There are several synonyms for the name of this disease. Until recently, it was assumed that cancer of the uterine body is 10-20 times less common than cervical cancer. However, in recent years, there has been a significant increase in patients with uterine body cancer in many countries, with a slight decrease in the number of patients with cervical cancer. It is possible that the increase in the incidence of cancer of the uterine body is in some connection with the increase in life expectancy of people in a number of countries. The age of a woman also plays a significant role. As clinical observations show, the occurrence of cancer of the uterine body is preceded by a number of features of the general state of the body and the state of the sexual sphere. A certain predisposition to the occurrence of cancer of the uterine body is manifested by the fact that in 12-28% of patients, someone in the family had a cancerous tumor. The disease of cancer of the uterine body is almost synchronously observed in twins. The disease is more common in well-off women, especially in patients with diabetes, hypertension, obesity. Cancer of the uterine body plays an increasingly important role in the structure of cancer incidence in the female population of the developed countries of the world. The ratio of the number of patients with cancer of the body and cervix is constantly changing in the direction of increasing the first localization.
Studies show that almost one in four women suffering from uterine body cancer has not had pregnancies. In the anamnesis of patients with cancer of the uterine body, there are often indications of a late onset of menopause, reduced generative function. The study of liver function in patients with cancer of the uterine body with the help of scanning revealed its violations. There is an obvious connection between the frequency of hormone-active ovarian tumors and cancer of the uterine body: 6-11% of patients with this pathology have cancer of the uterine body. Epidemiological studies of uterine body cancer should continue to clarify the causes of the tumor and build programs for their prevention and early detection.
A frequent clinical manifestation of cancer of the uterine body is pathological discharge from the genital tract in the form of milky, pus-like or bloody whites. In the case of infection, the whites acquire a yellowish-greenish color, cause irritation of the skin of the external genitals. Spotting is characterized by a duration, it stops for a short time. In a number of patients, the appearance of bloody discharge is associated with physical stress in the form of lifting weights, defecation; they can also be detected after sexual intercourse. An important symptom of cancer of the uterine body in women of reproductive age is a violation of menstrual function in the form of metrorrhagia. These pathological secretions do not always attract the attention of patients.
Sometimes it is only with careful questioning that it is possible to establish their presence and the time of their appearance. The occurrence of bloody discharge from the genital tract in postmenopausal women is more likely to give reason to suspect cancer of the uterine body.
A less frequent sign of cancer of the uterine body is pain. When the nerve trunks are compressed by a cancerous infiltrate, they constantly disturb patients, becoming especially intense at night. Pains of this nature indicate a far-reaching process. They can also occur in the late stage of the disease and in connection with a significant stretching of the walls of the uterus by the contents of its cavity, consisting of decaying tumor masses and secretions of the uterine mucosa. In the early period of the disease, the pain is of the nature of cramping. They radiate to the lower extremities, localized mainly in the lower abdomen. The origin of cramping pains, resembling contractions during labor, is associated with a convulsive contraction of the myometrium. Under the influence of contraction of the muscles of the uterus, the opening of the cervical canal and emptying of the uterine cavity with the release of bloody or pus-like fluid, sometimes in a significant amount, may occur. After emptying the uterine cavity, the pain stops for a while. One of the symptoms of cancer of the uterine body is itching of the external genitals. It can be caused by two reasons: irritation with secretions from the uterus and diabetes mellitus. If a cancerous tumor passes to neighboring organs, then their functions are disrupted.
The recognition of cancer of the uterine body and the determination of its stages are based on taking into account the totality of the data of anamnesis, two-handed, X-ray, cytological and histological studies. The possibility of developing cancer of the uterine body is indicated by pathological discharge from the genital tract in postmenopausal women and violation of menstrual function in patients of reproductive age. Special attention should be paid to the time of their appearance, which indirectly indicates the duration of the disease. A two-handed examination of the uterus allows you to determine its position and size. Cytological examination of the contents of the uterine cavity when finding tumor elements allows you to diagnose a cancerous lesion of the uterine body. The leading role in the recognition of cancer of the uterine body is played by histological examination of scraping from the uterine cavity. It must be performed when cytological secretions, especially of a bloody nature, appear in postmenopausal women. Important information is provided by hysteroscopy, which allows you to select the most suspicious part of the uterine body for a biopsy. Scrapings from the cervical canal and the uterine body should be marked separately and sent for histological examination in different vials or test tubes, so that the pathologist knows exactly where the material was taken from. Valuable information for recognizing the pathology of the uterine cavity can be obtained by hysteroscopy. The study is carried out using devices of various designs. One of the hysteroscopes used in our country is based on an examination cystoscope. Its use involves the introduction of a transparent rubber can filled with distilled water into the uterine cavity under pressure. The patterns observed during hysteroscopy may be different. In the first phase of the cycle, the endometrium appears smooth, thin, devoid of visible blood vessels. In the second phase, the mucous membrane of the uterine body is thickened, swollen, and acquires a reddish color. In hyperplasia, the endometrium is thickened, forming folds of various thicknesses and heights. For the early diagnosis of cancer of the uterine body, it is important to widely use cytological examination of aspirate from the uterine cavity in outpatient settings. It is performed in patients who consult a doctor about acyclic blood secretions from the genital tract, as well as in women from groups at increased risk of uterine body cancer with obesity, diabetes mellitus, hypertension, who have a history of indications of a violation of reproductive function, anovulatory uterine bleeding, late menopause. The cytological method is effectively used for the recognition of malignant neoplasms. However, its use in the diagnosis of endometrial pathology is incomparably more limited compared to the examination of the cervix. The use of this method is indicated for the systematic examination of patients with an increased risk of uterine body cancer. In recent years, thanks to the success in studying the pathogenesis of uterine body cancer, there has been a real possibility of preventing it by carrying out therapeutic measures in patients with diencephalic disorders and altered ovaries. Patients suffering from diencephalic pathology should be subjected to hormone therapy, following an appropriate diet, using physical and general restorative methods of treatment. The group of increased risk for cancer of the uterine body consists of women with a triad of symptoms that occur with this tumor: hypertension, obesity and diabetes mellitus.
In addition, this group includes women with blood discharge from the uterus.
Women who are at high risk for cancer of the uterine body should undergo regular gynecological examinations in a women’s consultation or in the office of endometrial pathology. At the same time, it is necessary to conduct control studies of the endometrium by cytological examination of aspirates from the uterine cavity. If necessary, after 3-6 months, repeated separate curettage of the uterus is performed to judge the state of the endometrium.