Disease sexually transmitted:

Candidiasis urogenital organs (thrush) in women

Endometrial cancer (cancer of the uterine body)

  • What is endometrial Cancer (cancer of the uterine body)
  • What triggers / causes of Cancer of the endometrium (endometrial cancer)
  • Pathogenesis (what is happening) at the time of endometrial Cancer (cancer of the uterine body)
  • Symptoms of Cancer of the endometrium (endometrial cancer)
  • Diagnosis of Cancer of the endometrium (endometrial cancer)
  • Treatment of endometrial Cancer (cancer of the uterine body)
  • Prevention of endometrial Cancer (cancer of the uterine body)
  • Which doctors should be consulted if You have endometrial Cancer (cancer of the uterine body)

What is endometrial Cancer (cancer of the uterine body) -

Cancer of the endometriumlining the uterus, is the most common cancer of the female genital organs, but ranks last among these diseases as causes of death, as is usually detected at an early stage, when the disease responds well to treatment.
In recent decades, the incidence of endometrial cancer has been steadily increasing, which, apparently, is connected with the increased life expectancy of women and their stay in the postmenopause. Cancer of the body of the uterus occurs mostly in postmenopausal women, the average age of patients is 60 to 62 years. During the life of endometrial cancer sick 2-3 women.

What triggers / causes of Cancer of the endometrium (endometrial cancer):

Endometrial cancer is characteristic for older women (usually in the postmenopause). More than 95 of cases of cancer of this localization occur in women aged over 45 years and the median age of the patients was 63 years. In the postmenopausal age risk of endometrial cancer increases factors such:
• Early onset of menstrual function.
• Late entry into menopause.
• Obesity.
• The presence of diabetes and high blood pressure.
• Colorectal cancer in the patient or close relatives (family history).
• Birth to only one child or no children.
• Infertility, irregular periods or endometrial hyperplasia in history (history of life and disease).
In the case of tamoxifen treatment breast cancer the risk of developing endometrial cancer is increased slightly. The frequency of endometrial cancer in women taking birth control pills 50 lower compared to females not taking such drugs.
The risk of developing endometrial cancer is associated with the concentration of female sex hormones (estrogens) in the body that affect the endometrium throughout a woman's life. Estrogens stimulate cell division in the endometrium. The risk of developing endometrial cancer is higher in women with a long time not stopping the menstrual function.
Modern postmenopausal hormone therapy contains very low doses of estrogen and progesterone (another female hormone, suppresses the formation of cells). Therefore, new hormonal drugs do not increase women's risk of endometrial cancer in women. However, patients receiving substitution therapy, you should regularly undergo a medical examination. A medication containing only estrogen without progesterone increases the risk of endometrial cancer.
Very rarely certain tumors ovaries produce estrogen, increasing the likelihood of women cancer of the uterus.
According to the results of recent research, a diet high in fat may increase the risk of developing certain types of cancer, including endometrial cancer. I suspect that high calorie foods are high in fat contributes to the development of obesity, which is one of the risk factors for endometrial cancer. This is due to the fact that adipose tissue can be a source of female sex hormones. Overweight is also associated with breast cancer, so these patients are at increased risk of development and endometrial cancer.

Pathogenesis (what is happening) at the time of endometrial Cancer (cancer of the uterine body):

There are two pathogenetic variant of endometrial cancer is hormone-dependent and Autonomous.
Hormone-dependent cancer of the uterus occurs in about 70 observations in the pathogenesis of this cancer plays the role of a long giperestrogeniya. The giperestrogeniya may occur as a result of anovulation, feminizing tumors of the ovary, obesity, diabetes, hormone replacement therapy and breast cancer treatment with tamoxifen, etc. Hormone-dependent cancer of the uterine body is preceded by the sequential occurrence of hyperplastic and premalignant endometrial processes. Risk factors for hormone-dependent endometrial cancer include infertility, lack of births in history, late menopause, obesity, diabetes, hypertension, family history of cancer with endocrine and metabolic pathogenesis (breast cancer, endometrial, ovarian, colon), hormoneproducing tumors of the ovary, substitution monotherapy with estrogen in postmenopausal women, the use of tamoxifen in treating breast cancer.
Offline variant of endometrial cancer occurs less than 30 observations, occurs against a background of endometrial atrophy in the absence of hyperestrogenic in patients without metabolic-endocrine disorders. It is believed that the development of an Autonomous variant of endometrial cancer plays a role severe depression of T-system of immunity on the background of violations of adaptation homeostasis. Changes of the immune system consist in a significant decrease in absolute and relative numbers of T-lymphocytes, inhibition of all subpopulations of T-lymphocytes.
Autonomous cancer of the uterine body develops at an older age. This option is not installed risk factors. Typically, it occurs in thin elderly women without previous hyperplastic processes. History may be bleeding in postmenopausal women on a background of endometrial atrophy. The tumor has a low differentiation, low sensitivity to hormone therapy, there are early invasion in myometrium and metastasis.
Since 1971, used the international classification of endometrial cancer.
Stage 0 - histological data with suspected malignant transformation of hyperplastic endometrial process. These cases cannot be included in the clinical classification.
Stage I - tumor limited to the body of the uterus - it should be particularly noted: a) the age and condition of patients - b) dimensions of the uterine cavity (an increase is a bad prognostic sign)- C) histological form of the tumor.
For stage I endometrial cancer also recommended unit based on objective criteria - the length of the uterine cavity: stage 1A, if the length of the uterine cavity does not exceed 8 cm, and stage 16 when the length of the uterine cavity 8 see more
In stage I endometrial cancer are the following histological groups:
1) well-differentiated adenocarcinoma-
2) differentiated adenocarcinoma with areas of solid structures
3) the predominance of the structure of a solid structure or not fully differentiated carcinoma.
Stage II - the tumor extends to the body and cervix. The diagnosis is based on the morphological study of biopsy material by separate curettage of the cervical canal and uterine cavity.
Stage III - the cancer had spread to parametersyou tissue of the pelvis or metastases in the vagina.
Stage IV - spread outside of the pelvis, the germination of the bladder and the rectum or the presence of metastases.
The classification of the International Federation of obstetricians and gynecologists (FIGO, 1988)
Stage IA - tumor limited to the endometrium.
Stage IB - the invasion by less than 1/2 of the thickness of the myometrium.
Stage 1C - the invasion by more than 1/2 of the thickness of the myometrium.
Stage IIA - the tumor captures only endocervical glands.
Stage IIB - the invasion of the cervical stroma.
Stage IIIA - the tumor that spread to serosa and / or adnexa, and (or) positive results of peritoneal Cytology.
Stage IIIB - metastases in the vagina.
Stage IIIC - metastases to pelvic and (or) para-aortic lymph nodes.
Stage IVA - the spread of tumors to the bladder and (or) the intestinal mucosa.
Stage IVB - distant metastases including abdominal and (or) the inguinal lymph nodes.
For stages IA-IVB further added parameter G.
G1 - deplorability or numerology solid growth of less than 5.
G2 - deplorability or numerology solid growth 6-50.
G - deplorability or numerology solid growth of more than 50.
Classification of endometrial cancer according to the TNM system
T - primary tumor.
Tis - carcinoma in situ carcinoma.
T1 - carcinoma, limited to the body of the uterus.
T1a - the uterus is not enlarged.
TB - the uterus is enlarged (to probe more than 8 cm).
T2 - transition to the cervix.
TK - transition to the lower third of the vagina and parametrium.
T4 - transition to the rectum, the bladder or spread of the tumor outside of the pelvis.
N - regional lymph nodes
Nx is not palpable.
Nx- - - not affected.
Nx - struck } histological examination.
N0 - not impressed
N1 - struck } if lymphography.
N2 - palpable enlarged lymph nodes.
M - distant metastases
MO - not found.
Ml - detected.
The pathways of endometrial cancer
• Down from the uterus into the cervical canal. Can lead to cervical stenosis and pyometra through the myometrium to serosa and abdominal cavity.
• Through the lumen of the fallopian tubes to the ovaries.
• Hematogenous route, leading to the appearance of distant metastases.
• Hematogenous route.

Symptoms of endometrial Cancer (cancer of the uterine body):

The symptoms of cancer (endometrium) of the uterine body to some extent depend on menstrual function. In menstruating women endometrial cancer can manifest abundant long periods, often irregular, acyclic bleeding. However, in 75 cases of endometrial cancer occurs in postmenopausal women and causes blood discharge from the genital tract, which are called bleeding in postmenopausal women. Bleeding can be scarce, spotting or heavy. Bleeding in postmenopausal women concerned about 90 of patients with endometrial cancer, 8 with diagnosed cancer clinical manifestations are absent. In addition to bleeding, patients may experience pus, and stenosis of the cervical canal may be formed pyometra. When compression of the ureter by infiltration with the emergence of the bloc kidney pain localized in the lumbar region. In individual observations can be formed ascites or tumor in the pelvis (metastases to the ovaries, omentum).
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Endometrial cancer (cancer of the uterine body)

Diagnosis of endometrial Cancer (cancer of the uterine body):

Women in postmenopause shown vaginal ultrasound of the pelvic organs 1 time per year, and at risk for endometrial cancer - 1 time in six months.
In the menstrual cycle and the ultrasound characteristics of endometrial pathology, but also when bleeding in postmenopausal women is shown gysterosalpingoscopy and separate diagnostic curettage of the uterine mucosa. Informative hysteroscopy with endometrial cancer in postmenopausal women is 98, histological examination of scrapings allows you to establish a definitive diagnosis.
After diagnosis conduct a thorough examination of the patient to determine the clinical stage of the process and tactics. Along with physical, gynecological and laboratory studies produce echography of abdomen, colonoscopy, cystoscopy, chest x-rays, if necessary, excretory urography, computed tomography, etc.

Treatment of endometrial Cancer (cancer of the uterine body):

Among patients requiring surgery, 13 there are contraindications to surgery due to comorbidities.
Preoperative radiation therapy in the early stages of the disease (stages I and II with hidden endocervical lesions). Total abdominal hysterectomy and bilateral salpingoophorectomy with biopsy periodontally lymph nodes, cytological examination of peritoneal contents, the assessment of estrogen receptors and progesterone and histopathological evaluation of the depth of penetration into the myometrium.
Women with a high risk of local recurrence, it may be necessary subsequent conduct postoperative radiation therapy.
Treatment of endometrial cancer depending on the stage. Cancer stage I, 1-St degree of histopathological differentiation. The optimal method of treatment - surgery: total abdominal hysterectomy and bilateral salpingoophorectomy. In the case of deep penetration into the myometrium, you can optionally assign the irradiation of the pelvic organs.
Cancer stage IA or 1B, 2-3-th degree of histopathological differentiation. Additional postoperative radiation therapy of the pelvic organs apply when infestation affecting more than half of the myometrium, and involvement of the pelvic lymph nodes.
Cancer stage II detected by scraping the cervical canal hidden endocervical lesions. Pseudo results of curettage of the cervical canal see more than 60 cases. The surgeonon-demand staging. Indications for additional postoperative radiotherapy. Expressed lesions of the cervix. The defeat more than half of the myometrium. Involvement of pelvic lymph nodes.
Cancer stage II with obvious spread to the cervix tumors 3rd degree very often metastasizes to the pelvic lymph nodes, distant metastasis and has a poor prognosis. There are two approaches to treatment.
The first approach is radical hysterectomy, bilateral salpingoophorectomy and the removal of para-aortic and pelvic lymph nodes.
The second approach is external and intracavitary radiation therapy with holding 4 weeks total abdominal hysterectomy and bilateral salpingoophorectomy.
Radical hysterectomy is indicated only somatically healthy, mostly young women with tumors with a low degree of histopathological differentiation. This approach is preferred for patients with a history of extensive surgery on the abdominal cavity and pelvis or a chronic inflammatory disease of pelvic organs, accompanying the formation of intra-abdominal adhesions. Preference give this method due to the high risk of damage to the small intestine in these patients after radiation therapy.
The combination of radiotherapy and surgery is preferred for patients with tumors of stage II and a pronounced spread to the cervix. Be aware that many women with cancer of the endometrium, is elderly, obese, hypertension, diabetes, etc.
Adenocarcinoma, stage III and IV - individual approach in the choice of treatment tactics. In most cases, the scheme of treatment include surgery, chemotherapy, hormonal therapy and radiation.
Treatment of recurrence of endometrial cancer depends on the prevalence and localization of recurrence, hormonal receptors status and health of the patient. Schematic treatment may include radiation, chemotherapy, hormone therapy and hysterectomy, if it was not done before.
The prognosis of cancer of the uterine body depends mainly on morphological stage and to a lesser extent on the patient's age, histological type of tumor, its size, degree of differentiation, switching to the cervix, and depth of invasion of the myometrium tumor emboli in lymph cracks of metastases in the ovaries and lymph nodes, peritoneal dissemination, the content of estrogen receptors and progesterone in the tumor, ploidy of tumor cells.
With increasing age, the prognosis worsens, the 5-year survival for cancer of the uterus in patients up to 50 years is 91, after 70 years - 61. With loss of tumor differentiation worsens the prognosis, the 5-year disease-free survival in low-grade cancer is 92, with moderately differentiated - 86, with poorly differentiated - 64. Metastases to lymph nodes increases the risk of progression of endometrial cancer 6 times. The 5-year disease-free survival in metastatic lesions of the lymph nodes is 54, and in the absence of metastases 90. The prognosis is significantly better in hormone-dependent pathogenetic variant of endometrial cancer than under independent 5-year survival rate is 90 and 60 respectively.

Prevention of endometrial Cancer (cancer of the uterine body):

Methods of primary prevention of cancer of the uterine body are designed to eliminate these risk factors for endometrial cancer and is essentially aimed at eliminating hyperestrogenic: decrease of body weight, compensation of diabetes mellitus, reproductive function, normalization of menstrual function, the causes of anovulation, timely surgical treatment for feminizing tumors, etc.
However, the most effective measures of secondary prevention, aimed at timely diagnosis and treatment of background and precancerous endometrial proliferative processes: adequate examination and treatment, screening women once in 1 year using transvaginal ultrasound, the formation of groups with high-risk endometrial cancer (on the basis of known risk factors) with regular supervision (transvaginal ultrasonography and aspiration biopsy of 1 every 6 months).

Which doctors should be consulted if You have endometrial Cancer (cancer of the uterine body):

Oncologist
Gynecologist
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