cancer of the uterus (endometrial cancer) is a common form of cancer. The uterus is a pear-shaped, muscular organ in the pelvis where the baby develops during pregnancy.
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With the patient in the clinic Assuta operates highly qualified team of doctors - experts. All options of therapy, after which most advanced recommended treatments with the least negative impact on the body.
Diagnosis of uterine cancer in the clinic Assuta
In 2012, the international organization OECD when checking the health system in Israel noted outstanding achievements in the field of oncology. This was made possible thanks to the generous public financing of medicine, high level of medical education, training doctors in leading hospitals in the world, active and timely innovation, management of the world's medical protocols and modern US and European technologies.
Assuta Hospital is equipped with excellent diagnostic and therapeutic equipment, which allows, including to put accurate and reliable diagnoses. Doctors are working on a contractual basis to work attracts only the best talent, many of whom have been recognized in the medical world.
Early and accurate diagnosis increases the chances of successful treatment of uterine cancer . The Assuta center applies the most advanced methods and technologies for the diagnosis of cervical cancer. This helps the doctor to later choose the best treatment option.
In the diagnosis of cervical cancer the following types of inspections may be carried out in the Assuta.
Consultation with a gynecologist examination and history taking
When collecting medical history questions will relate to the following points:
- general well-being;
- the presence of any health problems, including endometrial hyperplasia, diabetes, hypertension, gallbladder disease;
- the presence of close relatives of cancer of the uterus or bowel;
- substitution therapy;
- characteristics of the menstrual cycle;
- potential exposure of the pelvic organs;
- symptoms of the disease.
During the physical exam, your doctor:
- Determines the weight and the presence of obesity.
- Checks blood pressure.
- Listens to the chest.
- Conducting a pelvic exam, Pap takes.
- Stomach probes for enlarged liver, the presence of ascites.
- Examines the lymph nodes in the groin and above the collarbone.
With clinical analysis for the diagnosis of the uterus cancer was measured quantity of cells of different blood - leukocytes, erythrocytes and platelets. Checks for anemia due to bleeding, creates a basis for comparison in the future, blood tests during and after treatment.
Through biochemical analysis of blood measurement of produce certain chemicals. The results show the operating status of certain organs, and they can also be used to detect anomalies. Some of the increased rates of the chemical composition of the blood indicate metastatic cancer of the uterus.
To verify the renal function is measured urea and creatinine. Excess levels means that the cancer has spread to the ureters or kidneys.
In order to study the liver determine the level of alanine aminotransferase (ALT), aspartate transaminase (AST) and alkaline phosphatase. Increased number may indicate that a malignant process affected liver.
Tumor markers - usually proteins in the blood that indicate the presence of cancer. As for the diagnosis of cancer of the uterus generally these tests are used to check the body's response to treatment, but also can use when planning therapy. With this type of cancer the malignant antigen content measured 125 (CA125), increased number which indicates metastatic cancer.
Some women with uterine cancer or those who are at risk, it is recommended to pass genetic testing in Assuta in the following cases:
- Endometrial cancer was diagnosed before the age of 50 years.
- There was a cancer of the colon or rectum.
- Have close relatives with cancer of the colon, rectum or uterus cancer.
- I have a relative with a Lynch syndrome, which is associated with genetic mutations (MLH1, MSH2, MSH6, PMS2).
Transvaginal ultrasound - a procedure in which sound waves are reflected from the internal tissue or organs - the vagina, uterus, fallopian tubes, bladder - and form their images. This kind of diagnosis of the uterus cancer performed with a probe that was placed inside the vagina. US carried out in order to accurately determine the thickness of the endometrium (thickening may indicate oncology) to find abnormal mass in the uterus, to identify features indicative of the distribution of the tumor in the pelvis.
During a biopsy tissue or a small number of cells were removed from the uterus for further inspection in the laboratory. Pathology report to confirm or refute the presence or absence in a sample of cancer cells. Types of biopsies, which are commonly used for the diagnosis of cervical cancer in the Assuta.
Endometrial biopsy - a procedure in which a small extract of the mucous membrane of the uterus samples. Most often it is performed in a doctor's office, because there is no need for general anesthesia. This type of biopsy provides the same accuracy as the more invasive tests.
Dilation and curettage - a surgical procedure in which the cervix and expand using a curette scrapes certain amount of uterine lining. It is carried out in the following cases:
- If endometrial biopsy result is insufficient or indicates endometrial hyperplasia.
- biopsy sample was too small to make a definitive analysis.
- Endometrial biopsy can not be performed under standard conditions, because the cervical opening is too narrow, or the woman is experiencing much discomfort.
The procedure is performed in the operating room. It may be performed simultaneously hysteroscopy.
Endoscopic diagnosis of cancer of the uterus allows the doctor to look inside the body cavity. Hysteroscopy is recommended for abnormal uterine bleeding. Basic procedures tasks:
- Search abnormal areas inside the uterus, which can be caused by benign, pre-cancerous or cancerous changes.
- Determining the extent of the pathological process.
- Taking tissue samples for biopsy.
This test involves the use of a hysteroscope, a thin, flexible tube that allows a doctor to examine the lining of the uterus. The procedure can be performed on an outpatient basis. The doctor inserts a speculum into the vagina, injects a small amount of anesthetic to the cervix to make the test more comfortable. The patient may be advised to take pain medication an hour before the diagnosis. A few minutes later, the doctor inserts a hysteroscope through the vagina and cervix into the uterus. The image is displayed on the screen. For a clearer picture of the hysteroscope is inserted through a small amount of transparent liquid or air. Also, the doctor can take tissue samples from the mucosa. After the test, perhaps slight vaginal bleeding for a couple of days, pain - may be required intake of painkillers.
The following types of endoscopic diagnosis of cancer of the uterus is performed, if a woman has symptoms of the bowel or bladder, indicating that oncology could spread to them.
- Cystoscopy determines whether the process has affected tumor bladder and urethra.
- Proctoscopy determines whether the cancer struck rectum.
X-ray beams, types of energy beams passing through the organs and bones inside the chest, create images of the internal structures of the body. X-ray is performed to find out whether not spread to the lung disease.
Barium enema in the diagnosis of uterine cancer
This X-ray examination of the intestine with contrast (barium). It is conducted when there are signs that point to the emergence of cancer in the rectal area.
CT in the diagnosis of uterine cancer
Computed tomography X-ray equipment used to create 3 - dimensional transversal images of organs, tissues, bones, and blood vessels. The computer converts them into detailed pictures. CT is recommended to find out whether the tumor process hit other organs, whether there is a relapse after treatment.
MRI in the diagnosis of uterine cancer
MRI uses a powerful magnetic field and radio frequency waves to form cross-sectional images, then use the computer, they are transformed into three-dimensional images. MRI can be useful to determine how far the cancer has intruded into the myometrium (muscular layer of the uterus). Also, imaging is carried out to find out whether the cancer to other organs, if after treatment the disease spread back.
PET-CT in the diagnosis of uterine cancer
This type of survey combines the capabilities of PET and CT provides more detailed information about the study area. In soft radioactive substance is used as a contrast.
Surgery in the diagnosis of uterine cancer
Surgical staging is required to accurately determine the stage of cancer of the uterus. We study all tissues removed during surgery. Usually surgery through an incision made in the abdomen under general anesthesia. In some cases, it is possible to carry out the operation by laparoscopy, using special equipment that is introduced into the body through small incisions.
Surgical staging is usually recommended as a first step in the treatment of uterine cancer in Israel. This procedure may include:
- Detailed pelvic and rectal examination.
- Total hysterectomy and bilateral salpingo-oophorectomy (removal of the uterus, cervix, fallopian tubes and both ovaries). During these operations is determined by how far the cancer has intruded into the myometrium (muscular layer of the uterus), cervix, ovaries, and fallopian tubes.
- A biopsy of tissue from suspicious areas within the abdominal cavity.
- Removal of lymph nodes in the pelvis and around a large artery in the abdomen.
- Taking gland sample (adipose tissue in the abdominal area).
During surgery for uterine cancer pelvis and the abdominal cavity may be flushed with a liquid, its sample was then tested for the presence of malignant segments. This information is then used for the prediction.
About the disease - causes cervical cancer
The exact causes of the disease are unknown, but the researchers note certain factors that may increase the risk of developing the disease.
Age refers to the possible causes of different types of cancer.
Hormonal changes associated with an imbalance of estrogen and progesterone may be a potential cause of cancer of the uterus . Before menopause, the ovaries produce estrogen and progesterone, then the synthesis of hormones stops. But some women have estrogen production continues in the body. The increased amount of estrogen without progesterone increases the likelihood of cancer.
Factors that affect the balance of hormones:
- The absence of children.
- Menstrual history: early onset of menstruation before 12 years of age, late menopause - after 55 years, long periods, irregular periods, absence of menstruation.
- Hormone replacement therapy (HRT). Taking estrogen-only HRT, not containing progesterone, or drug tibolone, you can increase the likelihood of cancer. HRT, estrogen is prescribed only to women who have had a hysterectomy - surgery to remove the uterus.
Weight and physical activity
Being overweight is an important risk factor for cervical cancer. After menopause adipose tissue in the body is the major source of estrogen synthesis. Women with excess body weight may be high levels of estrogen. One of the three types of cancer of the uterus triggers obesity. In addition, there is some evidence that physical inactivity increases the likelihood of disease.
A very small number of cases of uterine cancer provoke changes in certain genes. But if you have close relatives (parents, children, sisters, brothers) who have had bowel cancer, breast cancer or endometrial cancer, there is a risk of the disease.
Women with hereditary nonpolyposis colorectal cancer have a defective gene that increases the likelihood of bowel cancer and uterine at 30-60%. In such cases it is necessary to carry out inspections.
When Cowden syndrome, a genetic disorder, there is an increased risk of benign and malignant tumors, including cervical cancer.
A hormonal drug, which is used in the treatment of malignant breast tumors. To some extent, it can increase the chance of cancer of the uterus, but, as a rule, with a long reception. But in the course of the treatment of breast cancer with tamoxifen benefits outweigh the risks.
Other possible causes of uterine cancer
- Thickening of the endometrium or endometrial hyperplasia. Symptoms include heavy menstruation and bleeding between or after menopause.
- Diabetes is associated with being overweight increases the risk of disease. There may also be a separate connection between the uterus and oncology insulin, a hormone that regulates blood sugar levels.
- Polycystic ovary syndrome (PCOS). In women with PCOS, a condition in which cysts grow on the ovaries may be fertility problems, failures or absence of menstruation, obesity, or diabetes - all of this is related to the probability of endometrial cancer.
- Rare species of ovarian cancer. Folliculoma or follikuloma produces estrogen, which increases the likelihood of uterine cancer.
Symptoms of cervical cancer
The most common symptom of uterine cancer is abnormal bleeding from the vagina, although the majority of women with this manifestation is not cancer:
- Bleeding after menopause.
- More severe menstruation than usual, if the woman has not reached menopause.
- Bleeding between periods.
- Bleeding or watery vaginal discharge.
- Bleeding during sexual intercourse.
Less common symptoms include pain in the lower abdomen and pain during sex. If cervical cancer reaches a more advanced stage, it can cause additional symptoms. These include:
- Pain in the back, legs or pelvis.
- Irregularities in the bladder: pain during urination, difficult urination, blood in the urine.
- Changes in the functioning of the intestine: pain during bowel movements and difficulty, blood in the stool.
- Loss of appetite.