Endometrial cancer is a disease characterized by the presence of tumor cells in the endometrial tissue, which is then distinguished from the tumor form that affects the muscular portion of the hollow organ that receives the fetus during pregnancy. The risk of developing endometrial cancer seems to be increased in women who are treated with ovarian hormones that act on the development of female character and menstruation.
Diagnosis
If these symptoms are present, the gynecologist proceeds to visit the. Given the fact that endometrial cancer develops inside the uterus and for this reason is usually undetectable in a Pap test, the gynecologist needs to take a sample of endometrial tissue and analyze it under a microscope to determine the presence of cancer cells. The gynecologist can choose between different procedures: an endometrial biopsy consists of inserting a flexible instrument inside the uterine cavity to gently scratch the uterine wall to extract a small amount of tissue to be analyzed under the microscope.
Dilation and curettage (D C) after cervical dilation, t.е. The lower part of this organ. Cervix, the gynecologist inserts a spoon-shaped surgical instrument into the uterine cavity through which he can take large tissue samples; hysteroscopy, using a thin instrument equipped with a small camera at the tip and a small loop, the gynecologist can visualize the uterine cavity and select a tissue sample for targeted analysis. It is currently the most correct and most commonly used method of. These procedures may sometimes require anesthesia. ” The stage of the tumor (if it is limited to the endometrium, if it affects the entire uterus or has spread to other organs), as well as from general health.
Stage of the disease
After confirming the presence of the tumor, further tests must be performed to check whether the cancer cells have spread to other parts of the body (a process that establishes the extent and spread of the tumor, therefore, its aggressiveness). Staging is important for choosing the most appropriate treatment.
Endometrial cancer is classified into the following stages: – Stage I: The tumor is limited to the uterine body, but has not invaded the cervix. Divided into stages IA and IB depending on the depth of infiltration of the muscular part of the uterus; – Stage II: the tumor has spread from the endometrium to the cervix, but not beyond the uterus; – Stage III: the tumor extends beyond the uterus into the lower part of the large abdomen, vagina, and lymph nodes. Recurrence: the tumor recurs after treatment, recurrence may develop in the pelvic area, lymph nodes and/or other organs at a distance.
How to care
The current treatment options for endometrial cancer are as follows:
- surgery;
- chemotherapy;
- therapy;
- administration of hormones for therapeutic purposes.
Surgery is the most common method of treatment. The surgeon may decide to remove the tumor by performing one of the following types of surgery: ” Bilateral: is an operation in which the surgeon removes the uterus, salpingitis (or fallopian tubes), and ovaries.To check the condition of the lymph nodes, the surgeon may proceed at the same site to excise the lymph nodes by removing the pelvic and/or aortic lymph nodes, with the role of examining the sentinel lymph node (the first lymph node that drains clear, clear, colorless fluid circulating in the vessels) still considered experimental-mphatic and which contains lymphocytes. ” Lymph from the tumor area; even if the surgeon removes the entire tumor during surgery, in some cases, based on certain risk factors identified by microscopic analysis of a tissue sample taken during biopsy. ” The oncologist may recommend radiotherapy or postoperative chemotherapy to induce death of any remaining tumor cells and prevent recurrence. Chemotherapy is a treatment that destroys cancer cells by administering drugs that can be taken by mouth in pill form or injected intravenously or intramuscularly. Chemotherapy is defined as a systemic treatment because the drug enters the bloodstream, spreads through the body, and thus can reach and destroy cancer cells that have spread away. Radiotherapy (also called radiation therapy) uses high-frequency radiation to kill neoplastic cells. Radiation can be delivered by a device outside the body (external radiotherapy) or by a radioactive substance ((or radionuclide) A substance capable of emitting radiation. ” The radioisotope) can be placed directly into the area affected by the tumor using plastic tubes (internal radiotherapy or intracavitary). Endometrial cancer radiotherapy can be done alone or in combination with surgery, chemotherapy, or both. Hormone therapy (or hormone therapy) consists of taking hormones to block the growth of cancer cells. Estrogens and progestagens are hormones that can somehow affect the growth of some cancer cells. If tests show that the tumor cells have proteins that recognize and selectively bind certain substances (e.g., hormones, antigens, sugars) or even microorganisms (e.g., viruses, bacteria). Receptors located on the surface or inside cells. Receptors for estrogen and/or progestagens, hormone therapy may be considered a therapeutic option.
Treatment depending on stage
The specialist may suggest standard treatment because of its proven efficacy, confirmed by previous experience, or participation in a clinical trial. Standard therapy is not always appropriate for all patients and sometimes comes with more side effects than you think. For this reason, clinical trials are being conducted to identify more effective therapies based on the most current information available.
Stage I
Treatment options are as follows: – in selected cases, in very initial very early stage tumors and in young patients who wish to become pregnant, conservative uterine therapy with hormone therapy and possible hysteroscopic removal of only a small portion of the endometrium affected by the cancer may be offered; – hysterectomy and bilateral adnexectomy; – hysterectomy and bilateral adnexectomy with excision of pelvic and/or abdominal lymph nodes, followed by internal or external pelvic radiotherapy. After surgery, a plastic tube can be inserted into the vagina, inside which a radioactive source is placed in order to destroy any residual tumor cells; – Radiotherapy only for inoperable patients.
Stage II
The treatment options are as follows: – Hysterectomy and bilateral adnexectomy with or without excision of pelvic and abdominal lymph nodes, followed by radiotherapy; – Hysterectomy and bilateral adnexectomy with or without excision of pelvic and abdominal lymph nodes, followed by internal or external pelvic radiotherapy. Internal radiotherapy may be recommended after surgery; – Radiotherapy alone for inoperable patients.
Stage III
Treatment options are as follows: – Radical hysterectomy with excision of the pelvic lymph nodes followed by internal and external radiotherapy; – Radiotherapy alone for inoperable patients; – Chemotherapy plus radiotherapy.
Stage IV
Treatment options are as follows: – Radiotherapy, aimed at relieving symptoms; – Palliative surgery, aimed at relieving symptoms.
Recurrent endometrial carcinoma
In this case, the therapeutic options are as follows: – Palliative radiotherapy, t.е. Directed dilatationTo reduce symptoms and improve quality of life.
Thanks to Prof. G Scambia and Dr. R. De Vincenzo (Women’s and Child Health Center – A. Gemelli University Polytechnic Foundation, Catholic University of the Sacred Heart – Rome) for critical revision of the text.
