Tumors of the uterus

Cancer of the uterus. In 75% of cases it is diagnosed in women in menopause, another 18% during premenopause, and in 7% under the age of 40 years. Risk factors are obesity, diabetes, arterial hypertension. The main reasons for the increase in the incidence of uterine cancer, along with the increase in women's life expectancy, is the increase in the frequency of anovulation, hyperestrogenism, and endocrine metabolic disorders in the general population.

There are two main pathogenetic variants of hyperplastic processes and uterine cancer. The first (hormone-dependent) variant is observed in 2/3 of patients and is characterized by the presence of pronounced endocrine and metabolic disorders in the form of anovulation, obesity, and diabetes mellitus. In 1/3 of patients, uterine fibroids are found, in 5% - hormonally active ovarian tumors, polycystic ovaries.

Background diseases of the endometrium include glandular hyperplasia and polyps. A precancer of the endometrium is its atypical hyperplasia. The following types of endometrial cancer are distinguished: adenocarcinoma, which is the most common; clear cell (mesonephroid) adenocarcinoma; glandular squamous cell carcinoma; adenoacanthoma and undifferentiated cancer.

Endometrial adenocarcinomas, depending on the degree of histological differentiation, are divided into highly differentiated, moderately differentiated and poorly differentiated, which is essential for determining treatment tactics.

There are three ways of spreading uterine cancer: lymphogenous, hematogenous and implantation. With lymphogenous spread of a tumor localized in the lower part of the uterine body, the iliac lymph nodes are mainly affected, and when it is located in the upper part of the uterus, the para-aortic lymph nodes are affected. The uterine appendages are affected in 10% of patients with uterine cancer.

Metastatic damage to the vaginal walls and lungs often occurs, and less often to the liver and bones.

Clinical picture. Bloody or purulent discharge appears from the genital tract. In women of reproductive age, the disease manifests itself as menstrual dysfunction in the form of metrorrhagia, less often in the form of intermeistral discharge. Pain occurs during a common process: the appearance of pain may be associated with stretching of the walls of the uterus by the contents of its cavity or with compression of the nerve trunks by cancerous infiltrate.

When the tumor spreads to neighboring organs, their function is impaired. At the beginning of the disease, the size of the uterus may not change, then as the process progresses, the uterus increases and its mobility decreases.

The diagnosis of uterine cancer and determination of its stages is based on data from anamnesis, two-handed, radiological, hysteroscopic, cytological and histological examinations. Of particular importance is the use of hysteroscopy, which makes it possible to identify the location of the tumor and the extent of the process, and to perform a targeted biopsy. Ultrasound examination is used as a screening method.

The leading role in the diagnosis of uterine cancer belongs to histological examination of scrapings from the uterine cavity. Diagnostic curettage of the uterus should be separate. Scrapings from the cervical canal and the body of the uterus should be separately labeled and sent for histological examination in different bottles or tubes.

Treatment. The most common treatment for patients with uterine cancer is surgery. If the tumor affects only the mucous membrane of the uterine body, extirpation of the uterus and appendages should be performed. When the tumor affects the isthmus area, it moves to the cervical canal. or the presence of radiological signs of metastases in the regional pelvic lymph nodes, an extended hysterectomy with adnexa and lymphadenectomy of the external, internal and obturator lymph nodes should be performed.

It should be borne in mind that the risk of such extended extirpation is high even in modern conditions due to the advanced age of patients and severe extragenital pathology. In case n