Endometrial cancer , endometrial cancer - Causes, Symptoms and Treatment .MF .
uterine cancer - one of the most common cancers, constituting, according to various estimates 30% of all gynecological cancer diseases, and located on the 3-4 place among cancers in women, after breast cancer, colon and lung.According to various sources the uterine body cancer sick to 3% of all women.On average, the disease occurs in people older than 60 years.
To date, two pathological variant of endometrial cancer can be distinguished:
1. Young women, on the background of hyperestrogenism, developing on a background of endometrial hyperplasia.Usually highly differentiated, it has a favorable prognosis.
2. In elderly patients - against the background of endometrial atrophy.In this case, the tumor is usually poorly differentiated and is characterized by less favorable prognosis.
Causes of uterine body cancer
Among the risk factors can be identified:
• Lack of labor - in 2-3 times higher uterine cancer in women not giving birth.
• infertility, menstrual disorders, anovulation.
• Late menopause.It is believed that this is due to an increase in anovulatory menstrual cycle after 45 years.
• Obesity.If the weight exceeds the rate of 20 kg and more the risk of endometrial cancer is 10 times higher.
• Hormone replacement therapy in postmenopausal women without progesterone.
• The use of tamoxifen in breast cancer.
symptoms of endometrial cancer
main clinical manifestations:
1. Bleeding and bleeding from the genital tract is menstruating or in menopause.The most characteristic symptom, especially for the elderly who have a long background in the menopause appear menstrualnopodobnye bleeding.Besides endometrial cancer may be associated with damage as well genital tract, uterine myoma, endometrial polyp.
2. Complaints of pain in the abdomen - a rare symptom occurs when the uterus and an increase in compression of adjacent organs.
3. Hematometra or pyometra - accumulation of blood in the uterus, since occlusion of the cervical canal, with the possible suppuration.It is characteristic for the elderly, worsens the prognosis.
4. constipation, urinary problems - with an increase in body size, he squeezes located near the rectum and bladder.
survey of suspected uterine cancer
Diagnosis and appropriate methods of examination:
1. Medical history, examination and palpation of the mirrors
2. Taking smears
3. Clinical and biohimecheskie blood tests.This sometimes watching the level of CA - 125, sincein late stages, it can be higher disease.However, the most patognamonichen this indicator for ovarian cancer, and is still used much less frequently for uterine body cancer.
4. US of abdominal and vaginal method - one of the main types of diagnostic uterine body cancer.
5. It is imperative for suspected cancer of the uterine body, especially in the presence of complaints of bleeding from the genital tract, taking biapsiynogo material - a separate diagnostic curettage of the uterus, or the capture of aspirate from the cavity if you can not perform kyurretazha.Perhaps the performance of hysteroscopy before scraping.
6. Chest X-ray - for diagnosis of lung metastases.
7. cystoscopy, sigmoidoscopy, irrigosokpiya, CT and MRI scans of the abdomen and pelvic organs - if indicated and prescribed by a doctor.
Stages of endometrial cancer (much simplified):
Stage 0 - cancer in situ
Stage I - tumor limited
body of the uterus Stage II - the transition to the cervix, without departing from the uterus
Stage III - Tumor extends withinpelvic
Stage IV - tumor invades mucosa of bladder or rectum, or there are distant metastases.
Treatment of endometrial cancer
1. Surgical treatment - the first stage of treatment.Produced removal of the uterus body, cervix and appendages.This treatment strategy is applicable in cancer of the corpus uteri Stage I - II.According to the testimony of operation can be extended up to the removal of deep pelvic and iliac lymph nodes and remove the gland.
In the absence of lymph node involvement at the initial stages of the disease surgery may be the only necessary treatment.
2. Radiotherapy - when used as the initial stages of the second method, following the surgical removal of the uterus.Usually used as an intracavitary and external beam radiotherapy.
3. Chemotherapy - is widely used in our country, often conduct prolonged courses of treatment.Perhaps the use of neoadjuvant (prior operation and accurate staging) chemotherapy for patients with more advanced forms of the disease.
4. Hormone therapy - used progestogens.Efficacy has not been proven.
prognosis of endometrial cancer depends on the stage at which treatment was started, the degree of differentiation, the patient's condition.Patients from the first stage and high-grade tumor survival is 96% in patients with low-grade tumor fourth and only 18%.The five-year survival rate for all stages is 73%.It is important to stress that the higher survival rate than higher tumor differentiation (its affinity to primary tissue from which it "has occurred").For example, as mentioned above, in the fourth stage of the disease with low differentiation survival is only 18%, while high-grade tumor at the same stage gives 36% survival pyatilenyuyu!
should be noted that adequate treatment of patients with any oncological disease is only possible in conditions of oncological hospital, or in the presence of specialized professionals in general hospitals.Patients in detecting endometrial cancer should be hospitalized in the most shortest terms.Treatment more effective the earlier it is started.
disease progression occurs in a quarter of patients treated for endometrial cancer.In this case 50% occurs in the first 2 years, 75% - 3. For the diagnosis of deterioration of the post-treatment is necessary, the first 2-3 years of patients inspect every 6 months.Held pelvic examination, pelvic ultrasound, radiography (once a year).
Gynecologist Kupatadze DD