Cancer of the endometrium ( uterine body )
Oncology / / August 12, 2017
Endometrial cancer is about 90% of all cancers of the endometrium and occupies a frequency second among malignant tumors of the female genital organs.In Europe, they fall ill each year around 18 women per 100 000 people.Endometrial cancer is now more common than a few decades ago, probably due to the increased number of women in a state of menopause and old age.In 75% of cases of endometrial cancer in women after menopause, and in old age, and only 4% - younger than 40 years.In the child-bearing age, this form of cancer is very rare.
If you have endometrial cancer have a certain role of endogenously-constitutional factors, to a lesser extent - exogenous.Predisposed to it women with excessive obesity, hypertension and other cardiovascular diseases, as well as the explicit or latent diabetes.
Endometrial cancer are regarded as hormone-dependent tumors.Proof of this are the clinical observations of the disease in women with abnormal estrogen stimulation, animal experiments and the effectiv
Symptoms The main symptoms of endometrial cancer are irregular bleeding or bleeding from the genital tract.The appearance of them after menopause in 40-60% of cases is caused by endometrial cancer.Sometimes purulent discharge have.
gynecological examination at the beginning of the disease often does not reveal any pathological changes.Only in severe process set the increase of the uterus and in the later stages - in the vagina.Therefore, when carrying out the above symptoms separate curettage of the uterus most appropriate for the diagnosis of endometrial cancer is cervical canal, which is important for more accurate topical diagnosis of the localization process, and determine the extent of its distribution, and, therefore, for a treatment plan.Be sure to hold the uterus probe indicating its length on the uterine probe.Additional studies to determine the propagation process can serve as cystoscopy and urography.
When atypical hyperplasia, even in young women, should be regularly monitored with the control curettage.In older women a hysterectomy is preferable.When dysplasia endometrial hysterectomy is feasible, and if there are contraindications to it - radiotherapy.Endometrial cancer can be treated: by surgery, radiation therapy, and combination of the two previous methods.
Surgical treatment - most rational method, but the operation is not very often due to old age patient, as well as cardiovascular disease, diabetes and extreme obesity.Surgical treatment in stage I is the abdominal or vaginal hysterectomy with bilateral removal of appendages.Some authors in connection with the frequency of metastasis to the vagina recommend hysterectomy with circular resection of the vagina.In the second stage it is justified by Wertheim hysterectomy.However, in the second step to make this operation is not always possible due to the above reasons, and therefore are often forced to make a conventional hysterectomy.However, there is no clear evidence of a significant difference in the results of these two operations.Surgical treatment is usually yields better than the results of radiotherapy.At the stage I operation is shown only.
radiotherapy is prescribed for stages I and II, unless there are contraindications to surgery, and all patients in stages III and IV.The basis of intracavitary radiation therapy is the administration of a radiation source.
Some cancer centers and with resectable tumors, preoperative radiotherapy is carried out, followed by (4-6 weeks), hysterectomy with appendages.However, the statistics did not prove to improve the results of the combined treatment as compared to the same operation.
metastases, particularly in the lungs, good results are obtained palliative treatment with high doses of progestogen;described cases of long-term cure.Progestogen combination with cytotoxic drugs has not justified itself.Prolonged treatment with progestins should be done with caution: in the presence of heart disease may develop fluid retention in the body and cardiac decompensation occur.
patients whose treatment consisted of radiotherapy, tumor disappearance controlled scraping.
rare form of endometrial cancers are sarcoma and carcinosarcoma.Sarcomas are even girls.The clinical symptomatology, diagnosis and treatment are similar to those of endometrial cancer.However, preference is given to a surgical treatment method, as these shapes are less sensitive to training.
In the early stages of endometrial cancer treatment is very good, and the five-year survival rate can reach 90% of those treated.Infiltration myometrium reduce this figure to 70%, and if the process infiltrates the neck, then to 50%.In the propagation process outside the womb only cure rates approaching 10%.On average, an overall five-year survival rate for all stages is about 60%.The prognosis of endometrial sarcoma and carcinosarcoma worse than endometrial cancer.