Endometrial cancer is a malignant tumor that is formed on the epithelial cells of the inner layer of the uterus. This oncological disease is more prevalent in developed countries than in developing ones. 60% of women suffer with endometrial cancer during postmenopausal period, 40% are in the reproductive or premenopausal age. The overall rate of endometrial cancer is constantly growing and now found in 15-20 cases per 100 thousands of population a year.
The reasons for endometrial cancer are unknown. The following risk factors of this disease are as follows:
There are two pathogenetic forms of endometrial cancer:
Estrogen form is a hormone-dependent pathogenic variant of endometrial cancer observed among 70% of patients. It has a favourable prognosis. It usually has a background of metabolic disorders (obesity, diabetes, etc.).
Estrogen independent form. The disease occurs without endocrine disorders (30% of patients). The endometrium is noted to have lower concentrations of oestrogen receptors. Often, the tumor develops in the inner layer on the base of the uterus atrophy.
Disease develops in several stages:
Functional disorders of the reproductive system organs (elevated oestrogen levels, anovulation).
Hyperplastic processes in the endometrium.
Precancerous lesions (epithelial dysplasia stage 3).
Malignant neoplasia. Initially the pre-invasive cancer occurs and then it begins to grow into the myometrium (muscle layer of the uterus).
In the initial stage of formation of a tumor endometrial cancer has no symptoms, so in this period it is possible to detect the cancer only by chance during examination for other diseases.
The earliest clinical signs are:
None of the symptoms is pathognomonic. All of the above are evident of gynecological diseases or tumors of other localization.
Main methods of endometrial cancer diagnostics are cytological and histological analysis.
Aspiration biopsy involves getting the biological material for cytology. The procedure is done with the help of Brown syringe without cervical dilatation. If a single cytology was held, the abnormal cells can be detected with a probability of 35%. If the diagnostic procedure is performed several times, the sensitivity of the technique increases up to 50-55%.
Cervicogisteroscopy is an endoscopic method of diagnostics that detects the tumor, assesses the prevalence of the pathological process and the targeted biopsy. Feasibility of fractional curettage implementation is also evaluated with the help of this procedure.
Fractional curettage allows the possibility to take the biological material from the different areas of the uterus and do a histological analysis after that. The procedure detects a tumor at the initial stage with a 80-100% probability depending on the location of the endometrial cancer.
The goals of treatment for endometrial cancer are to remove the tumor and prevent metastasis.
Traditionally, there are three ways of treatment:
Surgical treatment can have different volume.
This question is discussed individually judging on the exact clinical situation and a number of factors:
If the prognosis is positive, the procedure of hysterectomy is performed and extended hysterectomy with appendages, lymph nodes, omentum is done if the prognosis is negative.
Radiation therapy is an addition to the surgery. Pelvic area, vaginal tube (this is most often a tumor metastasizes), and other areas of regional metastasis are irradiated.
Chemotherapy and hormonal therapy presupposes the medications prescription. They are used before the surgery as well as after. There are many regimens of drug therapy, which are chosen individually for every patient by the doctor.
In addition to conventional methods of treatment of endometrial cancer that have already been used for many years, there are also latest therapeutic methods. In developed countries, the latest achievements in the field of pharmacology and surgery are applied.
Targeted therapy is different from the common chemotherapy as it acts selectively at the tumor, and not on all the cells that divide quickly. In the treatment of endometrial cancer drugs such as Temsirolimus, Gefitinib, Bevacizumab are used.
Sentinel lymph node biopsy is used for endometrial cancer with metastases treatment. Sentinel called lymph nodes that are closest to the malignant tumor, since they block its further metastatic spread. By introducing a tracer or dye into the body pelvic lymph nodes, which has metastasized can be detected and then removed.
It is possible to achieve great progress in the endometrial cancer treatment, especially in the initial stage of the disease development.
Five-year-survival depends on the stage:
The prognosis depends not only on the stage when it was detected, but also on the quality of the provided treatment. Provision of medical care in the best clinics of Europe enables the patient a much better chance of increasing life expectancy.
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