Tumors of the uterus
Tumors of the uterus. Cancer of the body of the uterus. In 75% of cases, it is diagnosed in women in menopause, another 18% during pre-menopause, in 7% - at the age of up to 40 years. Risk factors are obesity, diabetes, hypertension.
The main symptom of the cancer of the uterus body is the violation of vaginal bleeding (either during menopause, or not at the time of menstruation). Pain in the pelvis and fetid discharge are signs of late stages of the disease. The main method of diagnosis is separate scraping of the cervical canal and uterine cavity and subsequent histological examination. The cytological method of diagnosis is less reliable, as well as hysterography and hysteroscopy. Adenocarcinoma is the main morphological variant (up to 70%), adenoacanthomas and ferruginous squamous cell carcinomas are also found.
There are three degrees of differentiation of the tumor (highly differentiated, moderately differentiated and undifferentiated) and 4 stages of its development: stage 1 is the location of the tumor in the uterine body, stage II is the defeat of the body and cervix, the third stage is the spread to parametric fiber or metastases in the vagina, stage IV - spread beyond the pelvis, germination of the bladder or rectum.
Treatment is mainly surgical (extirpation of the uterus with appendages and sometimes removal of the lymph nodes of the pelvis). It is possible to combine treatment - surgery, and then remote irradiation to the vaginal stump area, intracavitary gamma therapy. Preoperative radiotherapy is also carried out mainly at stage III. Radiation therapy as an independent method is used for local spread of the tumor process, with contraindications to surgery. Progestins (hydroxyprogesterone capronate, provera, depot provera, medroxyprogesterone acetate) are effective in highly differentiated tumors in the III and IV stages of the disease. From antitumor drugs in metastatic phases can be used adriablastin, fluorouracil, methotrexate, thioTEP.
Prevention is the timely treatment of chronic endometrial diseases.
Cervical cancer occurs more often from the flat epithelium, less often from the glandular epithelium of the cervical canal. Cancer development is preceded by three stages of epidermoid dysplasia (mild, moderate and deep) and carcinoma in situ, in which cancer cells are located between squamous epithelial cells and do not penetrate the basal membrane.
Regular examinations and cytological examination (once every 2 years) contribute to the detection of precancerous diseases, and their treatment, cancer prevention.
Symptoms of cervical cancer - complaints of watery-leucorrhoea, contact or intermenstrual bleeding from the genital tract, pain. When examining the cervix in the mirrors or in a bimanual examination, an exophyte tumor (when it touches it, bleeding may occur) or an endophytic form of the disease with ulceration in the area of the external throat. Biopsy has a decisive diagnostic value. With cancer III and IV stages of isolation from the genital tract are putrefactive.
Treatment depends on the stage of the disease. At stage 1A (microinvasive cancer), the uterus is extirpated with the appendages. In stage 1B (cancer is limited to the cervix), remote or intracavitary radiation is indicated, followed by an expanded extirpation of the uterus with appendages, or, conversely, first an operation and then a remote gamma-therapy. In the II stage (involving the upper part of the vagina, it is possible to go to the uterus body and infiltrate the parameter without transition to the pelvic wall), the main method of treatment is radiation. Surgical intervention is rarely used. At stage III (transition to the lower part of the vagina, infiltration of the parameter with the transition to the pelvic bone), radiation treatment is indicated. Finally, in stage IV (transition to the bladder, rectum or distant metastasis) only palliative irradiation is used.
In later stages, the use of chemotherapeutic treatment (cisplatin, fluorouracil, mitomycin C, bleomycin, spirobromin) is possible.
Chorionepithelioma of the uterus is a malignant tumor of trophoblast that occurs during pregnancy or after an abortion. Given the widespread occurrence of abortions, chorioepithelioma of the uterus is a common disease. In 50% of cases the chorioepithelioma of the uterus is preceded by pregnancy, in 25% - spontaneous abortion, in 25% of cases - artificial abortion. Differential diagnosis is carried out with a bladder drift, which occurs much more often.
A bubble drift in 5-7% of cases is transformed into an invasive bladder drift, in 3-5% - in a chorionepithelioma. If the level of (-chorionic gonadotropin ((-XG) does not normalize within 2 months after removal of the bladder drift, the presence of recurrent blistering is established, and the risk of developing chorionepithelioma increases to 50%.
Clinical signs of uterine chorioepithelioma: vaginal or uterine bleeding, very high level (-HG.) Diagnosis is characterized by the characterization of clinical symptoms, cytological analyzes, ultrasound tomography.The course of the disease is aggressive.The fast-growing metastases are detected in the lungs, vagina, liver and other organs.
Early diagnosis is important for prognosis of treatment. With favorable prognostic characteristics it is possible to achieve complete cure and to keep the possibility of having pregnancy and childbirth in the future. Morphological analysis of the trophoblast's removed tissues and mandatory control (-CG before its normalization in cases of detected bladder drift or when signs of bleeding after abortion or pregnancy in the coming months are needed.
The non-metastatic chorionitis of the uterus is characterized by the absence of metastases and the spread of the tumor beyond the uterus. Treatment in this case occurs in more than 90% of patients without hysterectomy. With respect to the treatment prognosis, metastatic chorionapithelioma may have favorable characteristics (pelvic and / or lung metastases only, the titer of HG in the urine is less than 100,000 IU / day, treatment is started within 4 months after the onset of the disease) and unfavorable (metastases are localized in the pelvic region , Lungs, as well as in the liver, bones, brain, HG more than 100 000 IU / day, treatment started 4 months after diagnosis).
With localized chorioepithelioma of the uterus, chemotherapy is used (methotrexate-15-20 mg IM or IV daily for 5 days at intervals of 2-4 weeks to complete remission, which is confirmed by 3 normal weekly analyzes (-XG) .If the content of (- HG persists at a high level or increases, combined chemotherapy is carried out, hysterectomy is shown in the absence of the full effect.This tactic is used for metastatic chorionepithelioma with favorable prognostic signs.In addition to methotrexate, dactinomycin (10 mg / kg / day daily for 5 days With intervals of 2-3 weeks.) More difficult is the treatment of patients with neglected manifestations of uterine chorioepithelioma.There are combinations of methotrexate with dactinomycin, rubomycin or adriamycin, in resistant cases a combination of cisplatin with vinbpastine and bleomycetin.The use of a single drug, low doses of drugs , Large intervals between their administration contribute to the emergence of resistant cases of the disease. With metastases in the brain, radiotherapy is used. Chemotherapy with methotrexate is also used for bladder skipping in the case of an increase in HF titer 8 weeks after removal of the uterus.
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