menopause.
• Abundant persistent or unusual (watery or bloody) vaginal discharge.
• Pain in the lower abdomen and weight loss in patients with severe disease development.
• The main method of treatment is a full hysterectomy (surgical removal of the uterus).The fallopian tubes, the ovaries, the upper part of the vagina and nearby lymph nodes can also be removed depending on the degree of cancer spread.
• cancers at an early stage (non-invasive cancer cells with normal form) can be cured with the help of a hysterectomy without removal of adjacent organs.
• If the cancer is believed to have gone beyond a very early stage, radiation therapy (external and internal radiation) may be used in addition to surgery;internal exposure are small radioactive pellets are introduced into the tumor, or placed next to it for 48-72 hours in a single session.
• progestogens tools can be used in the treatment of cancer of the uterus;chemotherapy is not effective in most cases.
Therapies endometrial cancer over the past 2 decades, have undergone significant changes.This situation is largely due to the evolution of views on the biological properties and the radiosensitivity of malignant tumors of the uterus body, the deepening understanding of the characteristics of the pathogenesis and the role of the hypothalamic-pituitary system in the development and clinical manifestation of the disease, as well as the expansion of knowledge about the nature of lymphatic metastasis of endometrial tumors.It is generally recognized that are leading surgical and combined treatments.
most significant achievement in the field of surgical treatment of patients with uterine body cancer is the substantiation of the differentiated indications for the use of three types of surgical intervention.The use of extended hysterectomy has improved the 5-year results of treatment of patients with uterine body cancer by 12%.Thus, an important role in enhancing the effectiveness of the treatment itself belongs surgical component.
Opinions clinicians are unanimous in saying that the priority is for the combined method of treatment, providing a fairly high rates of 5-year survival rate of patients.
Widespread use of radiation therapy is an objective factor, requiring the improvement of existing and development of new methods of radiation exposure.
Radiation therapy as a component of the combined treatment of patients with uterine body cancer.Literature data on the role of the radial component in the combined and complex treatment of patients with uterine body cancer are quite contradictory.A number of researchers using preoperative intracavitary gamma therapy.
When preoperative irradiation suggest the following results:
1. achieve death or reducing the viability of cancer cells, to ensure the operation in ablastics conditions;
2. reduce the size of the tumor, allow surgical treatment in cases where the local spread of the cancer does not allow to carry out the operation at the I stage of treatment.
In some works the circle of indications for preoperative intra-cavitary irradiation limited observations, that there is an increase or decrease in uterine histological differentiation of the tumor, as well as for stages II and III disease.The number of foreign clinics, where preoperative irradiation is used, its proponents point to the following advantages:..
1. preferable from radiobiological point, ie, subjected to the effects of the tumor with an intact vascularization.
2. Reduction of transplantable tumor cells, and, therefore, the danger of intraoperative dissemination.
3. Reduces the risk of developing radiation complications from adjacent organs with the uterus.
noted a small but definite improvement in treatment outcome compared with hysterectomy without first gamma-therapy.However, in some hospitals, this conclusion has not been confirmed.And rightly pointed out that the impact of radiation is directed only to the primary tumor, which will still be removed.The issue with respect to the lymph nodes remains open in this case.However, it is to remove them or radiation plays an important role in the treatment of endometrial cancer.
Some researchers believe that when preoperative irradiation:
1. reduces the possibility of individualization of medical tactics;
2. «smeared» morphological picture of the tumor, causing difficulty in determining the degree of histological differentiation and depth of invasion;
3. surgery is performed in the worst conditions (in the irradiated tissue), leading to increased incidence of postoperative complications.
According to other authors, preoperative irradiation of patients with endometrial cancer causes excessive standardization of the treatment program, often leading to its aggressiveness, designated in English literature «overtreatment» concept.
also known work on the study of preoperative course EBRT in conventional fractionation mode with total doses 30-40Gr to point B. The main purpose of such an impact is recognized reduce the potential spread of cancer cells by irradiation of regional lymph system.Some authors consider it necessary to conduct a course of combined radiation therapy before surgery.
ranges used in the preoperative irradiation doses ranged from 30 to 60 Gy at the depot and 20-30 Gy intensely concentrated courses.
However, in patients after radiotherapy with subsequent histological study, removal of the uterus were found the remains of the tumor cells.For example, cancer cells are found in 67% of patients operated after preoperative radiation therapy, and when they are highly differentiated adenocarcinomas were detected in 46%, moderately differentiated - 80% and poorly differentiated - 89%.Many studies indicate that the remnants of the tumor were found in 47% of patients operated on after the end of radiotherapy.
Thus, the authors views on the possible positive role of preoperative irradiation presented mixed.All the above confirms the need to further improve the radial component of the combined treatment of endometrial cancer.
In the combined treatment of uterine body cancer patients more often used postoperative irradiation.
When postoperative irradiation seek:
1. cause the death of cancer cells remaining unremoved during surgery to prevent the development of local recurrence;
2. in the case of obviously non-radical intervention to ensure the suppression of the growth of the tumor unremoved;
3. achieve destruction of cancer cells in areas of regional metastasis.
When metastatic regional lymph nodes use of postoperative radiation due to the inability to perform an absolutely radical lymphadenectomy and taking into account the intraoperative dissemination of cancer cells after surgery acquiring high potency to grow.Appointment of postoperative external radiotherapy in this situation is considered to be mandatory.However, the possibility of recovery of regional metastases using existing methods of radiation therapy is questionable.Hands down, the regional lymph nodes reduces the five-year survival of 20-30%.
rank as a "preventive" external beam radiotherapy in preventing regional cancer recurrence is also a difficult task.A picture emerges of the uncertainty of our knowledge regarding the possible positive role of prophylactic irradiation obviously not affected lymph nodes.Apparently, despite the deep-rooted traditions of the combined treatment of patients with uterine body cancer indications for postoperative external radiotherapy need to be carefully re-evaluated.This is justified, among other things, by the fact that it is often observed in patients with uterine body cancer Obesity II-III degrees creates technological difficulties during external beam radiation therapy.
Despite the numerous number of papers dealing with various aspects of the combined treatment of patients with uterine body cancer, studies on the role of radiation therapy, we believe that insufficient attention.Further prospective studies in this direction.However, it should be noted that the planning of such studies deontologic raises difficult problems.For example, the planned waiver of post-operative external radiotherapy in patients with stage III disease, where the risk of recurrence and metastasis is very large.
One way to assess the role of postoperative radiotherapy in the combined and complex treatment is to compare the effectiveness of treatment in the retrospective material depending on a number of prognostic factors characterizing features of the body and the tumor.However, this approach is not free from drawbacks, since it is difficult to form a comparable group of patients.Moreover, in some clinical situations due to strict regulation postoperative irradiation, such as metastatic regional lymph nodes, a control group to form is practically impossible.
In actual clinical practice, the appointment of postoperative radiotherapy is decided based on the evaluation of prognostic criteria of the complex.The most important of these characterizing features of the local-regional tumor spread are histological structure (degree of differentiation), the depth of invasion into the myometrium, stage of the disease, involving in the process of regional lymph nodes, data cytology washings of the abdominal cavity.Accounting prognostic factors allows to rationalize the need for postoperative radiotherapy.However, it must be noted that the traditional use of more aggressive treatment programs for patients with a complex of unfavorable prognostic indicators does not always lead to the success of the treatment: the impact of features that characterize the features of the tumor, as it eliminates the effect of the treatment factors.Disclaimer of postoperative external radiotherapy in patients with favorable prognostic indicators is possible without compromising survival.
As can be seen from the literature, the role and indications for postoperative irradiation remains controversial.The correct analysis of postoperative radiotherapy values and specification of indications for its implementation is possible only as a result of further prospective studies, as well as multivariate analysis of retrospective material, given the complexity and ambiguity of the influence of various prognostic factors.
Radiation therapy as an independent method of treatment of patients with uterine body cancer.Radiation treatment is used as a radical method of treatment of patients with localized cancer of uterine body and somatic contraindications to surgery, as well as in inoperable tumors on prevalence.However, it should be recognized that the radiation treatment results markedly inferior performance combination.
results of radical radiation therapy is very ambiguous, accounting in the first clinical stage of uterine body cancer at FIGO 57.1- 85.7%;II - 53.1-76.5%;III - 37.5-44.5%;IV - 24.9%.
Due to the relatively poor results of treatment is of undoubted interest to consider radiotherapy failures structure.To this end, we analyzed aggregate data on 880 patients with uterine body cancer.
Relapses in the irradiation zone occurred in 23.8% of patients, distant metastases - 15.2%.Analysis Table 5 allows us to conclude that the main share in the structure of failures take recurrences in the primary tumor and zones of regional metastasis.This indicates that one of the real ways to increase the effectiveness of radiation therapy for endometrial cancer is to improve the intracavitary irradiation techniques based on extensive use of modern radiotherapy equipment.
Intracavitary radiotherapy. Implementation of intracavitary irradiation is associated with certain difficulties.This is due to the relatively low radiosensitivity of the tumor and the need to use in connection with the high doses of ionizing radiation.
This task is complicated by the fact that the settlement of relatively high doses to the primary lesion limited tolerance surrounding healthy tissues or organs.
value of the dose has been widely discussed in the literature.In fact a number of studies it was shown very convincingly.In particular, the idea of inefficiency radiotherapy at doses of failure has already affected in those years when the beam technique did not provide the required dose levels in the affected organ, and the parietal parts of the pelvis.The results of treatment depend on the total focal dose.And the optimal dose level is about 50-70 Gy, established at the level of the uterine serous integument.In general, the majority of authors believes that the therapeutic effect is directly dependent on the dose.However, the question as to the required radiation dose remains unsolved.