Cancer of the uterus body, of course, is not such a leader as, say, cervical cancer. Still, the endometrium begins to be attacked by neoplasms, mainly in Balzac’s age and older. The uterus is no longer responsible for procreation, and the hormonal background begins to rebuild in the direction of reducing its activity, because hormones do not need to monitor the menstrual cycle on a monthly basis. providing the processes of ovulation. possible conception and implantation of the egg.
However, from each rule there are exceptions, and hormones can sometimes behave at a young age as well as in postmenopausal women. so the emergence of endometrial adenocarcinoma for women of reproductive age is not an exception. The tendency to rejuvenation, unfortunately, is observed in all types of cancer of the uterus body.
What is cancer of the uterus and its types.
When it comes to cancer of the uterus body, in most cases it is the glandular tumor (adenocarcinoma) of the endometrium, and yet there are other, however, more rare types of malignant tumors that differ in their origin (histogenesis). Varieties of malignant tumors of the uterus body can be represented as follows.
epithelial: glandular cancer (adenocarcinoma) and squamous cell carcinoma.
tumors of mesenchymal origin: smooth muscle (leiomyosarcoma of the uterus) and stromal (endometrial stromal sarcoma.
mixed, epithelial-mesenchymal tumors, where both stromal and glandular malignant components are present (adenosarcoma, carcinofibroma.
However, the most common and common type of cancer of the uterus body is a tumor from the glandular epithelium of the endometrial adenocarcinoma, which also has its own intraspecific differences.
highly differentiated adenocarcinoma of the uterus is characterized by a weakly expressed polymorphism of cells, which, after several stages of maturation, became as close to normal as possible and even learned to fulfill their physiological function.
moderately differentiated adenocarcinoma is represented by polymorphic cells, other than normal cells, with an enlarged hyperchromic nucleus with nucleoli, with the presence of pathological mitoses.
the tumor of a low degree of differentiation differs by intensive proliferation with the expressed atypia of cells, presence of a large number of pathological mitoses, pronounced structural rearrangement of tumor tissue.
undifferentiated cancer, the nature of which can only be determined presumably, since cells are not developed and it is not possible to determine whether they belong to a particular tissue. They are called simply – cancer cells. Undifferentiated cancer has the highest degree of malignancy and the worst prognosis.
The higher the degree of differentiation of endometrial cancer, the more favorable the prognosis, but cytologically and histologically highly differentiated to the uterine adenocarcinoma can be difficult to distinguish from atypical hyperplasia. because the cancer cells still continue to masquerade as normal.
What factors provoke the development of endometrial cancer.
The main culprit and progenitor of adenocarcinoma of the body of the uterus has long been considered a hormonal background, where the imbalance between elevated estrogen levels and progesterone deficiency gives rise to pathological processes in the endometrium. The existing concomitant diseases can contribute to cancer and aggravate the situation.
Thus, the prerequisites for the emergence of malignant education is usually considered.
a violation of the hormonal balance between estrogens and progesterone.
hyperplasia, polyps and other benign processes of the endometrium. as a result of hormonal imbalance.
early onset of menstruation (menarche), absence of pregnancy and childbirth.
other cancers of the reproductive glandular organs (ovaries, mammary gland.
obesity and diabetes.
It is important that the combination of three or more factors increases the risk of malignant process, and presence.
violation of carbohydrate and fat metabolism, significantly increases the likelihood of endometrial cancer.
Stages of cancer of the body of the uterus.
Having begun its growth from one cancer cell, the tumor begins its development, capturing more and more new territories, and it grows both in depth (in the first stage) and towards endocervix (in the second stage). In this connection, on the basis of the structure and spread of tumor tissue, the following stages of the malignant process are distinguished (histologically.
Art. – a cancer cell generates similar ones and is developed in the endometrium. Gradually penetrating deep into the tissue, the tumor tissue reaches half the myometrium and moves on.
Art. – begins when germinated in myometrium cancer, begins to master the glandular passages of endocervix and seize the stroma of the cervix.
Art. – malignant process extends to the peritoneum, appendages, leaving metastases in the vagina, in the pelvic and peritoneal (intra-abdominal) lymph nodes.
Art. is characterized by the invasion of the cancer tissue into the mucosa of the bladder, intestine, the presence of distant metastases, including in the organs of the abdominal cavity (liver, pancreas, kidneys) and even easily a tumor can reach the lungs and brain.
Signs and symptoms.
As a rule, adenocarcinoma occurs in the presence of background diseases (polyp, endometrial hyperplasia.
Signs of malignancy can be found in cytological and histological studies of the material obtained with separate diagnostic curettage or aspiration biopsy of the uterine cavity.
The presence of atypia in the cells of the glandular epithelium gives grounds for the assumption of malignancy, which requires a number of additional diagnostic measures.
Cancer of the endometrium in the absence of background diseases in the initial stages of the brightness of the symptomatology is not different and can not identify itself for a long time. If a young woman’s pathology can tell.
prolonged menstrual bleeding.
constant aching pain in the lumbar region.
increased suddenly stomach, then for women in menopause in the absence of menstruation, such manifestations and so take place (all is written off for age.
However, the symptoms of endometrial cancer, although not numerous, but it is still possible to recognize them, the main thing is not to forget to visit a gynecologist and not to postpone your health in the long box.
Started suddenly after a long break, uterine bleeding in menopause, is a serious harbinger of future troubles, so the trip to the gynecologist should be carried out without delay.
Methods of diagnostics.
Diagnosis of uterine body cancer can be carried out using.
hysteroscopy with targeted biopsy, however, the most informative in terms of studying the morphological structure of the tumor is the material that can give: scraping of the cervical canal, separate scraping of the uterine cavity and cervical canal, aspiration of the contents of the uterine cavity.
The material obtained with the help of these methods, already visually (color, consistency) can indicate a malignancy of the process, to clarify which, it must go through the main stages of diagnosis.
I. Cytological research that allows.
find signs of malignancy in the cells themselves (cellular polymorphism, violation of the nuclear-cytoplasmic ratio in the direction of increasing the nucleus, mitosis.
determine the type of tumor and the degree of its differentiation.
II. Histological diagnosis will broadly examine the tumor and clarify.
all signs of atypia.
ratio of stromal and glandular component.
the degree of invasion, as it examines the tissue section.
presence of tumor cells in lumens of lymphatic and blood vessels (emboli). The appearance of emboli in the vessels is a bad harbinger and indicates that the tumor began to metastasize.
The entire structure of the tumor undergoes histological analysis. Malignant process as it develops often becomes heterogeneous. In the tumor, even more malignant foci may appear than it was originally, which reduce the degree of differentiation in individual sites. The diagnosis in such cases is set to the lowest degree. That is why a large amount of material taken from different sites is necessary for the conclusion.
In addition, all organs and tissues removed during surgery are subject to mandatory histological examination.
III. Immunohistochemical method is the most informative, but, unfortunately, is still not widely available due to the complexity and high cost of equipment and reagents, however, immunohistochemistry of a tumor can tell everything by revealing.
the presence of tumor markers, that is, proteins that are characteristic only for this type of tumor.
The presence of receptors for hormones specific for this cancer.
the nature of malignant formation and, of course, the degree of differentiation.
Immunohistochemistry, overcoming difficulties, confidently enters the clinical practice. because it is a highly informative method, not only in terms of diagnosis, but also for the purpose of determining the protocol of treatment and the prognosis of the disease. I am glad that the advantages of the new direction have already been successfully used in many clinics of the Russian Federation.
The treatment is suitable in a complex way, where the age of the patient, the stage of the disease and the degree of differentiation of the tumor determine the direction and tactics: how to treat uterine cancer.
Conservative treatment after the detection of a highly differentiated adenocarcinoma is theoretically possible. It is shown only to women of young age (up to 40 years). The treatment is based on hormone therapy, carried out under strict control of the effectiveness of treatment with mandatory repeated biopsies.
The surgical method of combating endometrial cancer has been and remains the most basic and most reliable, which involves the removal.
Of course, apart from differentiation and stage, age plays an important role for the surgical method. If treatment of women of reproductive age provides for maximum organ-saving surgery, then in the menopausal period, even with high cancer differentiation, the most radical variants are shown.
Laparoscopic extirpation of the uterus in adenocarcinoma of the endometrium is impractical due to the malignancy of the process. Oncologists state that no cancer cell should be lost during the removal of the affected organ. This is not always possible with laparoscopy. Extirpation should be performed by open access (laparotomy), where an obligatory stage of the operation is an extended audit of the abdominal cavity in order to exclude the volume formations of other organs.
In parallel with surgical treatment to prevent metastasis and relapses, chemotherapy with drugs that suppress tumor growth is performed at doses corresponding to the stage of the disease, the degree of malignancy and the age of the patient.
The approach to radiation diagnosis is also strictly individual and takes into account the criteria listed above.
With highly differentiated uterine body cancer (adenocarcinoma), the prognosis is relatively favorable, especially if it is detected at an early stage of its development. Adequate complex treatment, dynamic observation and prevention measures give hope for a complete cure. Unfortunately, a low-grade cancer gives only tears and doubts, while an undifferentiated one leaves little hope. Cancer is cancer.
And yet much depends on the woman. The sooner she turns for help, the more she does not have the chance to face this terrible word cancer, and if faced, it is easy to overcome the ailment.
Periodic visits to the women’s consultation for the purpose of preventive examination, cytological examination of the material taken from the cervix and cervical canal every six months, will provide systematic observation of their health. And women in the menopause this applies in the first place, because some, having reached the menopause, begin to argue that they do not need it anymore, in view of the extinction of hormonal activity and loss of genital function.
Women’s health is important at any age, take care of it.