Uterine cancer is very common, occupying a moment after the fourth female breast cancer, and skin zheludochchyu tract. This form of cancer usually occurs between the ages of 40 to 60 years. The risk factors - diabetes, hypertension, smoking, infection with the
human papilloma virus, HIV, early sexual activity, late menopause and
menstrual irregularities, infertility, a large number of sexual
partners, early first birth, sexually transmitted diseases, receiving
oral contraceptives.
One of the risk factors is obesity: women with a body weight exceeding normal 10-25 kg, the risk of endometrial cancer is 3 times more than normal body weight, and in women with excess body weight more than 25 kg risk 9 times higher.
Widely known precancerous conditions, which play a significant role in causing cancer. This erosion, ulcers, scars after birth trauma, epithelial growths (warts, polyps) and leukoplakia and chronic inflammatory processes - endocervicitis and endometritis.
Accordingly, the nature of the various divisions of the uterine epithelium differentiate cervical squamous cell carcinoma and adenocarcinoma (adenocarcinoma) of the cervical canal and the uterine cavity. Adenocarcinoma - the main morphological variant (70%). It should be noted that a relatively rare tumor, affecting the uterus, is a sarcoma. There are three degrees of differentiation of the tumor (highly differentiated, moderately differentiated and undifferentiated).
In cancer of the uterus are 4 stages of development: Stage 1 - the location of the tumor in the body of the uterus, II stage - the defeat of the body and cervix, III stadiya- extended to metastasis or parametrial tissue in the vagina, IV stage - spread beyond the pelvis, the germination of the bladder or rectum.
Clinic.
Clinical symptoms consists of complaints against whites, bleeding and pain. However, all three of these symptoms occur in the period of the collapse of the tumor and the time of their appearance depends upon the beginning of ulceration. Therefore, in some cases for a long period of uterine cancer may not produce any symptoms.
Beli there are different character: watery, mucous, blood-colored, odorless and malodorous. The admixture of blood gives belyam kind of meat slops. Delay secretions in the vagina and join the infection leads to septic cables with the smell. In cancer stage III and IV from the genital tract are putrid character. Bleeding may be in the nature of small bleeding, as well as single or multiple heavy blood loss. For cervical cancer is very typical of the so-called contact bleeding (during sexual intercourse, douching, vaginal examination or after lifting weights). If a woman has stopped menstruating, the occurrence of bleeding from the vagina in most cases is a sign of cancer.
The pains are late symptoms suggestive of involvement in the process of cancer of the lymph nodes and tissue infiltration basin to form, compressing the nerve trunks and plexus. Common symptoms and, in particular, cachexia (weight loss) occur very late, in a very advanced stage, and usually women suffering from uterine cancer remain outwardly flourishing, healthy appearance.
Diagnostics.
Detection of cancer of the uterus begin with a study of patient complaints and course of the disease. All suspected by history cases, patients must be immediately examined by a gynecologist. It is totally unacceptable to assign any treatment of such patients without a detailed examination.
The survey includes a two-handed study of vaginal, rectal bimanual research and examination with the help of mirrors.
When vaginal examination in cases fairly pronounced tumor process can not identify certain changes in the cervix, depending on the type of tumor growth (exophytic, endophytic and mixed). As a rule, the study is accompanied by bleeding due to injury tumor exploring finger. With widespread cancer of the uterus further research is carried out through the rectum to clarify the transition of the tumor on the walls of the pelvis and sacrum-uterine ligaments.
To identify the early stages of cervical cancer can not be limited to vaginal examination; be sure to conduct the inspection with the help of mirrors. To detect early cancers in all cases of any changes in the cervix take swabs for cytology or biopsy. If you suspect a cancer of the cervical canal and the uterine cavity is performed separate diagnostic curettage of the cervical canal and the uterine cavity and subsequent histological examination.
All of these studies can be carried out already in the clinic with the necessary tools and aseptic conditions. To illustrate the importance of a comprehensive survey is sufficient to indicate that cervical cancer remains undiagnosed for more than half of the patients, the survey which took place only in the two-handed vaginal examination. At the same time, when viewed with the help of mirrors the number of errors in the diagnosis decreases by almost 5 times, and when using the biopsy they observed only in isolated cases.
In recent years, widespread and of great importance acquired ultrasound imaging (US), which allows to detect changes in the uterus inaccessible to other methods of investigation and method of investigation became mandatory for suspected all benign and malignant formation in the womb.
To determine lymph node metastasis, and that very often accompanies cancer of the cervix, resort to methods of X-ray - lymphography and ileokavagrafii. With the same purpose, to chest radiography, intravenous pyelography, ergography, cystoscopy and sigmoidoscopy. Perhaps a CT, MRI, limfangiografii, fine needle biopsy of the tumor.
These studies are very important in cancer of the uterus to develop a plan, or a combination of radiation therapy.
Treatment.
Tactics of treatment depends on the patient's age, general condition and clinical stage of the cancer. Treatment is mainly surgical (hysterectomy with appendages, and sometimes removal of pelvic lymph nodes). Perhaps the combination treatment - surgery, radiation and then remote area on the vaginal stump, intracavitary gamma therapy. Wires and preoperative radiotherapy mainly in stage III. Radiation therapy as an independent method is used when the local prevalence of tumor process, with contraindications to surgery. Anticancer drugs are effective in low-grade tumors in stage III and IV disease.
In cancer of the cervix with the same success as the treatment is carried out by combined radiotherapy and surgery (extended hysterectomy with appendages). Treatment depends on the stage of the disease. When Ia stage (microinvasive cancer) produce a hysterectomy with appendages. At stage Ib (cancer confined to the cervix) is shown the remote or intracavitary irradiation followed by extended hysterectomy with appendages, or, conversely, first make the operation, and then remote gammaterapiyu. In stage II (involvement of the upper part of the vagina, can pass on the body of the uterus and infiltration parameters without switching to the pelvic wall) the main treatment is radiotherapy, surgery is rarely used. At stage III (the transition to the lower part of the vagina, infiltration parameters with the transition to the pelvis) shows radiation treatment. Finally, in stage IV (transition to the bladder, rectum, or distant metastasis) apply only palliative radiation. In the later stages of symptomatic treatment, application of chemotherapy.
After treatment, mandatory periodic visits to the doctor for pelvic examination and swab. Also, studies include chest X-ray, ultrasound and intravenous pyelography. During the first year of visiting the doctor every 3 months, and then for 5 years - every 6 months. After 5 years, control is carried out annually.
When relapse, if the process is localized, conduct a partial or total pelvic exenteration (removal of a single block of the uterus, cervix, vagina, parametrium, urinary bladder and rectum). In the presence of distant metastases, patients usually receive chemotherapy. Radiation therapy may be used for the palliative treatment of painful metastases.
Metastasis.
The most common tumors metastasize to the pelvic lymph nodes, at least in the groin. Distant metastases are often in the kidneys, liver, lungs, have a poor prognosis.
Forecast.
In cancer of the uterus 5-year survival rate after surgery from 84 to 45% depending on the stage of the disease. When relapse 25% of patients initially underwent surgical treatment may be spared from relapse using pelvic radiotherapy. When metastatic relapse cures are extremely rare, and the therapeutic effect is unique and short. In stage IV disease 5-year survival rate - up to 9%.
Prevention.Early diagnosis and prevention of cervical cancer is possible only through systematic preventive examinations of all women over 30 years (at least 2 times per year). Regular inspection is desirable to start with the onset of sexual activity. Regular checkups, ultrasound imaging and cytology (every 2 years) facilitate the identification of precancerous diseases and their treatment - cancer prevention.
No less important is the timely and proper treatment of precancerous cervical disease. Especially characteristic features that are unique to precancerous diseases of the cervix, no, they proceed as normal inflammatory diseases. Common to predrakyuvyh disease symptoms are chronic long, persistence of symptoms, and most importantly the lack of effect of conservative (anti-inflammatory) treatment. Treatment of precancerous cervical disease should be radical and is electrosurgical, electrocautery lesions or even amputation of the cervix. Also resorted to radiation treatment method in the form of applicative radium therapy. Among patients radically treated for various precancerous lesions, the death rate from cervical cancer has decreased by 6 times.
It also requires giving up smoking, prevention of sexually transmitted infection.
One of the risk factors is obesity: women with a body weight exceeding normal 10-25 kg, the risk of endometrial cancer is 3 times more than normal body weight, and in women with excess body weight more than 25 kg risk 9 times higher.
Widely known precancerous conditions, which play a significant role in causing cancer. This erosion, ulcers, scars after birth trauma, epithelial growths (warts, polyps) and leukoplakia and chronic inflammatory processes - endocervicitis and endometritis.
Accordingly, the nature of the various divisions of the uterine epithelium differentiate cervical squamous cell carcinoma and adenocarcinoma (adenocarcinoma) of the cervical canal and the uterine cavity. Adenocarcinoma - the main morphological variant (70%). It should be noted that a relatively rare tumor, affecting the uterus, is a sarcoma. There are three degrees of differentiation of the tumor (highly differentiated, moderately differentiated and undifferentiated).
In cancer of the uterus are 4 stages of development: Stage 1 - the location of the tumor in the body of the uterus, II stage - the defeat of the body and cervix, III stadiya- extended to metastasis or parametrial tissue in the vagina, IV stage - spread beyond the pelvis, the germination of the bladder or rectum.
Clinic.
Clinical symptoms consists of complaints against whites, bleeding and pain. However, all three of these symptoms occur in the period of the collapse of the tumor and the time of their appearance depends upon the beginning of ulceration. Therefore, in some cases for a long period of uterine cancer may not produce any symptoms.
Beli there are different character: watery, mucous, blood-colored, odorless and malodorous. The admixture of blood gives belyam kind of meat slops. Delay secretions in the vagina and join the infection leads to septic cables with the smell. In cancer stage III and IV from the genital tract are putrid character. Bleeding may be in the nature of small bleeding, as well as single or multiple heavy blood loss. For cervical cancer is very typical of the so-called contact bleeding (during sexual intercourse, douching, vaginal examination or after lifting weights). If a woman has stopped menstruating, the occurrence of bleeding from the vagina in most cases is a sign of cancer.
The pains are late symptoms suggestive of involvement in the process of cancer of the lymph nodes and tissue infiltration basin to form, compressing the nerve trunks and plexus. Common symptoms and, in particular, cachexia (weight loss) occur very late, in a very advanced stage, and usually women suffering from uterine cancer remain outwardly flourishing, healthy appearance.
Diagnostics.
Detection of cancer of the uterus begin with a study of patient complaints and course of the disease. All suspected by history cases, patients must be immediately examined by a gynecologist. It is totally unacceptable to assign any treatment of such patients without a detailed examination.
The survey includes a two-handed study of vaginal, rectal bimanual research and examination with the help of mirrors.
When vaginal examination in cases fairly pronounced tumor process can not identify certain changes in the cervix, depending on the type of tumor growth (exophytic, endophytic and mixed). As a rule, the study is accompanied by bleeding due to injury tumor exploring finger. With widespread cancer of the uterus further research is carried out through the rectum to clarify the transition of the tumor on the walls of the pelvis and sacrum-uterine ligaments.
To identify the early stages of cervical cancer can not be limited to vaginal examination; be sure to conduct the inspection with the help of mirrors. To detect early cancers in all cases of any changes in the cervix take swabs for cytology or biopsy. If you suspect a cancer of the cervical canal and the uterine cavity is performed separate diagnostic curettage of the cervical canal and the uterine cavity and subsequent histological examination.
All of these studies can be carried out already in the clinic with the necessary tools and aseptic conditions. To illustrate the importance of a comprehensive survey is sufficient to indicate that cervical cancer remains undiagnosed for more than half of the patients, the survey which took place only in the two-handed vaginal examination. At the same time, when viewed with the help of mirrors the number of errors in the diagnosis decreases by almost 5 times, and when using the biopsy they observed only in isolated cases.
In recent years, widespread and of great importance acquired ultrasound imaging (US), which allows to detect changes in the uterus inaccessible to other methods of investigation and method of investigation became mandatory for suspected all benign and malignant formation in the womb.
To determine lymph node metastasis, and that very often accompanies cancer of the cervix, resort to methods of X-ray - lymphography and ileokavagrafii. With the same purpose, to chest radiography, intravenous pyelography, ergography, cystoscopy and sigmoidoscopy. Perhaps a CT, MRI, limfangiografii, fine needle biopsy of the tumor.
These studies are very important in cancer of the uterus to develop a plan, or a combination of radiation therapy.
Treatment.
Tactics of treatment depends on the patient's age, general condition and clinical stage of the cancer. Treatment is mainly surgical (hysterectomy with appendages, and sometimes removal of pelvic lymph nodes). Perhaps the combination treatment - surgery, radiation and then remote area on the vaginal stump, intracavitary gamma therapy. Wires and preoperative radiotherapy mainly in stage III. Radiation therapy as an independent method is used when the local prevalence of tumor process, with contraindications to surgery. Anticancer drugs are effective in low-grade tumors in stage III and IV disease.
In cancer of the cervix with the same success as the treatment is carried out by combined radiotherapy and surgery (extended hysterectomy with appendages). Treatment depends on the stage of the disease. When Ia stage (microinvasive cancer) produce a hysterectomy with appendages. At stage Ib (cancer confined to the cervix) is shown the remote or intracavitary irradiation followed by extended hysterectomy with appendages, or, conversely, first make the operation, and then remote gammaterapiyu. In stage II (involvement of the upper part of the vagina, can pass on the body of the uterus and infiltration parameters without switching to the pelvic wall) the main treatment is radiotherapy, surgery is rarely used. At stage III (the transition to the lower part of the vagina, infiltration parameters with the transition to the pelvis) shows radiation treatment. Finally, in stage IV (transition to the bladder, rectum, or distant metastasis) apply only palliative radiation. In the later stages of symptomatic treatment, application of chemotherapy.
After treatment, mandatory periodic visits to the doctor for pelvic examination and swab. Also, studies include chest X-ray, ultrasound and intravenous pyelography. During the first year of visiting the doctor every 3 months, and then for 5 years - every 6 months. After 5 years, control is carried out annually.
When relapse, if the process is localized, conduct a partial or total pelvic exenteration (removal of a single block of the uterus, cervix, vagina, parametrium, urinary bladder and rectum). In the presence of distant metastases, patients usually receive chemotherapy. Radiation therapy may be used for the palliative treatment of painful metastases.
Metastasis.
The most common tumors metastasize to the pelvic lymph nodes, at least in the groin. Distant metastases are often in the kidneys, liver, lungs, have a poor prognosis.
Forecast.
In cancer of the uterus 5-year survival rate after surgery from 84 to 45% depending on the stage of the disease. When relapse 25% of patients initially underwent surgical treatment may be spared from relapse using pelvic radiotherapy. When metastatic relapse cures are extremely rare, and the therapeutic effect is unique and short. In stage IV disease 5-year survival rate - up to 9%.
Prevention.Early diagnosis and prevention of cervical cancer is possible only through systematic preventive examinations of all women over 30 years (at least 2 times per year). Regular inspection is desirable to start with the onset of sexual activity. Regular checkups, ultrasound imaging and cytology (every 2 years) facilitate the identification of precancerous diseases and their treatment - cancer prevention.
No less important is the timely and proper treatment of precancerous cervical disease. Especially characteristic features that are unique to precancerous diseases of the cervix, no, they proceed as normal inflammatory diseases. Common to predrakyuvyh disease symptoms are chronic long, persistence of symptoms, and most importantly the lack of effect of conservative (anti-inflammatory) treatment. Treatment of precancerous cervical disease should be radical and is electrosurgical, electrocautery lesions or even amputation of the cervix. Also resorted to radiation treatment method in the form of applicative radium therapy. Among patients radically treated for various precancerous lesions, the death rate from cervical cancer has decreased by 6 times.
It also requires giving up smoking, prevention of sexually transmitted infection.
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