Update: October 2018
Endometrial cancer (inner layer of the uterus) – one of the frequent
oncological diseases of Russian women. To his share
accounted for 7.7% of all malignant tumors. Than выше
the economic level of the country, the more common this disease.
The only exceptions are eastern countries (Japan), where
food traditions are somewhat different from the West. Average age
which identifies this type of cancer – 65 years, and the detection of a tumor
previously 50 years – a great rarity.
What is endometrial cancer?
Tumors of the inner layer of the uterus are called endometrial tumors.
This слой окружен мышцами, которые и образуют тело матки
(myometrium), and all this is covered with a thin serous membrane. Cervical cancer
uterus to endometrial tumors does not apply, it is a separate disease
with completely different reasons and predictions.
Endometrial cancer risk factors
- ATозраст более 65 лет
Statistics on the frequency of tumors in women
- Diagnosed polycystic ovary syndrome and other
- Infertility or 1 pregnancy
- Late menopause (later 55 years)
- Long-term hormone replacement therapy
- Withем Тамоксифена
ATсе вышеперечисленные факторы не являются непосредственными
causes of cancer of the uterus, they only increase the risk of cancer
Polycystic Ovary Syndrome
Polycystic ovaries are a syndrome in which in each of
ovaries simultaneously contains 12 or more follicles. Withчиной
such a phenomenon is considered a disturbed exchange of sex hormones: male and
female. Girls and women with this syndrome are usually irregular.
menstrual cycle, infertility and “male” signs: excessive growth
hair, fatty abdomen, rough voice. Body cancer risk
while the uterus rises due to a failure in estrogen metabolism. Besides
In addition, obesity can be an additional risk factor.
Obesity и избыточное потребление жиров в пищу
Being overweight increases the risk of uterine cancer by a factor of 2-3. it касается
women with a body mass index of more than 25. Such an increase
risks of excess estrogen synthesized through fat
tissue. This же механизм действует и при поедании большого
animal fat amounts. It is proved that in countries where in the diet
fats are prevalent and few vegetables are present, the risk of developing a tumor
endometrium is much higher.
Hormone replacement therapy
It is believed that women older than 55 years long
Replacement therapy increases the risk of cancer of the body of the uterus by 2-3 times.
It should be noted that the risk when taking outdated drugs (containing
only estrogen in large quantities) was sevenfold. Modern
agents that include progesterone, have the right to exist.
Therefore, the main rule of substitution therapy is timely
appointment under strict indications, using the latest
Separately, you need to say about oral contraceptives. Since the dose
estrogens are negligible in them, and progestins are contained in large
quantity, they not only do not increase, but even reduce the risk
disease 2 times.
Estrogen receptor blocker (Tamoxifen) has been used successfully
for the treatment of breast cancer. But its reception is longer than 2 years
increases the risk of endometrial cancer by 2-7 times. Since the risk is
this is not a disease, it is not recommended to refuse such
effective drug to cure a tumor
Cancer of the uterus and smoking
Endometrial cancer is one of the few tumors whose risk is not
increases with smoking. Moreover, this risk in women smokers even
reduced Such a paradox is associated with the effect of smoking on childbearing
function: reduced estrogen production, menopause
2-3 years earlier than in the general population. This факт, однако, не
is a reason to start smoking. Tobacco addiction increases many times
риски других опухолей, особенно – легких, желудка и the kidneys.
Uterine Cancer and Heredity
The direct connection of endometrial cancer with heredity is not
is celebrated. There is a genetic predisposition to
obesity, polycystic ovaries and other factors that increase
risk of uterine cancer. Also существуют наследственные формы
primary multiple tumors. For example, in Lynch syndrome
The chances of developing adenocarcinoma in all
organs, including the uterus.
Quite often malignant tumors of the uterus are formed on the background
existing hyperplastic processes (see symptoms and treatment
endometrial hyperplasia). Hyperplasia is an overgrowth.
endometrium, which may be total or local (the so-called
AT норме у женщин детородного возраста в конце каждого
menstrual cycle is the rejection of the inner layer of the uterus,
and then – his exit in the form of menstruation. But sometimes rejection occurs
not fully or not happening at all.
It is against this background that atypical cells can appear
to uncontrolled division and becoming a cancer. So atypical
hyperplasia is a precancerous condition. Therefore, a special
attention is paid to women with the following diagnoses:
- atypical hyperplasia at any age
- simple (glandular) hyperplasia in combination with exchange
disorders (obesity, diabetes, polycystic ovary)
- persistent glandular hyperplasia in women
Symptoms of endometrial cancer
Symptoms of uterine cancer are not specific to this disease.
They can mean banal irregular menstruation,
infectious processes and premenopausal hormonal
fluctuations. But it is necessary to know the possible manifestations and to be
- Infertility, ovarian dysfunction
- Bleeding from the genital tract
With the development of tumors in women in menopause may appear
heavy or scanty bleeding from the uterus (see discharge in
the middle of the loop). Should also be alerted pus or copious
clear, watery, fluid discharge (leukorrhea). Among women
of childbearing age, the tumor makes itself felt intermenstrual
bleeding as well as heavy menstruation. However, many
cancer cases develop without any discharge from the genital
Symptoms in the late stages
- A late symptom of uterine cancer is lower abdominal pain, pain in
lower back and sacrum. The pain is due to compression of the nerve plexus.
parametric infiltration and involvement in oncological process
serous membrane of the uterus.
- Secretions in the later stages have a purulent character (putrid
smell) or the color of meat slop.
- With the spread of the tumor in the cervix may develop
pyometra (accumulation of pus inside the uterus) and cervical stenosis
(narrowing or closing of the neck).
- Symptoms of compression of a tumor in other organs: sigmoid or
rectum – constipation, mucus in the feces, blood in the feces, when squeezed
ureter develops hydronephrosis, accompanied by uremia,
back pain, with the germination of the tumor in the urinary blood in the urine,
frequent or difficult urination
- Symptoms of distant metastases: with advanced cancer – pain in
bones and pathological fractures, jaundice with liver damage,
sharp weight loss.
- With the defeat of the pelvic organs often develop ascites.
Withмер из практики: Как-то раз на прием
обратилась женщина лет 53 – 54 с целью профилактическог
inspection. She did not complain, menstruation with her words went
regularly, did not differ abundance. When viewed from the cervix without
pathology, dairy, moderate. But on the palpation of the uterus
and appendages encountered difficulties. In place, the uterus is not
it was palpable, and its bottom was determined at the level of the navel. Appendages without
features. The uterus itself was dense, bumpy and with huge
knots. Когда я ее после гинекологическог
the couch and taking her hand, indicated to what size the uterus grew,
the woman was a little surprised.
From the anamnesis, it became known that there are no children, and no pregnancies
it was generally, but about 25 years ago she had a conservative myomectomy.
After such an operation, the woman should have been at the dispensary.
year, but for some reason unknown to me
removed after 5 years and here is the result. After consultation in
the regional hospital and oncologic dispensary the patient was assigned
radiation therapy with a palliative (relief) goal, but also
this did not bring at least temporary success.
After 2 months, the patient enters the gynecological department with
hepatic encephalopathy (liver metastases have not forced themselves
wait), where her condition is deteriorating (for several
hours), they fall into a coma and die in my arms. The only
�The “fault” of the patient was only a persistent reluctance to be checked at least once.
per year at the gynecologist, although there were suspicious signs:
swelling, which the woman could not feel, heavy periods,
intermenstrual daub. (Doctor obstetrician-gynecologist Anna Sozinova).
How to detect cancer in the early stages?
Most endometrial tumors are detected in women in
postmenopausal disease. Therefore, the first symptom of uterine cancer is bleeding,
the alarming majority of older women. In such cases
urgent medical consultation and appropriate
In young women, bleeding is not so rare.
an event so that you can suspect a serious illness.
Therefore, it is very important to know the length of your menstrual cycle,
profusion and duration of bleeding. When you change the usual
menstruation schedule is better to be examined to exclude all
Forms of endometrial cancer (according to the results of histology)
- Adenocarcinoma (including clear cell)
- Squamous cell carcinoma
- Glandular squamous cancer
- Undifferentiated cancer
Depends on the type of cancer of the uterus how much it lives with it, how fast
metastasis occurs, and what treatment should be applied. Than
organized cells than they are more like normal
endometrium, the slower the tumor grows and the better the prognosis.
All endometrial tumors have their own characteristics of growth. Therefore
Parameter they are divided into three groups:
- with exophytic growth (95%) – growing in the uterine cavity
- with endophytic growth – walls of a uterus growing in thickness
As the disease progresses, exophytic tumors often
переходят в mixed и endophytic, which increases the risk
Stages of uterine cancer (according to the FIGO classification)
- Ia – tumor growth within the endometrium
- Ib – the tumor penetrates half the myometrium
- IC – tumor penetrates to the serous membrane of the uterus
- IIa – intra cervical glands are involved in the process
- IIb – rise to the depth of the cervical canal
- IIIa – cancer germinates the serous membrane of the uterus and / or affects
ovaries, and / or in the abdominal cavity there are cancer cells
- IIIc – metastases in the vagina appear
- IIIc – there are metastases in the paraaortic and pelvic
- IVa – the tumor grows into the bladder and / or direct
- IVc – there are distant metastases
Diagnosis of endometrial cancer
The term “cytology” is usually associated with smear research.
on cervical oncocytology (PAP-test). Unfortunately, it is affordable and
the simple method is not suitable for screening uterine body tumors.
Therefore, if you suspect endometrial cancer, examine the contents
uterus obtained by aspiration.
The method is to drive a special syringe directly into the cavity
uterus and collection of its liquid contents. After the procedure, aspirate
examined under a microscope to detect cancer cells. This
the method helps to establish the fact of cancer, but does not
full picture. It is good for advanced cases, while early
cancer stage can be skipped.
Ultrasound diagnosis is informative and safe.
method of detecting tumors of the uterus. С помощью трансвагинального Ultrasound
signs of cancer can be detected even in the early stages, when
the tumor did not reach 2 cm in diameter.
The main criterion for normal endometrium is the M-echo. it
the reflection that gives the inner layer of the uterus depending on
its thickness. Among women детородного возраста норма М-эха не
exceeds 10-16 mm, whereas after menopause it is 3-4
mm With the increase of this parameter to 6-7 mm in climacteric
периоде необходимо наблюдение, повтор Ultrasound и дополнительные
Magnetic resonance imaging is used in the propagation
disease, the appearance of metastases and the germination of other organs.
MRI помогает рассмотреть рак при наличии миомы в матке, когда
возможности Ultrasound ограничены.
Hysteroscopy allows to assess the condition of the endometrium visually,
using a special device connected to the video monitor. With
This procedure can examine the entire uterine cavity, evaluate
the prevalence of the process and take a biopsy of suspicious
plots. Scraping is usually done after the inspection is completed.
(“Cleaning”) the uterus and cervical canal, followed by
histological examination. About the state after hysteroscopy.
With обнаружении опухоли необходимо выяснить, чувствительна ли
she to hormonal treatment. To do this, determine the number
receptors for estrogen and progesterone by immunochemical
It is very important to establish all prognostic factors in order to
choose appropriate and appropriate methods of treatment. Than хуже эти
factors, the more aggressive the therapy should be.
|Stage of the disease||I||III and IV|
|Type of tumor||Adenocarcinoma||Clear cell adenocarcinoma and other types|
|Tissue differentiation||Highly differentiated tumor||Undifferentiated cancer|
|Depth of penetration into the wall of the uterus||Less than one third||More than one third|
|Lesion area||Limited||Common, with the transition to the cervical canal|
Endometrial cancer treatment
Most cases of uterine tumors are treated comprehensively, with
using three main methods: surgery, radiation and
chemotherapy. it сочетание увеличивает в разы 5-летнюю
The main operation for endometrial cancer is the removal of the uterus
together with appendages. Often have to delete nearby
lymph nodes and tissues affected by the tumor.
Irradiation of the uterus and adjacent tissues is carried out at
common cancer sensitive to rays. To this method
resorted to and in patients whose operation is contraindicated. it
elderly women, often suffering from liver, heart and
Chemotherapeutic drugs (doxorubicin, cisplatin) with
uterine carcinoma gives not so impressive results as with other
tumors. They are used when running processes, as well as
contraindications to surgery.
Another stage of the combined treatment of endometrial cancer can
be hormonal drugs (progestogen derivatives), because
some of the tumors are sensitive to these substances.
The regimen of drugs is designed for 2-3 years. Given the frequent
side effects examine sensitivity before starting therapy
tumors and its differentiation.
Observation after therapy
After surgery and completion of treatment, the woman should regularly
be observed by a doctor. In the first year it is necessary to be examined every 4
months, in the second year – once in 6 months, then – once a year. AT
recent years there have been recommendations to be observed every 4 months in
flow first three years. If signs and symptoms of cancer appear
uterus suspicious of relapse, then you need to commit an unscheduled
visit to the doctor.
ATыживаемость при раке эндометрия
AT связи с ранней диагностикой и совершенствующейся терапией рак
The uterus is quite successfully treated. So, 5-year survival of patients with
Stage I – up to 98%, with Stage II – about 70%, with Stage III – 32%,
Stage IV – about 5%.
- Having at least one pregnancy
- Long-term breastfeeding
- Physical activity