Uterine disease code micb 10. Endometrial cancer - description, treatment

AT modern world cases of detection of oncological processes are becoming more and more frequent. Cancer remains one of the most common forms of cancer in women reproductive system(of its organs) in general, and uterine cancer in particular. This is a fairly common cause of death for women both in reproductive and post-reproductive age, since it does not depend on hormonal balance.

This article talks about this disease, its forms and pathogenesis, as well as symptoms. It is the knowledge of the symptoms that will allow for timely diagnosis and treatment, which means that it will significantly increase the likelihood of a favorable prognosis.

Definition

What is uterine cancer? This is the process of formation of atypical cells in the tissues of an organ, which eventually form a tumor that grows and has a negative effect on the body. In the International Classification of Diseases (ICD 10), this condition is classified in the section "Malignant neoplasms of the body of the uterus" and assigned the number C54. ICD code 10 C54.0 has cancer of the lower segment, C54.1 - endometrium, C54.2 - myometrium, C54.3 - uterine fundus, C54.8 - when the process goes beyond a certain localization, C54.9 - a code that is given with unspecified localization.

The reasons

Reliably the causes of uterine cancer, as well as other oncological processes, have not yet been discovered. However, when it comes to the reproductive system, factors can be identified that significantly increase the likelihood of such a course of the condition. The main such factor is the presence of the human papillomavirus. Two strains of this virus cause processes in the uterus that eventually develop into oncology. This does not always happen, but the percentage of such cases is high, and the causes of rebirth have not been established.

Pathogenesis

Cancer of the cervix or uterus proceeds with the passage of several stages. At the initial stage, the focus of pathological division is local, located in the uterus or on the neck. Then it grows and deepens into the tissues (if the process is first localized in the outer layer of the squamous epithelium, then it penetrates deeper, affecting other cellular and tissue layers). At this stage, metastases may already be present in nearby organs and systems.

In the future, with a typical development in stages, the process may spread to neighboring organs, metastases appear in these organs. Further, in the course of the development of the condition, metastases appear in very distant organs and systems, signs of an oncological process can be observed in the bladder, intestines, etc.

Symptoms

In different patients, this disease may manifest itself in different ways or not at all. It is these implicit, non-specific and mild signs of uterine oncology that often do not allow diagnosing the disease at an early stage, when the prognosis for a cure is most favorable. In most cases, the following symptoms may occur:

1. Rapid unexplained weight loss;
2. Decreased appetite, feeling tired, weak, etc.;
3. Acyclic bleeding outside of menstruation;
4. More abundant and / or longer periods;
5. Sometimes there are atypical discharges in cancer;
6. Pain in the lower abdomen, not too pronounced.

The first signs and symptoms of uterine cancer usually go unnoticed due to their mild severity. Therefore, usually, treatment begins only at the second or third stage, when the process has developed significantly.

Symptoms with menopause

Symptoms and signs of menopause can be even more blurred and atypical. However, there is one important diagnostic sign that helps to diagnose the disease at an early stage, and which is not informative in the reproductive stage - the presence of bleeding from the uterus. During the period after menopause, such a symptom is always a sign of cancer, since there are no other causes of bleeding during this period.

Classification by localization

During treatment, it is important not only to determine uterine cancer, but also to establish its localization, since depending on this there may be some features in the treatment of the condition. The following types of state are distinguished by localization:

• is a process localized with outside cervix or in the cervical canal. It is relatively favorable in that it is often possible to diagnose it in a timely manner during a routine routine examination;
• Cancer of the uterine body is a process localized in the uterine cavity itself, on its walls. It can be located on its bottom, isthmus, middle part, etc. It is capable of striking both its outer and inner shell. It is diagnosed quite easily with a timely examination;
• - a process in which atypical cells are localized in the inner mucous layer of the uterine cavity. It is he who actively grows and causes symptoms of pathology;
• Adenocarcinoma is a process that develops in the glandular tissue of the organ. The same name has any cancer of the glandular tissue (in other organs too). Quite difficult to diagnose visually;
• Clear cell adenocarcinoma is the same type of uterine cancer as the previous one, however, the process is localized predominantly or exclusively in clear cells, that is, cells with weakly stained cytoplasm. This type can be diagnosed only by the results of histology;
• - a process localized in squamous epithelial cells. It is they who become atypical and grow, forming a tumor. It is characterized by discharge in uterine cancer;
• Serous cancer develops in the outer epithelial layer;
• Mucinous cancer is papillary cancer, but in which there is also a certain amount of glandular tissue, its sections. This type of cancer is very rare;
• Undifferentiated cancer is one of the most aggressive forms of the disease, which, moreover, is common. It is characterized by the fact that mutating cells do not go through a full cycle of development, that is, they do not become similar to cells of a particular tissue.

There are other types of classifications.

Classification by form of growth

The form of cancer growth is important, mainly in its surgical treatment. There are the following forms:

• Exophytic cancer has clear boundaries of localization and grows outward, into the lumen of the organ. In the case of the uterus, it is clear that it grows into the uterine cavity and is clearly visible on ultrasound for this reason;
• Endophytic cancer does not have such well-defined boundaries of the focus. It does not grow outward, but inside the tissues, that is, it is less noticeable, since for a long time it does not violate the symmetry and external outlines of the organ, therefore it is more difficult to diagnose such a tumor. Symptoms, usually, also gives less;
• Mixed cancer, in essence, is an exophytic-endophytic form of the disease, that is, one in which growth occurs both inward and outward. The boundaries of the focus are blurred, but they can still be determined.

Usually, no additional work is required to diagnose the form of tumor growth. It can be obvious and is determined immediately when diagnosing the condition.

Classification according to the degree of differentiation

A cancerous tumor is formed by atypical cells, that is, those that have lost the features of normal cells of a particular tissue. They may differ in size, structure, number of organelles, shape, etc. Differentiation is precisely the degree of severity of these changes. It can describe how strongly the cells have deviated from their normal state, how active the atyping process is, and how pronounced its results are.

• (G1. With such cancer, the changes are mild. That is, the tumor tissue has many features of normal healthy tissue. This is a relatively favorable condition in which the pathological process develops slowly, and metastases form inactively;
• (G3) is one in which the cells change a lot. It is aggressive, develops rapidly, metastasizes, has a poor prognosis;
• (G2) is an intermediate form between the two listed above.

Although the form of cancer plays a large role, the positive prognosis depends on the right choice and timely treatment to a greater extent.

Diagnostics

What does uterine cancer look like? It is sometimes possible to visually diagnose the presence of a tumor during colposcopy or hysteroscopy, but it is impossible to determine the specific type of tumor and even confirm or deny whether it is an oncology. In addition, sometimes the presence of a tumor can be seen on ultrasound. You can find out what body and cervical cancer looks like in these articles:

In order to confirm that it is the oncology of the uterus that takes place, it is necessary to conduct a blood test for tumor markers. A tumor marker is a special compound that appears in the blood when oncological processes are underway (or is present in the body initially, but in lower concentrations).

Treatment

In treatment given state highest value has an integrated approach. Usually, they combine methods of radiation and chemotherapy, treatment with drugs and surgical methods of treatment. This is due to the fact that there is a need for reliable prevention of relapses. Diagnosis and treatment must be started at the earliest stage, since during this period the probability of a successful cure is highest.

Surgery

Chemotherapy

Survival prognosis

Forecast for this disease hard enough to do. This is due to the fact that it largely depends on the stage at which treatment began, the form of cancer, individual features organism. In general, when uterine cancer is treated at an early stage, the survival rate in the first five years is over 50%, which is quite favorable. Further, this indicator decreases as the stage grows. Also, regardless of the stage, there is always a high probability of recurrence (if the uterus has not been removed).

Prevention of cervical cancer

This disease can be prevented by taking a set of preventive measures. They differ slightly both in the reproductive stage and in postmenopause, since cancer often occurs regardless of the hormonal status of the patient. In order to reduce the likelihood of this occurrence, follow a few simple recommendations:

1. Be responsible in choosing a sexual partner, as casual relationships can lead to infection with the human papillomavirus, which increases the likelihood of developing cancer;
2. For the same reason, it is recommended to use barrier contraceptive methods during intercourse - although they do not provide an absolute guarantee of protection, they nevertheless significantly reduce the likelihood of infection;
3. Lead in general healthy lifestyle life and eat right, as this reduces the likelihood of the onset of the pathological process;
4. Keep the immune system strong so that it can suppress the division of abnormal cells;
5. Regularly undergo a physical examination by a gynecologist and take the necessary smears, as this will allow you to diagnose the disease at an early stage when it appears;
6. If possible, avoid surgical interventions in the reproductive system and uterus (abortions, etc.) as well as inflammatory, infectious and viral diseases.

Such measures will help not only prevent uterine cancer, the signs and features of which are discussed in this article, but also other diseases. And also, compliance with these rules in general can improve the quality of life for women.

Cervical Cancer Vaccine

It is believed that the most common cause The development of a pathological process of this type in the uterus is considered to be the human papillomavirus. Some strains of this virus cause the appearance of papillomas, which quite often regenerate and acquire an oncological form.

There is a papillomavirus vaccine. It is recommended to do it for the first time even before the onset of sexual activity. It is able to fully protect against any, including. Potentially dangerous types of virus.

You can read more about the human papillomavirus vaccine in the article: "".

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Oncological diseases of the reproductive system are quite common, as these are hormone-regulated organs, the growth of tissues in which also occurs under the influence of hormones. Therefore, any hormonal imbalance or violation of the theoretical can lead to ...

Endometrial cancer is a malignant tumor caused by the uncontrolled growth of endometrial cells in the uterus. This disease is also called uterine cancer or endometrial cancer, since tumor growth begins in the tissue lining the uterus from the inside, i.e. in the endometrium. This type of cancer is considered the most common among tumors of the female reproductive system.

Another type of uterine cancer is uterine sarcoma. It occurs when a tumor affects muscle or connective tissue. Sarcoma is rare, accounting for about 8% of all uterine tumors.

Cancer of the body of the uterus in women

Endometrial cancer mainly affects postmenopausal women, that is, from 45 to 74 years old. Up to 45 years, this disease is extremely rare, less than 1% of women. Uterine cancer ranks 4th among all cancers in women. Fortunately, it often shows up in early stages when a cure is possible.

Cancer of the body of the uterus in the ICD-10

According to the international classification of diseases, pathology is classified under section C54 - “Malignant formation of the body of the uterus. Isthmus cancer - C54.0, endometrium - C54.1, myometrium - C54.2, uterine fundus - C54.3, lesion beyond one localization - C54.8, and unspecified C54.9.

Causes of uterine cancer

The causes of uterine cancer are still not fully understood. However, risk factors have been identified.

Hormone imbalance. Disruption of hormone production plays a major role in the onset of the disease. Before menopause, estrogen and progesterone levels are in a balanced state. After menopause, a woman's body stops producing progesterone, while a small amount of estrogen continues to be produced. Estrogen stimulates the reproduction of endometrial cells, the inhibiting effect of progesterone disappears, which increases the risk of developing cancer.

Another reason for hormonal disorders occurs if a woman receives replacement hormone therapy estrogen only, no progesterone component.

Overweight. The risk of uterine cancer increases with excess body weight, since adipose tissue itself can produce estrogens. Overweight women are three times more likely to develop endometrial cancer than women of normal weight. In women with severe obesity, the risk of getting sick increases 6 times.

History of the reproductive period.

Taking tamoxifen. The threat of illness will arise if a woman takes tamoxifen. This medicine is used to treat breast cancer.

Diabetes. The disease doubles the chance of cancer of the uterine body. This is due to an increase in insulin levels in the body, which in turn raises estrogen levels. Often, diabetes is associated with obesity, which exacerbates the situation.

Diseases of the genital organs. PCOS (polycystic ovary syndrome) also predisposes to the disease because estrogen levels are elevated in this pathology. A precancerous condition is considered endometrial hyperplasia, i.e. thickening of the lining of the uterus.

Family history. Women whose relatives (mother, sister, daughter) have uterine cancer are at risk. Also, the chances of getting sick increase when there is a hereditary type of colorectal cancer (Lynch syndrome) in the family history.

Uterine cancer and pregnancy

Women who have not given birth are more likely to have uterine cancer. During pregnancy, there is an increase in progesterone levels and a decrease in estrogen levels. This hormonal balance has a protective effect on the endometrium.

Also at risk are women who began menstruating before the age of 12 and / or menopause occurred later than 55 years.

What happens with uterine cancer

The process begins with a mutation in the DNA structure of endometrial cells. As a result, the cells begin to multiply and grow uncontrollably, causing the appearance of the tumor itself. Without treatment, the tumor can extend beyond the inner lining of the uterus and grow into the muscle layer, and further into the pelvic organs. In addition, cancer cells can spread throughout the body through the blood or lymph. This is called metastasis.

Symptoms and signs of uterine cancer

The most common manifestation of endometrial cancer is bleeding from the vagina. Allocations are both meager, in the form of streaks of blood, and in the form of profuse uterine bleeding.

There are also less specific signs:

• discomfort when urinating
• pain or discomfort during sex
• lower abdominal pain.

If the disease caused damage to organs near the uterus, then pain in the legs and back, general weakness may disturb.

Symptoms before menopause

Before the onset of menopause, a disease can be suspected if menstruation has become more abundant than usual, or there is spotting in the intermenstrual period.

Manifestations in postmenopause

After menopause, any bleeding from the genital tract is considered a pathology. Regardless of the amount of bleeding, if any, you need to visit a gynecologist.

stages

There are several stages of uterine cancer. At the zero stage, atypical cells are found only on the surface of the inner lining of the uterus. This stage is very rare.

1 stage. Cancer cells grow through the thickness of the endometrium.

2 stage. The tumor grows with the capture of the cervix.

3 stage. The cancer has grown into nearby organs, such as the vagina or The lymph nodes.

4 stage. The tumor affects the bladder and/or intestines. Or cancer cells, forming metastases, affect organs located outside the small pelvis - the liver, lungs or bones.

Diagnosis of cancer of the body of the uterus

During a routine gynecological examination, the doctor can determine the change in the shape, density, size of the uterus, and suspect the disease.

Ultrasound examination (ultrasound) of the pelvic organs, carried out through vaginal access, is considered more accurate: the doctor inserts a probe into the vagina and examines the endometrium in detail. If there is a change in its thickness, the next step in the diagnosis is a biopsy - a small fragment of the uterine mucosa is studied in the laboratory. There are two ways to perform a biopsy:

· Aspiration biopsy when a piece of mucous membrane is taken with a thin flexible probe inserted through the vagina.

Hysteroscopy, in which a flexible optical system (hysteroscope) is inserted into the uterine cavity, which allows you to examine the entire surface of the uterus from the inside. Then the doctor can do a diagnostic curettage, after which a fragment of the endometrium is also sent for examination. The procedure is performed under general anesthesia.

If cancer cells were found during the biopsy, then an additional examination is carried out to understand how much the cancer has spread. For this use:

• X-rays of light
• magnetic resonance imaging (MRI), which allows you to get a detailed image of the pelvic organs
• computed tomography(CT), which is also able to detect metastases outside the uterus.

Analyzes

The study of tumor markers in the blood serum is not considered a reliable way to diagnose uterine cancer, although the level of the CA-125 marker may be elevated during the disease.

The test used to diagnose cervical cancer (Pap test or Pap smear) will not detect early endometrial cancer. However, if the cancer has spread from the uterus to the cervix, the test may be positive.

Treatment of uterine cancer

A gynecologist-oncologist, a chemotherapist, a radiologist can participate in helping the patient. For effective treatment doctors consider:

• stage of the disease
• general state health
• the possibility of pregnancy is relatively rare, since this type of cancer is typical for older women.

The treatment plan may include the use of several methods at the same time.

Surgical treatment of uterine cancer

At stage 1 of the process, a hysterectomy is performed, i.e. removal of the uterus along with the ovaries and fallopian tubes. If necessary, nearby lymph nodes are removed. The operation is performed through a wide incision in the abdomen or laparoscopically. At stages 2-3, a radical hysterectomy is performed, additionally removing the cervix and the upper part of the vagina. At stage 4, as much of the affected tissue as possible is removed. Sometimes, with a pronounced germination of cancer in other organs, it is impossible to remove the tumor completely. In this case, surgery is done to reduce symptoms.

Radiation therapy for uterine cancer

This method is used to prevent the recurrence of the disease. It is carried out in two ways: internal (brachytherapy) and external. With the internal, a special plastic tube with a radioactive substance is inserted into the uterus. For external use, irradiation with the help of radiation therapy devices. In rare cases, both options are used: both internal and external irradiation at the same time.

Chemotherapyuterine body cancer

She can complement surgery in 3-4 stages of the disease, and can be used independently. The drugs are usually administered intravenously.

Medicines and preparations

Most often used

• carboplatin
• cisplatin
• doxorubicin
• paclitaxel.

hormone therapy uterine body cancer

Some types of uterine cancer are hormone-dependent, i.e. the tumor depends on the level of hormones. This type of formation in the uterus has receptors for estrogen, progesterone, or both hormones. In this case, the introduction of hormones or hormone-blocking substances inhibits tumor growth. As a rule, use:

• gestagens (medroxyprogesterone acetate, megestrol acetate)
• tamoxifen
• gonadotropin-releasing hormone analogs (goserelin, leuprolide)
• aromatase inhibitors (letrozole, anastrozole, exemestane).

Complications

During radiation therapy, ulceration, redness, and soreness at the site of radiation may occur. There is also diarrhea and damage to the colon with bleeding from it.

With chemotherapy, hair loss, nausea, vomiting, weakness are not excluded.

Hormone treatment can cause nausea, muscle cramps, and weight gain.

In 5% of women, fatigue and malaise persist even after the end of treatment.

Recurrence of uterine cancer

With the return (relapse) of the disease, tactics will depend on the state of health and the treatment already performed. Usually, a combination of surgery, radiation and chemotherapy, as well as targeted and immune therapy in various combinations is used.

After the treatment has been carried out for the first time, the patient is observed.

Urgent medical advice is needed if:

• bleeding from the uterus or rectum occurs
• the size of the abdomen has sharply increased or swelling of the legs has appeared
• pain in any part of the abdomen
• troubled by cough or shortness of breath
• Appetite disappeared for no reason and weight loss occurs.

Rehabilitation after treatment

Uterine cancer, both at the stage of diagnosis and at the stage of treatment, disrupts the usual way of life. For more effective fight with the disease, it is worth trying to communicate with women who have the same disease, ask relatives for support, try to learn as much as possible about your condition and, if necessary, get a second opinion on treatment methods.

Nutrition should provide enough calories and protein in order to avoid being underweight. Chemotherapy can cause nausea, vomiting, weakness, in which case a nutritionist can help.

After a successful cure, follow-up visits to the doctor and examinations are necessary to make sure that the disease has not returned.

Patient Survival Prediction

In stage 1, 95% of women recover and live five years or more.

At stage 2, the five-year survival rate is 75%.

In stage 3, 40 out of 100 women live more than 5 years.

At stage 4, the 5-year survival rate is 15%. The outcome depends on how quickly the tumor spreads to other organs.

Prevention of uterine cancer

Since the exact cause has not been identified, it is impossible to carry out a complete prevention of uterine cancer. However, to reduce the risk you need to:

• maintain normal weight. Knowing your body mass index (BMI) is important. Its value between 25 and 30 indicates overweight, and above 30 - obesity. It is recommended to keep the BMI below 25.
• do not use hormone replacement therapy containing only an estrogen component. This type of HRT is only safe in women who have already had a hysterectomy, ie. the uterus was removed.
• use oral contraceptives on the advice of a doctor.
• see a doctor immediately if spotting occurs after menopause or during treatment with hormones for breast cancer.

Uterine adenocarcinoma is the most common type of endometrial cancer. This tumor arises from the inner (mucosal) lining of the uterus and is estrogen-dependent. The incidence of uterine cancer in the world is increasing, so the issues of timely diagnosis and treatment are very relevant. Uterine cancer or adenocarcinoma is malignancy.

ICD-10 code: In the International Classification of Diseases (ICD), oncological diseases are assigned codes with the letter “C”: C54. Malignant neoplasm of the uterine body

C54.1 Endometrial cancer.

It is important to note that 90% of women with endometrial cancer are over 50 years old. Approximately 1 woman in 100 is affected, usually starting at the age of 50, however, the tumor can develop later in life. Endometrial cancer is common throughout the world, but is more common in European women.

Classification

Depending on how endometrial cancer looks under a microscope (histologically), the following types are distinguished:

• adenocarcinoma;
• clear cell adenocarcinoma;
• squamous adenocarcinoma;
• glandular-squamous;
• serous adenocarcinoma;
• mucinous;

There is also undifferentiated uterine cancer.

Risk factors

Prolonged periods of elevated estrogen are a major risk factor for uterine adenocarcinoma. Normally, the action of estrogens is balanced by progesterone, but in some cases this balance is disturbed.

This can happen as a result of medication or anovulatory menstrual cycles when corpus luteum does not mature and does not secrete progesterone. It can be difficult to make a diagnosis in this case, because endometrial hyperplasia may appear as highly differentiated uterine adenocarcinoma.

Risk factors for endometrial cancer:

• In nulliparous women, the risk increases by 2-3 times. This may be by choice or as a result of infertility with anovulatory cycles.
• Menopause at the age of less than 52 years.
• Obesity raises estrogen levels:
  • diabetes mellitus and arterial hypertension also increases the risk, can develop against the background of obesity and without it
  • Polycystic ovary syndrome (PCOS) and metabolic syndrome are also associated with obesity
  • The greater the degree of obesity (estimated body mass index), the higher the risk
• A woman who has hereditary colon cancer has a 22-50% chance of developing cancer.
• Hormones administered from outside. For example, tamoxifen.
• Hormone replacement therapy (HRT) used in the treatment of menopause.
• Combined oral contraceptives (COCs) reduce the risk of developing uterine cancer.

Precancerous diseases of the endometrium

The conditions of the endometrium that are important for the oncological clinic are classified as follows:

1) background processes: glandular hyperplasia, endometrioid polyps;

2) precancerous disease: atypical glandular hyperplasia.

By themselves, these conditions are not uterine cancer, but can lead to it, so their detection requires special vigilance from both the doctor and the patient.

The onset of the disease

The classic symptom of uterine adenocarcinoma is postmenopausal bleeding, and although adenocarcinoma is not the only cause of such bleeding, it must be ruled out. Bleeding is also possible before menopause in 20-25% of cases in women with menstrual irregularities.

Three stages can be distinguished in the development of the oncological process.

Stage I begins with the development of invasive endometrial cancer until the tumor grows into the middle layer of the uterus - the myometrium. The prognosis will depend on the degree of differentiation. If the cells are highly differentiated, one can think of a slow tumor growth. And vice versa , poorly differentiated tumor grows rapidly.

• In stage II, local spread occurs. It begins with a deep germination of the tumor in the myometrium, after which the rate of its growth of tumor formation can accelerate sharply. An increase in malignancy can be judged by a decrease in the degree of tumor differentiation and regional metastasis.
• Stage III is characterized by the appearance of regional or distant metastases.

What should you do when you go to see a specialist?

1. Write down any symptoms that bother you, including any that may seem unrelated to endometrial cancer.
2. Make a list of all medicines that you are taking, especially pay attention to hormonal drugs.
3. Ask someone close to accompany you. Sometimes it can be difficult to understand all the information presented during a meeting with a doctor.
4. Write down your questions ahead of time.

Survey

If endometrial cancer is found, you will probably choose a doctor who specializes in the treatment of female genital cancer (gynecologist-oncologist).

The purpose of diagnosing uterine adenocarcinoma is to confirm the tumor process and identify metastases. A comprehensive assessment of other organs is also carried out.

Methods used to confirm the diagnosis of endometrial cancer:

1. histological examination endometrial tissue;
2. hysteroscopy, in which the hysteroscope is inserted into the uterine cavity through the vagina and allows the doctor to assess the condition of the endometrium, as well as perform a biopsy
3. curettage (curettage) of the cervix and uterine cavity for the purpose of further laboratory research(degree of cell differentiation)
4. transvaginal ultrasound (TRUS) of the uterus - carried out by a special sensor inserted into the vagina. Using this technique, some indicators are measured, such as: the thickness of the endometrium, the size and shape of the uterine cavity, the location of the tumor, the length of the cervix and uterine body;
5. Ultrasound examination of the pelvic organs and lymph nodes to visualize metastases;
6. analysis of hormonal status to select the necessary hormonal preparations;
7. x-ray diagnostics of the chest;
8. colon endoscopy (colon cancer increases the risk of uterine cancer);
9. bone examination for suspected skeletal metastases.

Transvaginal ultrasound

The procedure for performing a transvaginal ultrasound is common enough that a doctor may recommend this test to determine the risk of developing uterine adenocarcinoma. The study is based on the fact that the average thickness of the endometrium in postmenopausal women is significantly thinner than in premenopausal women. Thickening of the endometrium may indicate the presence of pathology. In general, the thicker the endometrium, the higher the chance of uterine adenocarcinoma. Usually the threshold is 5 mm.

Biopsy of the endometrium

The final diagnosis of uterine adenocarcinoma can be made after a histological examination (study of endometrial tissue under a microscope). Previously, a sample of the endometrium was obtained by scraping the uterus. Currently, there are other, more gentle methods. An endometrial biopsy can be performed either on an outpatient basis or in a hospital under anesthesia.

Histological examination. The final and most important method for diagnosing uterine adenocarcinoma is histological examination (the tissue is examined under a microscope), it allows you to assess the nature of the altered cancer cells. It should be remembered that the absence of a histological conclusion does not exclude the presence of a malignant neoplasm.

Process steps

According to the International Federation of Obstetrics and Gynecology (FIGO), the following stages of endometrial cancer are distinguished:
- Stage I: carcinoma is limited to the body of the uterus:

Stage IIA is limited to more than just the endometrium, or less than half of the myometrium is affected.

• IIB - tumor invasion to a depth equal to or more than half of the myometrium.

Stage II includes damage to the body of the uterus and partially affects the cervix, but does not spread beyond the uterus.
Stage III has local or regional spread outside the uterus (metastases):

• Stage IIIA is invasion into the serosa, uterine appendages, or peritoneum.
• Stage IIIB is manifested by vaginal or periuterine metastases.
• Stage IIIC: pelvic (IIIC1) or para-aortic (IIIC2) lymph node metastases, or a combination

Stage IV is manifested by the involvement Bladder or intestinal mucosa, or distant metastases:

• Stage IVA-involvement of the intestine or mucous membrane of the bladder occurs
• Stage IVB is distant metastasis. , including lymph nodes in the abdomen or groin.

Another classification, which is predictive in FIGO, is based on the degree of tumor differentiation as follows:

• G1 highly differentiated cancer
• G2 moderately differentiated cancer
• G3 low-grade cancer

Treatment: how to manage the disease

Schemes and methods of treatment of uterine adenocarcinoma are almost identical in all countries. The main task is not only to remove the tumor, but also to prevent recurrence and metastases. Treatment depends on the stage:

• Stage I requires a total abdominal hysterectomy with bilateral adnexal removal. The role of lymph node dissection (excision of lymph nodes where metastases can potentially be located) is discussed.
• In stage II, a radical hysterectomy with removal of the pelvic lymph nodes should be performed. Para-aortic lymphadenectomy may also be considered.
• Stages III and IV are best used as far as possible. Although there is no conclusive evidence, a combination of surgery, radiation and chemotherapy is usually used.
• Open surgery and laparoscopic techniques are equivalent in terms of survival prognosis, with laparoscopy having a less painful postoperative recovery period.
• When surgery is not possible due to medical contraindications, radiation therapy
• Progestins are not currently recommended.
• Relapse may respond to radiation therapy. Radical radiation therapy of local recurrence is effective in half of the cases.
• Doxorubicin gives a good, but often temporary effect.
• Carboplatin preparations are also used.
• Tamoxifen may be used as a preoperative treatment.

Forecast

The International Federation of Obstetrics and Gynecology (FIGO) gives the following figures: the survival rate of patients with endometrial cancer within 5 years after the diagnosis of stage I is 70-97%, II - 48-86%, III - 11-49%. Uterine adenocarcinoma is less aggressive than ovarian, cervical, or breast cancer.)

Looking at these statistics, it is easy to conclude that despite the wide spread of malignant neoplasms of the female genital area, timely detection and treatment of uterine adenocarcinoma can save life with a high probability.

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C54 Malignant neoplasm of uterine body

Epidemiology

Endometrial cancer is a widespread malignant neoplasm. It ranks second in the structure of oncological diseases in women. It is the fourth most common type of cancer, after breast, lung and colon cancer. Cancer of the body of the uterus is predominantly found in postmenopausal patients with bleeding during this period of life, it is detected in 10% of cases. Diagnostic errors in women at this age are due to an incorrect assessment of spotting, which is often explained by menopausal dysfunction.

Risk factors

The risk group includes women who are more likely to develop malignant tumor in the presence of certain diseases and conditions (risk factors). The risk group for developing uterine cancer may include:

1. Women in the period of established menopause with spotting from the genital tract.
2. Women with a sequel menstrual function after 50 years, especially with uterine fibroids.
3. Women of any age suffering from hyperplastic processes of the endometrium (recurrent polyposis, adenomatosis, glandular cystic hyperplasia of the endometrium).
4. Women with impaired fat and carbohydrate metabolism (obese, diabetes) and hypertension.
5. Women with various hormonal disorders that cause anovulation and hyperestrogenism (Stein-Leventhal syndrome, postpartum neuroendocrine diseases, fibroids, adenomyosis, endocrine infertility).

Other factors contributing to the development of endometrial cancer:

• Estrogen replacement therapy.
• Polycystic ovary syndrome.
• No history of childbirth.
• Early onset of menarche, late menopause.
• Alcohol abuse.

Symptoms of uterine cancer

1. Beli. Are the most early sign manifestations of uterine cancer. Beli liquid, watery. Blood often joins these secretions, especially after physical activity
2. Itching of the vulva. May appear in patients with endometrial cancer due to irritation with vaginal discharge.
3. Bleeding - a late symptom that occurs due to the collapse of the tumor, can be manifested by secretions in the form of meat "slops", smearing or pure blood.
4. Pain is of a cramping nature, radiating to lower limbs, occur when there is a delay in discharge from the uterus. Dull, aching pains, especially at night, indicate the spread of the process outside the uterus and are explained by compression of the tumor infiltrate of the nerve plexuses in the small pelvis.
5. Violation of the functions of adjacent organs, due to the germination of the tumor in the bladder or rectum.
6. Obesity (rarely weight loss), diabetes, and hypertension are characteristic of these patients.

stages

Currently in clinical practice several classifications of uterine cancer are used: the 1985 classification, and the international classification of FIGO and TNM.

FIGO staging of uterine cancer

Damage volume

• 0 - Pre-invasive carcinoma (atypical glandular hyperplasia of the endometrium)
• 1 - The tumor is limited to the body of the uterus, regional metastases are not detected
  • 1a - The tumor is limited to the endometrium
  • 1b - Invasion of the myometrium up to 1 cm
• 2 - The tumor affects the body and cervix, regional metastases are not detected
• 3 - The tumor has spread outside the uterus, but not outside the pelvis
  • 3a - Tumor infiltrates the serosa of the uterus and/or has metastases in the uterine appendages and/or in the regional lymph nodes of the pelvis
  • 3b - Tumor infiltrates the pelvic tissue and/or has metastases to the vagina
• 4 - Tumor extends beyond the pelvis and/or there is invasion of the bladder and/or rectum
  • 4a - Tumor invades bladder and/or rectum
  • 4b - Tumor of any degree of local and regional spread with detectable distant metastases

International classification of uterine cancer according to the TNM system

• T0 - Primary tumor is not determined
• Tis - Preinvasive carcinoma
• T1 - The tumor is limited to the body of the uterus
  • T1a Uterine cavity no more than 8 cm long
  • T1b Uterine cavity more than 8 cm long
• T2 - Tumor extends to the cervix but not outside the uterus
• T3 - Tumor extends beyond the uterus but remains within the pelvis
• T4 Tumor invades bladder, rectum, and/or outside the pelvis

N - regional lymph nodes

• Nx - Insufficient data to assess the status of regional lymph nodes
• N0 - No evidence of regional lymph node metastases
• N1 - Metastases in regional lymph nodes

M - distant metastases

• Mx - Insufficient data to determine distant metastases
• M0 - No signs of metastases
• M1 - There are distant metastases

G - histological differentiation

• G1 - High degree of differentiation
• G2- Average degree differentiation
• G3-4 - Low degree of differentiation

Forms

Distinguish between limited and diffuse form uterine cancer. With a limited form, the tumor grows in the form of a polyp, clearly delimited from the unaffected uterine mucosa; with diffuse - cancerous infiltration extends to the entire endometrium. The tumor most often occurs in the fundus and tubal corners of the uterus. Approximately 80% of patients have adenocarcinoma varying degrees differentiation, in 8-12% - adenoacanthoma (adenocarcinoma with benign squamous cell differentiation), which has a favorable prognosis.

More rare tumors with a worse prognosis include glandular squamous cell carcinoma, in which the squamous component resembles squamous cell carcinoma, the prognosis is worse due to the presence of an undifferentiated glandular component.

Squamous cell carcinoma, like clear cell carcinoma, has much in common with similar tumors of the cervix, occurs in older women and is characterized by an aggressive course.

Undifferentiated cancer is more common in women over 60 years of age and occurs against the background of endometrial atrophy. It also has a poor prognosis.

One of the rare morphological variants of endometrial cancer is sero-papillary cancer. Morphologically, it has much in common with serous ovarian cancer, it is characterized by an extremely aggressive course and a high potential for metastasis.

Diagnosis of cancer of the body of the uterus

Gynecological examination. When viewed with the help of mirrors, the condition of the cervix and the nature of the discharge from the cervical canal are clarified - the discharge is taken for cytological studies. During vaginal (recto-vaginal) examination, attention is drawn to the size of the uterus, the condition of the appendages and parauterine tissue.

Aspiration biopsy(cytology of aspirate from the uterine cavity) and the study of aspiration wash water from the uterine cavity and cervical canal. The latter is performed at the age of postmenopause, if there is no possibility of aspiration biopsy and diagnostic curettage.

Cytological examination of vaginal smears taken from the posterior fornix. This method gives a positive result in 42% of cases.

Despite a small percentage positive results the method can be widely applied in polyclinic conditions, excludes trauma, does not stimulate the tumor process.

Separate diagnostic curettage of the uterine cavity and cervical canal, under the control of hysteroscopy. Scraping is advisable to obtain from areas where pre-tumor processes occur more often: the area of ​​\u200b\u200bthe external and internal pharynx, as well as tubal corners.

Hysteroscopy. The method contributes to the detection of the cancer process in places difficult to access for curettage, allows you to identify the localization and prevalence of the tumor process, which is important for choosing a method of treatment and for subsequent monitoring of the effectiveness of radiation therapy.

tumor markers. To determine the proliferative activity of endometrial carcinoma cells, it is possible to determine monoclonal antibodies Ki-S2, Ki-S4, KJ-S5.

Ultrasound procedure. The accuracy of ultrasound diagnostics is about 70%. In some cases, the cancer node in terms of acoustic characteristics practically does not differ from the muscle of the uterus.

Computed tomography (CT). It is carried out to exclude metastases in the uterine appendages and primary multiple ovarian tumors.

Magnetic resonance imaging (MPT). MPT in endometrial cancer allows you to determine the exact localization of the process, differentiate stages I and II from III and IV, as well as determine the depth of invasion into the myometrium and distinguish stage I of the disease from the rest. MRI is a more informative method in determining the prevalence of the process outside the uterus.

Treatment of uterine cancer

When choosing a method of therapy for patients with uterine cancer, three main factors must be considered:

• age, general condition of the patient, the severity of metabolic and endocrine disorders;
• the histological structure of the tumor, the degree of its differentiation, size, localization in the uterine cavity, the prevalence of the tumor process;
• the institution where the treatment will be carried out (not only the oncological training and surgical skills of the doctor are important, but also the equipment of the institution).

Only taking into account these factors, it is possible to carry out the correct staging of the process and adequate treatment.

About 90% of patients with uterine cancer undergo surgical treatment. Perform usually extirpation of the uterus with appendages. By autopsy abdominal cavity a revision of the pelvic organs and the abdominal cavity, retroperitoneal lymph nodes is performed. In addition, swabs are taken from the Douglas space for cytological examination.

Surgical treatment of uterine cancer

Volume surgical treatment determined by the stage of the process.

Stage 1a: if only the endometrium is affected, regardless of the histological structure of the tumor and the degree of its differentiation, a simple extirpation of the uterus with appendages is performed without additional therapy. With the advent of methods endoscopic surgery at this stage of the disease, it became possible to carry out ablation (diathermocoagulation) of the endometrium.

Stage 1b: with superficial invasion, localization of the tumor of small size, high degree of differentiation in the upper-posterior part of the uterus, a simple extirpation of the uterus with appendages is performed.

With invasion up to 1/2 of the myometrium, G2- and G3-degrees of differentiation, large tumor sizes and localization in the lower parts of the uterus, extirpation of the uterus with appendages and lymphadenectomy is indicated. In the absence of metastases in the lymph nodes of the small pelvis, endovaginal intracavitary irradiation is performed after surgery. If lymphadenectomy is not feasible after surgery, external irradiation of the small pelvis should be performed up to a total focal dose of 45-50 Gy.

At stage 1b-2a G2-G3; 2b G1 produce extirpation of the uterus with appendages, lymphadenectomy. In the absence of metastases in the lymph nodes and malignant cells in the peritoneal fluid, with a shallow invasion, endovaginal intracavitary irradiation should be performed after surgery. With deep invasion and a low degree of tumor differentiation, radiation therapy is performed.

Stage 3: the optimal volume of the operation should be considered the extirpation of the uterus with appendages with the implementation of lymphadenectomy. If metastases in the ovaries are detected, it is necessary to resect the greater omentum. In the future, external irradiation of the small pelvis is performed. If metastases are found in the para-aortic lymph nodes, it is advisable to remove them. In the case when it is not possible to remove metastatically altered lymph nodes, it is necessary to conduct external irradiation of this area. In stage IV, treatment is carried out according to an individual plan, using, if possible, surgical method treatment, radiation and chemohormonotherapy.

Chemotherapy

This type of treatment is carried out mainly with a common process, with autonomous tumors (hormonally independent), as well as with the detection of a relapse of the disease and metastases.

Currently, chemotherapy for uterine cancer remains palliative, since even with sufficient effectiveness of some drugs, the duration of action is usually short - up to 8-9 months.

Use combinations of drugs such as platinum derivatives of the first generation (cisplatin) or second generation (carboplatin), adriamycin, cyclophosphamide, methotrexate, fluorouracil, phosphamide, etc.

Among the most effective drugs that give a complete and partial effect in more than 20% of cases, should be called doxorubicin (adriamycin, rastocin, etc.), farmarubicin, platinum preparations I and II generation (platidiam, cisplatin, platymit, platinol, carboplatin).

The greatest effect - up to 60% - gives a combination of adriamycin (50 mg / m 2) with cisplatin (50-60 mg / m 2).

hormone therapy

If by the time of the operation the tumor has gone beyond the uterus, then local regional surgical or radiation exposure does not solve the main problem of treatment. It is necessary to use chemotherapy and hormone therapy.

For hormonal treatment The most commonly used progestogens are 17-OPK. depo-provera, provera, farlugal, depostat, megeys in combination with or without tamoxifen.

In a metastatic process, in case of ineffectiveness of progestin therapy, it is advisable to prescribe Zoladec

Carrying out any organ-preserving treatment is possible only in a specialized institution, where there are conditions for in-depth diagnostics both before and during treatment. It is necessary to have not only diagnostic equipment, but also highly qualified personnel, including morphologists. All this is required for the timely detection of the ineffectiveness of the treatment and the operation in the future. In addition, constant dynamic monitoring is necessary. Possibilities of organ-sparing hormonal treatment of minimal endometrial cancer in young women using progestogens: 17-OPK or depo-prover in combination with tamoxifen. With a moderate degree of differentiation, a combination of hormone therapy with chemotherapy (cyclophosphamide, adriamycin, fluorouracil or cyclophosphamide, methotrexate, fluorouracil) is used.

Cervical cancer is a malignant tumor that affects the cervical mucosa at stage 1 and spreads to the vagina and vulva at stages 2-4. According to medical data, women aged 45-50 are at risk.

Risk group

Causes of uterine cancer are:

• Early sexual life.
• Frequent change of partners.
• Unprotected intercourse.
• Abortions, natural terminations of pregnancy.
• Papillomavirus infection types 16 and 18.
• Other diseases: herpes, chlamydia.
• Smoking.

Clinical picture

It is almost impossible to diagnose cervical cancer even at the initial stage: the disease is not accompanied by special symptoms.

• Bleeding, contact and non-contact, arising involuntarily or from minor mechanical damage.
• Pain localized in the lower abdomen, intestines, lower back, as well as in the left side and thigh, lower extremities.
• Vaginal discharge - leucorrhoea. Watery character with blood impurities. At later stages with tissue impurities (the result of tumor decomposition).

Additional symptoms are urination disorders, headaches, weakness, loss of appetite, weight loss, pallor and peeling of the skin.

Classification of cervical cancer

Used in medicine international classification pathologies:

• "T" - the initial stage (primary tumor).
• "T0" carcinoma of a preinvasive nature.
• "T1" tumor, limited to the body of the uterus, without spreading to other organs, lymph nodes.
• "T1a1" tumor, not exceeding a diameter of 7 mm and a depth of 3 mm.
• "T1a2" tumor, not exceeding a diameter of 7 mm and a depth of 5 mm.
• "T1b" tumor visible to the naked eye, limited to the area of ​​the cervix.
• "T1b1" tumor, up to 4 cm in diameter.
• "T1b2" tumor, with a diameter of more than 4 cm.
• "T2" tumor, the area of ​​\u200b\u200bwhich is located outside the body of the uterus, but lower third the vagina or pelvic wall is not affected.
• "T2a" parametria is not invasive.
• "T3" pathology is extended to the lower part of the vagina, the pelvic wall, there is hydronephrosis or a non-functioning kidney.
• "T3a" area of ​​tumor spread - the lower part (one third) of the vagina.
• "T3b" the tumor has affected the pelvic wall, hydronephrosis is observed, or the functionality of the kidney is impaired.
• "T4" in the affected area gets the membrane of the bladder and intestines, goes beyond the pelvis.

Information about lymph nodes:

• "N0" - there are no signs of metastases.
• "N1" - metastasis of regional lymph nodes.

Classification of uterine cancer MBC 10:

1.1.1. C00 - D48: neoplasms;
1.1.2. C00 - C97: neoplasms of a malignant nature;
1.1.3. C51 - C58: malignant neoplasms affecting the female genital organs;
1.1.4. C53 cancer of the uterus;
1.1.5. C 53.0 Tumor affecting the interior;
1.1.6. C 53.1 tumor affecting the outer part;
1.1.7. With 53.8, a tumor localized in the outer and inner parts or goes beyond.
1.1.8. C 53.9 localization of cancer is not defined.

Classification of cervical cancer MBC 10:

1.1.1. C00-D48 - signs of neoplasm;
1.1.2. D 00-D09 - "in situ";
1.1.3. D 06 - carcinoma;
1.1.4. D 06.0 - a tumor that affected the inside of the cervix;
1.1.5. D 06.1 - a tumor that affected the outer part of the cervix;
1.1.6. D 06.7 - localization of the tumor in other parts of the cervix;
1.1.7. D 06.9 - localization of cancer is not defined.