How to identify uterine cancer

The body of the uterus is the most frequent subject of the formation of malignant tumors in the female reproductive system in addition to cervical department. uterine cancer includes carcinoma of the endometrium - the inner layer of the mother body.

There are two main reasons for the development of cervical cancer:

• the formation of carcinoma on the background of endometrial hyperplasia at constant hyperestrogenia. Increasing estrogen production is observed in the reproductive age, so this type of cervical cancer more often determined in young women;
• endometrial cancer on the basis of its atrophy, which is prevalent diagnosis in patients menopause.

Cancer of the uterus, which developed against the background of endometrial hyperplasia was determined as highly differentiated, respond well to treatment and has a favorable prognosis. Malignant neoplasm of endometrium atrophic processes when it is characterized by poorly differentiated cells in the diagnosis and poor prognosis. Approximately 80% of patients with the diagnosis of the type of uterine cancer is determined adenocarcinoma - a kind of neoplasm of endometrial glands.

Diagnosis of uterine cancer It involves determining the histological characteristics of the formation and process steps to select the treatment tactics and forecasting.

Diagnosis is performed using the following methods:

• needle aspiration biopsy of the endometrium;
• separate diagnostic curettage;
• Pelvic ultrasound, abdominal and areas of the peritoneum;
• determination of blood levels of tumor marker CA-125;
• blood biochemistry, clinical blood and urine tests, coagulation;
• hysteroscopy;
• colposcopy;
• cystoscopy;
• laparoscopy;
• bowel investigation (colonoscopy and sigmoidoscopy);
• stsintiografiya bones;
• X-rays of the chest;
• MRI and CT scans.

In order to determine the time of diagnosis of uterine cancer at oncology alertness requires biopsy, ultrasound, curettage and blood tests for tumor markers. As a rule, these analyzes is sufficient to verify the diagnosis. For the purpose of diagnosing the stage and metastasis research conducted radiological, videoskopicheskie study, CT and MRI.

MRI in the diagnosis of cancer of the uterus is more informative way, compared with CT. The penetration depth of the tumor and its transition to the cervix more clearly visualized on MRI. With respect to determining the presence of metastases in the peritoneal cavity and retroperitoneal lymph node MRI and CT as diagnostic techniques, have the same information content.

After performing diagnostic procedures, doctors determine the prognosis. The leading factor that determines the prognosis is the stage of malignancy. In the early stages of the progression observed in 25% of patients, and the rest have a significant chance of a full recovery.

Adverse prognostic features at diagnosis include:

• patient age older than 60 years;
• poorly differentiated cancer of the uterus, the presence of aneuploidy cells (change in the number of chromosomes), which is determined after histological examination of biopsy;
• invasion into the myometrium tumors of more than 50% of its thickness;
• presence spread to the cervix or the isthmus;
• in the case of determining tumor emboli in veins and lymphatics of the uterus;
• diagnosing metastases in regional lymph nodes and ovaries;
• spread of cancer cells on the peritoneum;
• a minor amount of estrogen receptors and progesterone receptors in the tumor tissues as determined by immunohistochemical study with biopsy;
• presence of cancerous cells in the washings of the abdominal cavity;
• active expression of oncogenes, such as CA-125.

Histological examination of a biopsy sample of the inner layer define the type of formation, which is essential for the assessment of prognosis in diagnostics. So, clear cell adenocarcinoma and papillary serous carcinoma are the most aggressive histotype uterine cancer. The frequency of metastasis in the early stages of high, five-year survival rate is characterized by a low level.

An important aspect of the diagnosis is to identify the opportunities for women at risk of pregnancy and childbirth. After performing ultrasound, MRI with contrast, immunohistochemistry determine the required characteristics of the tumor, topical, from the viewpoint of reproductive functions. Favorable to the future fertility signs in the diagnosis are:

• no evidence of cancer ingrowth into the myometrium;
• a large number of receptors for estrogen and progesterone in the tissues of the endometrium, as determined in immunohistochemistry.

In general, a patient with 1A and B-differentiated uterine cancer stage have a significant chance of success in the aspect of reproductive function.

clinical diagnosis

Detection of cancer of the uterus is not in fact a daunting task. Problem diagnosis of cancer in the early stages is the lack of vigilance of doctors.

The main symptoms suggestive of cancer of the uterus, intermenstrual bleeding are both character and excessively heavy menstruation. Women in menopause complain of bleeding from the genital tract.

With such features almost every woman goes to a doctor soon. Adequate diagnosis to determine the cervical cancer at an early stage.

The main reason for the formation of the corpus uteri carcinoma is to increase the production of the female sex hormone estrogen, which leads to endometrial hyperplasia. This pathology is a favorable background for the development of cancer. Patients notice spotting or brown discharge, daub, arising in the middle of the menstrual cycle before menstruation. Furthermore, described abundant and long menstrualnopodobnye bleeding, irregular cycle. This is caused by excessive endometrial thickness. In contrast, patients in menopause, with the depletion of ovarian and endometrial atrophy, also at higher risk of developing uterine cancer. In the presence of obesity, hepatic pathologies, chronic intoxications, estrogens from other sources or their chemical analogs bind to receptors in the uterus and provoke neoplasm growth.

If there are complaints of spotting, the doctor prescribes screening, which includes ultrasound diagnosis, the biopsy-paypel.

ultrasound

Using ultrasonic studies with uterine cancer diagnosis can determine the thickness of the inner layer that allows to conclude that there hyperplasia. Diagnosis of hyperplasia is a cause for further investigation. The criteria for the next stage in the cancer survey are:

• Endometrial thickness in one cycle phase in women of reproductive age is determined by more than 6 mm;
• menopausal patients thickness of the inner layer of the uterus exceeds 4 mm.

The thickness of the endometrium in women at a young age can be defined as increased, and it does not always mean a pathology. For long cycles, performing ultrasound diagnosis at the end of phase 1 layer can be increased in size, but not hyperplastic. Patients mature endometrium priori should not be increased in size.

Informativeness of ultrasound in the diagnosis of uterine cancer in young women is low, so the critical method assumes patients in menopause.

As a rule, women who say hyperplasia, determine the level of sex hormones, tumor marker CA-125 and administered in the form of further diagnosis paypel biopsy and hysteroscopy with curettage. In the group of patients menopause stage performance ultrasound diagnostic informativeness are close to 100%.

In the diagnosis of the stage of cancer of the uterus on ultrasound determine the following characteristics:

• at the first stage is marked thickness of the inner layer is 7 to 13 mm, the boundary of its crisp, smooth contours is determined, there is a homogeneous hyperechoic structure median M-echo or heterogeneity due to the presence of inclusions rounded, hyperechoic, with blurred, but smooth contours, size 8-14 mm;
• 2 in the diagnosis step marked cells invasion into the myometrium, endometrium infestation at the five millimeter thickness is determined in within 14 - 23 mm, indistinct boundary between the layers, swelling the structure may be homogeneous or inhomogeneous and hyperechoic hypoechoic;
• The third stage is defined as having a center in the uterine cavity with undetectable boundaries blurred contours, characterized absence lamination, the thickness of the inner layer is 18-34 mm, and its structure is often due to non-uniform hyperechoic inclusions;
• tumor actively supplied with blood, which determines the Doppler scan with ultrasound diagnostics.

Alarming data ultrasound and Doppler diagnostics are cause for cytology biopsy of separate curettage and hysteroscopy.

Biopsy and immunohistochemistry

Diagnosis of uterine cancer is not possible without a hysteroscopy and curettage, of sighting paypel biopsy. Only on microscopic examination of the material experts define cancer. But it carried out not only tissue structure evaluation and microscopic cells. They perform a number of tests that can determine the diagnosis of aggressive tumors and to help in the selection of treatment.

In the diagnosis of endometrial cancer is of primary importance to determine the sensitivity of the tumor to hormones. It is known that the hyperplasia develops against the backdrop of increasing the synthesis of estrogen, which means that in the uterine tissues there are receptors for the hormone - structures in the cells, by which estrogen can exert its proliferating act. In the treatment of uterine body cancer specialists use agents which block these receptors that stops the growth of the tumor. If these receptors are, then the chances of recovery increase significantly. Diagnosis of this type of cancer is characteristic for young women and has a favorable prognosis.

If tissue formation not determine receptors for sex hormones, treatment will be more aggressive, and the chances of recovery are reduced. This type is diagnosed in older women.

To determine the presence of receptors, using a method such as immunohistochemistry. perform endometrial biopsy and examined tissue piece obtained by means of special reagents.

In addition to identifying receptors in uterine tissues determine the proliferative activity of tumor - its tendency to increase intensively. Diagnosis ability of cancer cells actively proliferate by using the search Ki-67 antigen. It reflects the ability of tumors to aggressive growth, invasion into the myometrium, metastasis, and largely determines the treatment tactics.

Tumor marker CA-125

Diagnosis of cancer, as well as post-treatment followed by determination of tumor markers in the blood level. uterus carcinoma involves the analysis of content in the CA-125 blood. This protein substance synthesized by epithelial cells. Since the prostate consists of epithelial endometrial cells specialists determine marker levels to assess the effectiveness of the treatment.

Normally, the blood levels of tumor marker CA-125 in women does not exceed 35 U / ml. Slight excess (no more than 100 U / ml) indicate a benign or inflammatory processes.

About cervical cancer can be thought of as determined by a significant excess in the blood marker level. Note that in the diagnosis of this figure has low information content. Its amount in the blood of the patient serves as a starting point for assessing the dynamics of treatment.

CA-125 may be raised not only when malignancy in women. Its excess is determined in the following cases:

• pregnancy;
• ovarian cyst;
• endometriosis;
• inflammatory diseases of the reproductive tract;
• peritonitis;
• pleurisy;
• diseases of liver and pancreas.

In addition to cervical cancer, elevated levels of the marker in the diagnosis of:

• ovarian cancer;
• breast cancer;
• Malignant epithelial tumors of the liver, pancreas, intestine, stomach and lungs.

In the diagnosis step 1 CA-125 level was determined as increased only in 50% of patients. In general, at any stage of the cancer marker number increased only 80% of patients. After the operation determines the number of markers in the blood in patients to assess the efficacy of the treatment, the risk of metastasis and the likelihood of relapse. CA-125 was evaluated in dynamics. By reducing the exponent for the first 3 months after surgery or another type of treatment, increased chances of survival significantly. When approaching the indicator to zero indicate complete remission. With the growth of the marker levels, even within the normal course of time talking about the pre-clinical manifestation of relapse. If the diagnosis of recurrence of uterine cancer with remission determine the increase in CA-125, a more detailed investigation. Perform CT, MRI, X-ray, stsintiograficheskie, videoskopicheskie studies to search for metastasis.

After treatment of uterine cancer patient undergoes further monitoring a performance of a number of diagnostic methods. Determine the number of indicators to assess the cancer spreads further or not. Observation includes:

• every 3 months for 3 years, a woman examining a gynecologist, then every six months for 2 years;
• carried cytology smears of the cervix or vagina stump with the frequency of the above scheme;
• chest X-ray once a year for the diagnosis of distant metastasis of uterine cancer;
• determining the level of CA-125 prior to each visit to a gynecologist.

Diagnosis of recurrence and metastasis search, as well as the questionable results of US, cytology, histology considered the reason for more advanced study, necessarily including multislice CT and MRI with contrast.