Endometrial cancer is a frequent oncological disease of the reproductive system. Pathology has a latent origin, so it is rarely diagnosed in the early stages. Let us consider in detail the cancer of the endometrium: symptoms and signs, causes, forms, the main directions of therapy.
Endometrial cancer - risk factors
In patients with endometrial cancer, the age often exceeds 45-50 years. The trigger mechanism for structural changes in the cells of the uterine layer is the processes associated with menopause. The extinction of the reproductive system does not pass without a trace for the body. Among other possible risk factors, doctors identify such conditions as:
- disorders of the endocrine system, metabolic processes of the body - diabetes mellitus, obesity;
- arterial hypertension;
- hormone-dependent disorders of the reproductive system - hyperestrogenism;
- hormone-active ovarian tumors - Brenner's tumor in every fifth case accompanies cancer;
- Stein-Levental syndrome - combined with endometrial cancer in 30% of cases;
- genetic predisposition;
- burdened heredity - the presence of close relatives of tumor-like pathologies;
- late onset of sexual activity, lack of it;
- absence of pregnancy and childbirth in the anamnesis;
- late menopause (after 55 years);
- the passage of hormone therapy (use of Tamoxifen).
Endometrial cancer - classification
According to the histological International Classification, endometrial cancer of the uterus is divided into the following morphological forms:
- adenocarcinoma;
- clear cell adenocarcinoma;
- squamous cell carcinoma;
- glandular cancer;
- mucinous;
- serous cancer;
- glandular-squamous;
- undifferentiated cancer.
Clear cell endometrial adenocarcinoma
Clear cell adenocarcinoma occurs more often than other forms of pathology. For this type of cancer is characterized by the presence in the affected areas of tissue large polyhedral epithelial cells. It is often noted the presence of typical cells that occur alternately with elements of light-cell adenocarcinomas. Some specialists attribute pathologies and meson-fusion cells to this group. These elements outwardly resemble a shoe nail with a hat.
Endometrial carcinoma of the gland
The glandular cancer of the endometrium is a pathology in which mainly glandular cells are involved in the process. In practice, glandular adenocarcinoma affects the uterine cavity and cervical canal. This type of cancer accounts for about 70% of all oncological processes, is more often diagnosed in older women, but is also found in young people.
Squamous cell carcinoma of the endometrium
Squamous cell carcinoma of the uterus refers to malignant neoplasms. The formation of the tumor is from cells of the flat epithelium, which acquire a different degree of atypia. With the progression of pathology in the later stages, the cells change to the region of the cervical canal. In such cases, oncology is diagnosed during a gynecological examination. Because of the lack of a vivid clinical picture, it is not found in the early stages. The rare symptoms of pathology include:
- pelvic pain;
- dysfunction of the bladder and rectum;
- spotting and leucorrhoea.
Iron-squamous cell carcinoma of the endometrium
Iron-squamous cell carcinoma of endometrial tissue is a separate form of pathology. A distinctive feature of it is the presence of a tumor that has a dimorphic structure. Squamous and glandular components are present in such formations. As a rule, squamous cell predominates over glandular. This form of endometrial cancer accounts for 4% of all cases of pathology. It is more common in women older than 55 years, in single cases occurs in young people.
In comparison with other adenocarcinomas, the glandular squamous cell carcinoma has a low differentiation. Because of these structural features, the tumor often acquires an aggressive course. Macroscopically, without the use of apparatus with a large increase, this form practically does not differ from other adenocarcinomas. Outwardly resembles polypoid or ulcerated formation. Determining the form of pathology is carried out at a microscopic level, taking into account the degree of differentiation of individual components.
Serous endometrial cancer
Serous cancer belongs to a large group of epithelial neoplasms. Pathology is formed from altered or degenerated cells of epithelial tissue. In this case, it is often difficult to establish the origin of such. This form is characterized by a latent flow, and is found when the woman is randomly examined for the cycle, the reproductive system. Signs of endometrial cancer of this form is difficult to diagnose to the woman herself.
Mucinous Cancer
This type of oncology is characterized by the proliferation of cells that contain intra-cytoplasmic mucin inside themselves. This form of pathology accounts for 10% of all cases of oncology of the uterus body. A distinctive feature of the neoplasm is the high differentiation of tumor elements, which is confirmed by the ultrasound diagnosis and further microscopy of the tissue sample. Mucinous cancer is often treated by doctors as a consequence of taking synthetic gestagens.
Endometrial cancer of the uterus - symptoms and signs
When endometrial cancer develops, the symptoms of the pathology occur after a long time. Most patients do not complain at the time of the neoplasm. This explains the frequent accidental diagnosis of the disease in the course of searching for the causes of abnormalities in the reproductive system. The main symptom that indicates cancer is uterine bleeding.
These discharges have no connection with the menstrual periods. They are unprivileged, often accompanied by a minor soreness, which deceives the patients. Women themselves take symptomatology for extraordinary monthly and consult a doctor only after repeated repetition. Conducting differential diagnosis helps to establish the true cause of bloody discharge - cancer of the uterine endometrium.
As the pathology progresses, the symptomatology grows. Among other signs of such a disease as endometrial cancer, it is necessary to distinguish:
- The appearance of whites is a pathological discharge from the genital tract. Occur when the tumor grows. Accumulation in the uterine cavity of such secretions, causes painful sensations in the lower abdomen, pulling character.
- Purulent discharge from the vagina. Violation of the outflow of leucorrhea can cause infection, provoke the formation of pyometers - a buildup of pus in the uterine cavity. The woman at the same time fixes the appearance of pain of a bursting nature, an increase in body temperature, a deterioration in overall well-being.
- Pain syndrome - appears when the pathological process spreads, infiltrative changes in the pelvic cavity. With the rapid growth of the tumor, there is compression of the ureter, there are pains in the lumbar region.
- Violation of the process of urination and defecation. The large size of the primary tumor provokes the appearance of additional symptoms (soreness with urination, defecation, tenesmus - false, painful urge to defecate).
- Violation of the menstrual cycle - lengthening, shortening, increasing the volume of menstrual blood. Often associated with hormonal changes in the patient's body.
Endometrial cancer - stages
Depending on the clinical manifestations and extent of the disorder, the following stages of endometrial cancer of the uterus are distinguished, according to the classification of the International Federation of Obstetricians and Gynecologists (FIGO):
1. Zero stage (0) - there is atypical endometrial hyperplasia, which is the initial stage of oncology.
2. The first stage - the tumor does not go beyond the body of the uterus (IA-C). It is accepted to distinguish:
- ІА stage - the tumor does not germinate inside, it is limited by a layer of epithelium;
- ІВ stage - the muscular layer is involved in the pathological process, and does not reach its midpoint;
- The ІС stage - carcinoma sprouts half of the muscular layer and deeper, but does not reach the serosa.
2. The second stage is divided into:
- ІІА - only the glands are involved;
- ІІВ stage - stroma is affected.
3. The third stage - the cancer of the endometrium leaves the border of the organ, but does not go beyond the small pelvis. Depending on the clinical features, this stage is divided into:
- ІІІА - carcinoma sprouts serous membrane or affects the appendages;
- ІІІС - is characterized by the appearance of metastases in the adjacent lymph nodes.
4. Fourth stage:
- the tumor sprouts into the bladder or rectum - IVA.
- the appearance of distant metastases outside the small pelvis - IVB.
Endometrial cancer - diagnosis
Present signs of endometrial cancer of the uterus are an indication for a comprehensive examination of the patient. For the purpose of this:
- vaginal ultrasound of pelvic organs;
- hysterocervicoscopy - scraping of pelvic and cervical tissues for further microscopy;
- echography of abdominal cavity organs;
- colonoscopy ;
- cystoscopy.
Endometrial cancer on ultrasound
Endometrial cancer on ultrasound, the signs of which are described above, can be diagnosed by transvaginal echography. In this study, the doctor discovers a rounded or irregular shape. Small tumors have increased echogenicity and homogeneous structure. In this case, the contour of the tumor is more often even (with an infiltration, the edges change). The increased acoustic conductivity of the tumor forms an acoustic effect, which enhances the echo signal. So doctors diagnose endometrial cancer of the uterus, the symptoms of which are also confirmed by the analyzes.
Endometrial cancer - oncomarkers
Onkomarkery - biologically active substances, synthesized in a cancer cell. They consist of a protein molecule to which a lipid and carbohydrate are attached. Markers are developed depending on the phase of the pathological process, the peculiarities of the structure of the tumor. Partly they penetrate into the blood, where they are detected with the help of laboratory studies. To diagnose microinvasive endometrial cancer, patients are assigned to the following tumor markers:
- squamous cell carcinoma antigen (SCCA);
- CA 125;
- cancer-embryonic antigen (CEA);
- cancer marker CA 27-29.
Endometrial cancer - treatment
Having learned about the terrible diagnosis, the first question of patients: whether or not endometrial cancer is treated. Doctors talk about a possible recovery. A successful outcome depends on the type of pathology, severity of the disease, stage. The following therapies are used in treatment:
- surgical method;
- radiation therapy ;
- chemotherapy ;
- hormonotherapy.
The choice of method of treatment depends on many factors. When selecting the method of therapeutic treatment, the following are taken into account:
- stage of the disease;
- tumor size;
- histological structure;
- degree of differentiation;
- depth of germination;
- spread of the tumor beyond the affected organ.
Of these methods, surgical is used more often than others. It reduces the recurrence of endometrial cancer. During the operation, the doctors not only remove the affected tissue from the organ, but also inspect the nearby ones. Surgical staging includes:
- revision of the abdominal cavity;
- conducting a biopsy of lymph nodes;
- cytological examination of a tissue sample.
Based on the results obtained during the inspection, a decision is made on the scope of the operation:
- extirpation of the uterus (complete organ removal) with appendages;
- radical extirpation of the uterus with appendages and lymphadenectomy - removal of the uterus along with local lymph nodes.
Endometrial cancer - prognosis
Determining when predicting the outcome of the disease are:
- stage of pathology;
- age;
- depth of invasive changes;
- degree of differentiation;
- tumor size.
One of the determining factors are metastases of endometrial cancer, which are localized in the lymph nodes. It has been statistically established that, since the diagnosis of endometrial cancer of the first stage, 82% of patients live five years or more. When diagnosing the disease in the second stage, and the proper administration of therapy, 65% of all patients live more than five years. In 25% of cases of pathology, progression of the disease with an unfavorable prognosis is noted.