Endometrial cancer

Description:

Endometrial cancer, covering a body of the womb, is the most widespread type of cancer of female generative organs, but takes the last place among these diseases as a cause of death as it comes to light usually at an early stage when the disease well responds to treatment.

In the last decades cancer cases of a body of the womb steadily increase that, apparently, is connected with increase in life expectancy of women and their stay in the postmenopause period. The hysterocarcinoma arises generally in a postmenopause, average age of patients makes 60-62 years. During life 2-3% of women develop endometrial cancer.

Endometrial cancer symptoms:

Symptoms of cancer (endometria) of a body of the womb somewhat depend on menstrual function. At the menstruating women endometrial cancer can be shown by plentiful long periods, often irregular, acyclic bleedings. However in 75% of cases endometrial cancer arises at women in a postmenopause and causes blood allocations from a genital tract which calls bleeding in a postmenopause. Blood allocations can be scanty, smearing or plentiful. Blood allocations in a postmenopause disturb 90% of patients with cancer of an endometria, in 8% at the diagnosed cancer clinical manifestations are absent. In addition to blood allocations, at patients purulent discharges can be observed, and at a stenosis of the cervical channel the pyometra can form. At an ureter prelum are localized by infiltrate with emergence of the block of a kidney of pain in a waist. In separate observations ascites or volume educations in a small basin (can form at metastasises in ovaries, a big epiploon).

Endometrial cancer reasons:

Endometrial cancer is characteristic of women of advanced age (usually in the postmenopause period). More than 95% of cases of cancer of this localization develop at women aged 45 years are more senior, and average age of patients makes 63 years. At post-menopausal age the risk of developing of endometrial cancer is increased by such factors:
• Early beginning of menstrual function.
• The late introduction in a menopause.
• Obesity.
• Existence of a diabetes mellitus and the increased arterial pressure.
• A colorectal cancer at the patient or at close relatives (the burdened heredity).
• Birth only of one child or absence of children.
• Infertility, irregular monthly or an endometrial hyperplasia in the anamnesis (life stories and diseases).

In case of reception of Tamoxifenum concerning cancer therapy of a mammary gland the risk of development of endometrial cancer increases slightly. Endometrial cancer frequency at the women taking a contraceptive pill is 50% lower in comparison with representatives of a female, not accepting such drugs.
The risk of development of endometrial cancer is connected with concentration of female sex hormones (estrogen) in an organism influencing an endometria during all life of the woman. Estrogen stimulates cell fission of an endometria. Risk of development of endometrial cancer above at women with it is long not stopping menstrual function.
Modern post-menopausal hormonal therapy contains very low doses of estrogen and progesterone (other women's hormone suppressing formation of cells). Therefore new hormonal drugs do not increase risk of development of endometrial cancer at women. Nevertheless, to patients, accepting replaceable hormonal therapy, it is necessary to undergo medical examination regularly. The drugs containing only it is oestrogenic without progesterone, increase risk of development of endometrial cancer.
Very seldom some new growths of ovaries produce estrogen, increasing probability of emergence at women of cancer of uterus.
According to results of recently conducted researches, a diet with the high content of fats, can increase risk of development of some types of cancer including endometrial cancer. Suspect that high-calorific food with the high content of fats promotes development of obesity, the being one of risk factors of developing of endometrial cancer. It is connected with the fact that fatty tissue can be a source of female sex hormones. Excess weight is also connected with a breast cancer therefore such patients treat group of the increased risk of development and endometrial cancer.

Cancer therapy of an endometria:

Among the patients needing operation 13% have contraindications to operational treatment caused by associated diseases.
Preoperative radiation therapy at early stages of a disease (a stage of I and II with the latent endocervical injury). A total abdominal hysterectomy and a bilateral salpingooforektomiya with a biopsy of periaortic lymph nodes, a cytologic research of peritoneal contents, assessment of a condition of receptors of estrogen and progesterone and patogistologichesky assessment of penetration depth in a myometrium.
To women with high risk of a local recurrence there can be necessary the subsequent performing postoperative radiation therapy.
Cancer therapy of an endometria depending on a stage. Cancer of a stage of I, 1st degrees of a histopathological differentiation. An optimum method of treatment - surgical: total abdominal hysterectomy and bilateral salpingooforektomiya. In case of deep penetration into a myometrium it is possible to appoint radiation of pelvic bodies in addition.
Cancer of a stage of IA or 1B, 2-3 degree of a histopathological differentiation. Additional postoperative radiation therapy of pelvic bodies is applied at the invasion mentioning more than a half of a myometrium and involvement in process of pelvic lymph nodes.
Cancer of a stage of II with the latent endocervical injury revealed at a scraping of the cervical channel. Pseudo-positive takes of a scraping of the cervical channel observe more than in 60% of cases. Surgical definition of a stage. Indications to additional postoperative radiation therapy. The expressed damage of a neck of uterus. Defeat more than a half of a myometrium. Involvement of pelvic lymph nodes.
Cancer of a stage of II with obvious distribution on a neck of uterus of a tumor of the 3rd degree very often gives metastasises in pelvic lymph nodes, the remote metastasises and has the bad forecast. There are two approaches to treatment.
The first approach - a radical hysterectomy, a bilateral salpingooforektomiya and removal of periaortal and pelvic lymph nodes.
The second approach - outside and intracavitary radiation therapy with carrying out in 4 weeks of a total abdominal hysterectomy and a bilateral salpingooforektomiya.
The radical hysterectomy is shown only somatic to healthy, preferential young women with tumors of low degree of a histopathological differentiation. Such approach is preferable to the patients having in the anamnesis extensive surgical intervention on abdominal organs and a basin or the chronic inflammatory disease of bodies of a basin accompanying formation of intra belly commissures. Preference this method is given because of high risk of injury of a small intestine at such patients after radiation therapy.
The combination of radiation therapy and surgical intervention is more preferable to patients with tumors of a stage of II and the expressed distribution on a neck of uterus. It is necessary to consider that many women, patients with cancer of an endometria, - advanced age, having obesity, arterial hypertension, a diabetes mellitus, etc.
Adenocarcinoma, stages of III and IV - an individual campaign in the choice of medical tactics. In most cases schemes of treatment include surgical intervention with chemotherapy, hormonal therapy and radiation.
Treatment of a recurrence of endometrial cancer depends on prevalence and localization of a recurrence, a condition of hormonal receptors and health of the patient. Schemes of treatment can include radiation, chemotherapy, hormonal therapy and a hysterectomy if it was not carried out earlier.
The forecast at a hysterocarcinoma generally depends on a morphological stage and to a lesser extent on age of the patient, histologic type of a tumor, its sizes, degree of a differentiation, transition to a neck of uterus, depth of an invasion of a myometrium, tumoral emboluses in lymphatic cracks, metastasises in ovaries and lymph nodes, dissiminations on a peritoneum, the maintenance of receptors of estrogen and progesterone in a tumor, ploidy of tumor cells.
With increase in age the forecast worsens, 5-year survival at a hysterocarcinoma at patients up to 50 years makes 91%, after 70 years - 61%. With loss of a differentiation of a tumor the forecast, 5-year bezretsidivny survival at the high-differentiated cancer worsens makes 92%, at moderately differentiated - 86%, at low-differentiated - 64%. Metastasises in lymph nodes increase risk of progressing of a hysterocarcinoma by 6 times. 5-year bezretsidivny survival at metastatic damage of lymph nodes makes 54%, and in the absence of metastasises of 90%. The forecast is much better at hormonedependent pathogenetic option of endometrial cancer, than at autonomous, 5-year survival makes 90 and 60% respectively.