Myoma is a malignant or benign tumor. Can uterine fibroids turn into cancer (malignant tumor)? What about prevention

24.09.2020

Last updated article 07.12.

A uterine fibroid can appear in a woman at any age. The exception is the period before puberty and menopause. It is a benign mass of muscle and fibrous tissue. It can be one or several. Sizes often range from 2-3 cm to 10-15 cm.Sometimes they can reach 25 cm.

About 25% of women over the age of 35 are diagnosed with uterine fibroids. Despite the fact that the tumor itself is benign, many are worried about the question: can uterine fibroids develop into cancer, and how to avoid this disease? With timely diagnosis, treatment and prevention, negative consequences can be avoided.

Not every woman with this ailment can immediately understand this. According to statistics, about 30% of patients learn about the diagnosis by chance during an ultrasound scan. Small formations usually do not bother, so they can only be recognized with regular examinations.

Symptoms appear when the fibroid increases in size. The following symptoms will indicate a problem:

aching pain in the abdomen and lower back outside of menstruation;
violation of the cycle: increase or decrease;
increased pain during menstruation;
reproductive problems;
profuse menstruation, heavy bleeding, and, conversely, too little discharge;
abnormal enlargement of the abdomen;
violation of urination and defecation.

The consequences of the disease can cause severe harm to the female body - lead to infertility, inability to bear a child, anemia, depression, and even the need to remove the uterus.

The exact reasons for the active division of cells in the wall of the organ and the appearance of a neoplasm are not fully determined by science. So, the disease can occur due to a genetic predisposition - if it was in the family, among close relatives before. The second reason is a change in hormonal levels. In particular, estrogen and progesterone affect the development of fibroids. Therefore, during pregnancy, when hormone levels are much higher, education grows faster. During menopause, it stops growing and decreases over time.

In addition, inflammation of the ovaries, the presence of cysts, and previous abortions contribute to the occurrence of nodes.

When fibroids can turn into cancer

A characteristic feature of the disease is unpredictability. A neoplasm can remain in the same size for a long time, increase or, conversely, decrease and even disappear. However, this is not a reason to just wait and hope for a positive outcome.

As statistics show, in 1.5% of cases, the pathology turns into oncological disease. Early diagnosis, correct treatment, adherence to certain rules for uterine fibroids will help avoid cancer.

You should know that such factors contribute to its development:

bad habits. Drinking alcohol and smoking leads to intoxication of the body. Therefore, you need to lead a healthy lifestyle, have a good sleep;

excess weight. Because of it, the metabolism is disturbed. In addition, adipose tissue puts pressure on the uterus. Therefore, it is recommended that overweight women lead a moderately active lifestyle;
improper nutrition. Excessive consumption of animal fats and carbohydrates is fraught with negative consequences. To fight the disease, you need food rich in fiber, trace elements, vitamins. The latter can be used separately as prescribed by a doctor. It is important that the body gets enough vitamin E;
physical exercise. Intense exercise can lead to increased blood flow to the pelvic organs. It is a kind of food that promotes cell growth. The more education, the greater the risk of cancer;
trauma. They have a beneficial effect on the multiplication of pathological cells;
stress. It is a well-known fact that most diseases appear and develop when a person is depressed or under stress. Cancer is no exception. Therefore, you need to try to be less nervous. A stable emotional state is good for the body;
Warming up. Applying heat close to the uterus increases blood circulation, which again contributes to unnecessary cell nourishment.

As mentioned earlier, in general, fibroids do not bother, and can remain in the same size for a long time.

A sudden change in the clinical picture is an alarming signal that speaks of changes in the uterus. So, bright red discharge, the appearance of pain of varying intensity, a sharp increase in the node, may indicate the degeneration of a tumor into a cancerous one. This is especially dangerous for women who have gone through menopause.

But do not rush to draw conclusions without a doctor's opinion. To determine a malignant node or not, a thorough examination is necessary:

Ultrasound determines the localization of the node, size, degree of damage;
hysteroscopy and lateroscopy - tests that detect the presence of cancer cells.

However, there is no need to panic prematurely, because in the vast majority of cases, fibroids do not degenerate into cancer. To prevent illness, you need to be regularly examined, treat on time, lead a healthy lifestyle and, most importantly, think positively.

Oncology treatment

If the examination showed the presence of cancer cells, then it is necessary to contact an oncologist. The method of treatment depends on the degree of the disease, the area and nature of the affected tissue. Some types of cells can grow very quickly, while others, on the contrary, develop slowly and hardly metastasize. In both cases, the operation is inevitable.

The tumor must be removed. Unfortunately, in most cases, together with other organs - the uterus, and sometimes the ovaries, regional lymph nodes. This is a kind of prevention of metastases, since in the future any cyst can cause a relapse.

In addition, radiation or chemotherapy is given before or after surgery. These procedures help stop the development of the node and prevent metastases. As with ordinary fibroids, vitamins, trace elements, and antioxidants help to recover faster.

Myoma is a common pathology of the muscular wall of the uterus. Myoma is often called "benign myoma" or "benign tumor of the uterus."

Please note that this text was prepared without our support.

The true cause of the formation of nodes in the muscular wall of the genital organ is still unknown, but factors are known that can stimulate the development of fibroids.

What is benign uterine fibroids

Fibroids or leiomyomas, fibroids - the names of a benign formation, depending on the predominance of connective or muscle tissue in the tumor, develop in the myometrium, the muscle layer of the uterus. A benign mass consists of intertwining smooth muscle fibers. Due to the round shape, fibroids are called nodular formations, nodes. Fibroid nodes range from a few millimeters in diameter to huge sizes, when the weight of the fibroid reaches several kilograms. Research into the causes of the appearance of the tumor, the factors affecting its growth, continues. For a long time, it was believed that the cause of the development of a benign tumor is a hormonal imbalance in a woman's body, but fibroids began to be detected in women with normal hormone levels. It was believed that they develop in women of late reproductive age, in the premenopausal period, but fibroids have become increasingly diagnosed in young girls and women.

Benign tumor-like nodes are more often found in women of childbearing age, often in very young girls. Benign nodules are diagnosed in the premenopausal period, after 40 years, there are cases of growth after menopause. Such cases are associated with hormonal changes in the body, imbalance of hormones - this has a negative effect on the genital organ, accelerates the growth of tumor-like nodes. Women who have not given birth and women with one or two children are forced to cope with hormonal surges (menstruation) all their lives - this becomes the reason for the development of fibroids. Menstruation is a damaging factor for the myometrium, numerous periods during life cause somatic mutation of myometrium cells - myoma develops. The factors that stimulate the development of the tumor include: genetic predisposition, acute and chronic gynecological diseases, abortion, difficult childbirth, lack of pregnancy, stress and many other factors.

In most countries, removal of the uterus has been the main treatment in the past. The tumor-like node, which reached a certain size, was removed along with the uterus, which became the cause of the development of severe complications in women who underwent uterine extirpation. Modern doctors are developing new organ-preserving methods of treating the disease, preserving the reproductive organ and women's health. Often, doctors call myoma a benign tumor, at the same time, such a statement is not entirely accurate. Myoma is a benign formation of muscle tissue, which very rarely turns into a malignant state, may not manifest itself with symptoms and is detected by chance on examination by a doctor, and may be accompanied by painful menstruation, bleeding, rapid growth of benign formation, rapid fatigue, anemia, infertility. If you have such symptoms, it will help you get timely medical attention.

Benign fibroids and pregnancy

The disease rarely becomes the cause of a woman's infertility. The chance of conception and pregnancy decreases if a benign node prevents the advancement of sperm, compresses the fallopian tubes, and interferes with the attachment of the ovum. A large number of women become pregnant, unaware that the uterus is affected by nodes. Small tumors rarely affect the fetus during pregnancy, with the exception of multiple organ damage. The ability to endure pregnancy will depend on the location of the fibroids, the place of attachment of the ovum, at the same time, the risk of premature termination of pregnancy increases.

Changes in hormonal levels during pregnancy in some cases lead to a decrease in the tumor, in most cases, under the influence of hormones, muscle tissue grows. Doctors recommend getting treatment before planning a pregnancy. Myoma of the uterus not only creates a risk of complications during pregnancy (placental abruption, abnormalities in presentation and position of the fetus, other complications), it can cause prolonged labor, in many cases it becomes the cause of caesarean section, postpartum complications.

Is there a malignant tumor of uterine fibroids

Fibroids rarely degenerate into a malignant tumor, but such cases do occur. Very rarely, a benign formation of the uterus degenerates into a sarcoma of the uterus. Most often, a sarcoma tumor develops during the postmenopausal period, accompanied by bleeding and pain, and the rapid growth of a malignant tumor. Factors contributing to the development of a malignant tumor of the uterus include:

Stress. Chronic stress often causes the development of oncological diseases, as it leads to a decrease in immunity.
Organ trauma.
Obesity. Obesity is accompanied by metabolic disorders, hormonal balance.
Bad habits.
Poor nutrition. Lack of vitamins and microelements leads to disruption of the work of many organs, systems, a decrease in the body's defenses.
Great physical activity.
Women with tumors of the uterus are not recommended to go to the sauna, steam bath, or take a hot bath.

To avoid the degeneration of a benign node into a malignant tumor, you should regularly visit a gynecologist, undergo treatment for diseases of the genital area, fibroids.

Benign Education Treatment - Fibroids

Treatment of benign fibroids consists of several methods. Each method is used in certain cases:

Conservative method: drug treatment with GnRH agonists.
Surgical methods: hysteroresectoscopy, laparoscopic removal of nodes, amputation of the uterus.
Minimally invasive procedures: uterine artery embolization.

The treatment of the disease is preceded by an examination that helps to establish the type, location, size of fibroids, the state of the uterine cavity, the presence of concomitant diseases. Diagnosis of the disease is carried out using ultrasound with a transvaginal sensor, MRI, CT, hysteroscopy, the patient is sent for research - blood tests for hormone levels and others. With the help of hysteroscopy, the localization of the tumor-like formation, its size and quantity are determined with great accuracy. During the procedure, the doctor may take a biopsy of tumor tissue. Hysteroscopy allows you to determine the deformation of the organ cavity, the state of the uterine mucosa. Ultrasound allows you to determine the presence of nodes in the myometrium, deformation of the contours of the organ, the size of benign formations, the area of \u200b\u200blocation. To consult an experienced professional, you should

Conservative treatment of fibroids

The choice of treatment method depends on many factors: the patient's age, health status, size, location, growth rate of fibroids, and the presence of children. Conservative therapy can include treatment with one hormonal drug or a complex of hormones, one of the methods of treatment is an intrauterine device with hormonal content. Such treatment is carried out with small myomatous nodes, helps to stop the growth of benign formations. It is not recommended to use the drug "Duphaston", which belongs to the factors affecting the increase in fibroids.

Surgical treatment of myomatous node

Surgical treatment is carried out using organ-preserving methods and a radical method. Organ-preserving methods are the removal of nodes by laparoscopic and hysteroscopic access. Hysteroscopic myomectomy is considered the most optimal method for removing submucous myomas. Organ-preserving techniques make it possible to shorten the rehabilitation period after surgery, but they have certain indications for their implementation.

A radical operation to remove the genital organ with large tumor-like nodes is performed using an abdominal approach, during which the anterior abdominal wall is injured. After such an operation, various complications often arise, the rehabilitation period is long.

Uterine artery embolization

Uterine artery embolization is an innovative, organ-preserving, minimally invasive treatment. During the procedure, emboli from a medical polymer are used. The procedure does not require general anesthesia, long-term preparation of the patient. UAE preserves the woman's reproductive organ, improves the quality of life, practically does not give complications.

During the procedure, emboli are inserted into the blood vessels of the uterus using a special catheter through the femoral artery. Emboli accumulate in the blood vessels of tumors and stop circulation. Tumors begin to degrade, decrease in size, and eventually degenerate into connective tissue. The endovascular surgeon observes the procedure on a monitor, uterine artery embolization is carried out under the control of modern X-ray equipment. After EMA, the patient is under the supervision of a doctor for some time, then goes home. A small puncture remains at the site of the catheter insertion, which heals quickly.

Embolization of the uterine arteries allows you to subsequently successfully endure pregnancy, childbirth takes place naturally. After the procedure, no scars remain on the uterus, emboli are soldered by connective tissue, lose the ability to move, and do not have a negative effect on the woman's body. Relapses occur very rarely after UAE. They are determined on an ultrasound scan within the first six months after the procedure, when a renewed blood supply to the tumor is detected. In addition, embolization of the uterine arteries is performed, and the myoma dies. An important role in the effectiveness of UAE is played by the drug for embolization and the experience of the endovascular surgeon. When deciding on a procedure, take responsibility for choosing a clinic and a surgeon. Here you can choose highly professional services and doctors, choose.

Bibliography

Savitsky G.A., Ivanova R.D., Svechnikova F.A.Role of local hyperhormonemia in the pathogenesis of the rate of increase in the mass of tumor nodes in uterine myoma // Obstetrics and gynecology. - 1983. - T. 4. - S. 13-16.
Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In the book: Myoma of the uterus. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
Meriakri A.V. Epidemiology and pathogenesis of uterine fibroids. Sib Med Zhurn 1998; 2: 8-13.

Almost 30% of the entire adult female population around the world asks the question: what is fibroids? This disease creeps up unnoticed, and it is very difficult to recognize it at the very initial stage. She is like a black cat in a dark room: both is, and is not visible. So what kind of disease is it?

Myoma is a benign tumor of the uterus that develops from muscle fibers and connective tissue elements. Depending on the ratio of muscles and connective tissue in the structure of the tumor, in recent times it had a variety of names: myoma, fibroma, fibroids. But since fibroid nodes often develop from muscle cells, most doctors today consider the term "myoma" or "leiomyoma" correct.
Most often, fibroids are a slowly growing tumor, and a tumor that is capable of recurrence and degeneration into a malignant neoplasm. Every woman should know about this!

When does it arise?

The development of uterine fibroids is a benign hormone-controlled increase in the thickness of the muscle layer of the uterus - the myometrium. And the reasons contributing to the beginning of this process can be many.
Hormones only control the growth of fibroids, and it occurs spontaneously - after abortion, improper contraception, chronic inflammatory processes in female organs, hormonal disorders, stress, due to excessive love for sunburn, against the background of obesity or hereditary predisposition. In a word, fibroids are formed after everything that can provoke tumor growth in our body.
If we had the opportunity to look inside the muscular layer of the uterus at the very beginning of the development of fibroids, we would see an extremely interesting picture. Uterine cells spontaneously begin to divide actively. The reasons for this phenomenon are not fully understood, however, it has been established that it is primarily associated with increased secretion of estrogen hormones, which stimulate the growth of fibroids. Progesterone, on the other hand, causes it to reverse. This is confirmed by the fact that fibroids increase in size during pregnancy and decrease in the postmenopausal period.
At the same time, the normal balance of the content of estrogen and progesterone in the blood is not at all a guarantee of the absence of fibroids: it can arise with minor fluctuations in the hormonal level.

How is myoma diagnosed?

Fibroids are most often detected at a gynecologist's examination. In this case, the doctor can only state the presence of uterine fibroids. In other situations, the first signs of fibroids may be pain in the lower abdomen or in the lumbar region, bleeding, changes in the menstrual cycle, dysfunctions of neighboring organs, for example, frequent urination. The classic manifestations of uterine fibroids are prolonged regular menstruation, against which there are often irregular uterine bleeding - metrorrhagia. When such symptoms appear, it is necessary to go to an appointment with a gynecologist.
Diagnosing fibroids is not difficult if there is an increase in the size of the uterus, uterine bleeding, deformation of the uterus with fibroid nodes. It can be detected by probing the uterus through the anterior abdominal wall. The final confirmation of the diagnosis is given by ultrasound, hysteroscopy or hysterography. The last two methods are contraindicated in pregnant women. Sometimes doctors may prescribe computed tomography, nuclear magnetic resonance imaging to clarify the diagnosis.

Should she be treated?

Myoma can "dissolve" on its own if the hormonal background of the body changes. Conditions contributing to this: the small size of the fibroids, the absence of symptoms and progression for a fairly long period of time. For example, during or after menopause.
However, fibroids are often operated on. By itself, the presence of fibroids is not always an indication for surgery. It all depends on the patient's condition, the severity of the symptoms and the size of the tumor.
Indications for surgery to remove fibroids are pain, rapid growth of the node size, suspicion of degeneration into a malignant tumor, impaired blood supply to the fibroid nodes and inflammatory changes in them, failure of functions of neighboring organs - the bladder, intestines; infertility - when all other causes have already been excluded. If an experienced gynecologist believes that the operation is necessary, then the sooner it is done, the better.
In general, after 40 years and in the postmenopausal age, if there are surgical indications, the operation to remove the myomatous uterus is necessary, since if the myoma has not regressed in the first 2 years of postmenopause, its further existence is accompanied by the risk of oncopathology - adenocarcinoma, sarcoma.
There is also a conservative solution to the problem. Myoma of the uterus should be monitored regularly using a vaginal probe ultrasound. In many cases, this is quite enough, and no treatment - neither conservative, let alone prompt - is required. If a woman periodically experiences discomfort or pain in the pelvic area, non-steroidal anti-inflammatory drugs are effective. But the appointment of hormonal drugs in order to reduce the size of the node is completely unwarranted.

Today, another method of treatment has been developed - transcatheter embolization of myomatous nodes, in which the node loses blood supply and undergoes regression without the slightest harm to the uterus as a whole, but this method is still experimental and is not widely used.
The most modern method of treating fibroids is considered to be immunocorrection using a special vaccine that promotes the formation of a specific immune response against this disease. This treatment is used in young patients with tiny fibroids and at the very beginning, at the start of the disease. The goal of treatment is to preserve the uterus and enable the patient to live at the right time.

But what about prevention?

We have already talked about it. It:
- regular visits to the gynecologist for early diagnosis of the disease;
- prevention of abortion;
- reasonable intake of hormonal contraceptives under the supervision of a physician.

Apr 26, 2016 tigress ... s

A fibroid is a benign tumor of the uterus that grows from the muscle layer. The disease is accompanied by the appearance of chronic pelvic pain, intermenstrual discharge and other cycle disorders. Nodules are found mainly in women over 35 years old, and every woman is primarily concerned about one thing: can fibroids turn into cancer? By and large, it is on the answer to this question that the entire tactics of diagnosis, treatment and monitoring of a patient with identified pathology depends.

The first thing that every woman should remember is that uterine fibroids are not cancer, but under certain conditions, a malignant tumor may develop in the tissues of the reproductive organ. Knowing how and why oncology occurs, you can notice the first signs of an insidious disease in time, start treatment and prevent the development of deadly complications.

The complexities of terminology: is there cancer?

It is important to understand that fibroids can never turn into cancer simply because it is physically impossible. Cancer is a malignant tumor arising from the epithelial tissue of various organs. At a certain moment, a failure occurs in the structure of cells, and they begin to divide uncontrollably, filling the surrounding space and metastasizing through the blood and lymphatic vessels. Rare types of cancer grow only deep into tissues, destroying them to the very base, but do not give metastases.

Sarcoma is a malignant tumor of the muscular layer of the uterus, which can occur both against the background of fibroids and independently of it.

Proponents of this theory have identified several reasons why fibroids degenerate into cancer:

Lifestyle: addiction to smoking and alcohol in the presence of a benign tumor;
Visit to the sauna, steam bath and solarium;
Poor nutrition and vitamin deficiency;
Excess weight as a factor in metabolic disorders and the accumulation of estrogen;
Significant physical activity that increases blood flow in the pelvic organs;
Injuries to the uterus during childbirth or during medical and diagnostic interventions;
Irrational intake of hormonal drugs.

Proponents of the theory of the transformation of fibroids into a malignant tumor are sure that visiting a sauna or bath is one of the reasons for the degeneration of a neoplasm.

In recent years, there have been many studies on this topic, and most gynecologists are inclined to believe that fibroids are not capable of becoming a cancerous focus. A benign tumor of the uterus does not turn into sarcoma under any circumstances. Against this background, recommendations for quitting smoking, a ban on physical activity and a visit to the sauna make no sense. But it is important to understand that unequivocal evidence for this version has not been obtained, which means that oncological alertness regarding fibroids remains.

Supporters of the second theory point out that uterine sarcoma is an independent disease. A malignant tumor can occur with or without fibroids. The presence of one pathology does not exclude the appearance of another. That is why, when a fibroid is detected, the first thing to think about is whether it is cancer, and to undergo a full diagnosis by a gynecologist.

Only a complete diagnosis will help to accurately establish the type of tumor, its location, size, and degree of damage.

On a note

Sarcoma can arise directly in the myomatous nodes, but this does not mean that the myoma itself has degenerated into a malignant tumor.

How to recognize the disease in time

Even if the gynecologist accepts the fact that myoma is not oncology, and it does not develop into a malignant tumor, as an axiom, he should still carefully examine the woman and conduct the necessary diagnostic tests. The clinical picture of sarcoma is very similar to the manifestations of fibroids, and at the initial stages of the development of the disease, it is quite difficult to identify a dangerous neoplasm.

Uterine sarcoma refers to "dumb" tumors. The disease is asymptomatic, and only over time do characteristic signs appear:

Drawing pain in the lower abdomen, radiating to the lower back. Depending on the location of the tumor, pain can go to the thigh or perineum;
An increase in the volume and duration of menstrual bleeding;
Acyclic bleeding from the genital tract;
Uterine bleeding;
Signs of compression of neighboring organs: constipation, a feeling of incomplete emptying of the intestines, increased urination.

One of the characteristic signs of uterine sarcoma is profuse and prolonged periods.

All these symptoms are very similar to the manifestations of uterine fibroids, and in the early stages it is easy to confuse the disease without special diagnosis. , we wrote in one of our articles.

The following manifestations of the disease can speak in favor of sarcoma:

Rapid node growth (more than 4 weeks per year);
The appearance of foci in the appendages (metastases of a malignant tumor);
Frequently recurring uterine bleeding, especially during menopause and against the background of a rapid increase in the size of the uterus.

It's important to know

Among all the symptoms of fibroids, the growth of the node and the appearance of acyclic bleeding during menopause deserve close attention. According to doctors' observations, in 80% of cases this is not a true increase in the tumor, but the development of a malignant neoplasm. After examination, a large number of women over the age of 55 are found not only sarcoma, but also ovarian cancer, as well as other oncological processes of the reproductive organs.

The following symptoms indicate the development of sarcoma:

Unmotivated weight loss;
Severe weakness, fatigue and other signs of tumor intoxication;
Long-term slight increase in body temperature;
Anemia;
Ascites (accumulation of fluid in the abdominal cavity);
Increased regional lymph nodes.

Sudden weight loss may indicate the development of cancer in the uterine cavity.

The problem is that similar symptoms occur in the later stages, when the tumor metastases. Treatment at this stage does not always bring the desired effect. That is why it is important to distinguish benign myoma from malignant sarcoma in time and start treatment. The earlier a tumor is detected, the better the prognosis of the disease.

Diagnostic algorithm for suspected uterine sarcoma

It does not matter what position the gynecologist takes with regard to benign education. If a doctor has the slightest suspicion that a dangerous tumor is hiding under the guise of a fibroid, he must conduct a full examination and make an accurate diagnosis. In this case, it is not critical whether the myoma has degenerated into cancer or a malignant neoplasm has arisen without previous myometrial pathology.

Survey scheme for detecting sarcoma:

Mandatory, but not very informative research in this case. The doctor should examine the woman in the chair, but all he can determine is the presence of a mass in the uterus. In favor of sarcoma speaks its non-displacement, cyanosis of the mucous membrane of the cervix, but these signs are not too accurate and cannot be the basis for a diagnosis.

During a gynecological examination, the doctor can determine the presence of a tumor, but not differentiate it.

On a note

If sarcoma is suspected, the gynecologist conducts a rectovaginal examination to assess the condition of the tissues of the vagina and rectum. This method allows you to determine the size and localization of the node, as well as to identify metastases of a malignant tumor.

Laboratory research

The following tests help to find out that the fibroid is benign:

General blood analysis. Both with myoma and with sarcoma, anemia can be noted as a result of blood loss. With a malignant tumor, an increase in ESR is often recorded;
Tumor marker test: CA-125 (norm up to 35 U / ml). The growth of this indicator testifies in favor of uterine sarcoma.

Note

CA-125 can also increase in some other diseases, so it is not an unambiguous sign of a malignant tumor of the uterus. And yet, gynecologists say that it is necessary to take an analysis for a tumor marker, since its growth gives rise to further targeted examination.

Increased indicators of the CA-125 tumor marker may indicate a malignant degeneration of tissues.

Of practical importance is the identification of genetic tumor markers - special substances that indicate a person's predisposition to a particular type of cancer. In the case of sarcoma, it is important to identify the following indicators:

MSH6;
MSH2;
MLH1;
RASSF1.

The same markers are also detected with a tendency to cervical dysplasia and endometrial cancer.

Doppler ultrasound

With an ultrasound examination, the doctor sees a volumetric formation in the walls of the uterus, but cannot make an accurate diagnosis based on these data. Echographic signs of fibroids and sarcomas are very similar, and on ultrasound, a malignant tumor looks almost the same as a benign tumor. You can read about that in a separate article dedicated to this topic. The following signs may speak in favor of a sarcoma:

Rapid growth of the node in dynamics (according to previous measurements during ultrasound);
Changes in the structure of the tumor and the appearance of foci of heterogeneous echogenicity (this symptom may also indicate the development of necrosis of benign myoma).

An ultrasound scan helps a specialist determine if a tumor is in the uterus.

Doppler ultrasonography provides significant assistance in making a diagnosis. When assessing the blood flow in the uterine vessels, the following signs indicate the development of sarcoma:

Severe vascularization of the formation (a large number of blood vessels);
The appearance of irregular and chaotically scattered signals from blood vessels;
Registration of low-resistance blood flow in the tumor;
The uterine artery resistance index is less than 0.4;
The appearance of pathologically dilated vessels feeding the node.

Such features of blood flow are due to the fact that a malignant tumor produces its own vessels and creates a large number of arterio-venous anastomoses.

Endometrial aspiration biopsy

Not the most informative method, since it does not allow to identify a sarcoma located exclusively in the thickness of the muscle layer. However, atypical cells are often found in the biopsy specimen, which gives rise to further examination. Aspiration biopsy can also detect comorbidities (endometrial cancer or hyperplasia).

Endoscopic examination allows:

See a node located in the uterine cavity or close to the endometrium;
Assess the structure of the mucous membrane and the visible part of the tumor;
Conduct targeted biopsy of the neoplasm.

Diagnostic hysteroscopy allows you to examine the uterine cavity using a hysteroscope - a thin optical instrument.

Histological examination

"Gold standard" in the diagnosis of uterine fibroids ... Histology is the only method that allows you to accurately diagnose. All other tests, including ultrasound, do not give complete confidence that there is a sarcoma in the tissues of the uterus. Only after examining the tumor itself can you be guaranteed to find out its nature and decide on the tactics of treatment.

Methods for obtaining material for histology:

After (provided that the tumor grows to the mucous membrane);
With aspiration biopsy of the endometrium;
During hysteroscopy;
During the removal of the node by open or laparoscopic access.

In the latter case, we are talking about urgent intraoperative histological examination. The doctor removes the bundle, and the nurse immediately takes the material to the laboratory. After 15-20 minutes, the answer comes, and now the doctor knows exactly what he is dealing with. If a sarcoma is detected, the scope of the operation is expanded up to the removal of the uterus and adjacent organs.

Immunohistochemical study

The material for testing is a remote site or biopsy. The method is based on the identification of specific antigens characteristic of a particular tumor. Today, immunohistochemistry is an expensive but effective method for the differential diagnosis of fibroids and sarcoma.

Immunohistochemical study is one of the most reliable methods for detecting malignant cells.

Tactics for detecting a malignant tumor of the uterus

Organ-preserving operations for sarcoma are practically not performed. Detection of a malignant tumor is a reason for radical removal of the uterus. The scope of the operation will depend on the location of the node, the stage of development of the disease and the presence of metastases. In some situations, supravaginal amputation is sufficient, in others, extirpation is indicated (removal of the uterus together with the cervix). Extended surgery may also be required with excision of lymph nodes, peritoneal sheets, removal of the ovaries and fallopian tubes.

Radiation and chemotherapy for uterine sarcoma are used as auxiliary methods and serve to destroy tumor foci in the pelvic cavity, as well as to suppress metastases. Radiation therapy in this situation can be performed both before surgery and after removal of the tumor.

The prognosis for sarcoma depends on at what stage the disease was detected and what treatment was carried out. The average five-year survival rate is:

Stage I - 47%;
Stage II - 44%;
Stage III - 20-40%;
Stage IV - 10%.

Radiotherapy is an auxiliary method of treatment for uterine sarcoma. Its purpose is to suppress the activity of malignant cells.

Instead of a conclusion

Summing up, several important points should be highlighted:

Myoma and sarcoma are not the same thing;
Uterine fibroids are not an oncological pathology;
Sarcoma can occur both in the myomatous nodes and in the intact tissues of the uterus;
The average age of patients with sarcoma is 45-55 years. That is why certain fears are caused by the growth of fibroids during menopause, because this symptom may indicate the development of a malignant tumor;
In the clinical picture of fibroids and sarcomas, there are similarities and differences, and it is almost impossible to distinguish one disease from another in the early stages;
The only method that can accurately determine a malignant tumor of the uterus is histological examination;
Even if we take for granted the fact that fibroids degenerate into cancer, this does not happen very often - in 2% of cases.

In relation to uterine fibroids, oncological alertness remains, and this is fully justified. Without special tests, the doctor cannot say for sure which tumor is in the uterus. It is better to play it safe and undergo the necessary examination than to start the disease. However, this does not mean that all women with suspected sarcoma need to remove the uterus just in case. The final decision on the choice of a particular treatment tactics should be made after receiving the results of the histological examination.

Useful video about uterine cancer

Details about the causes of tumors in the uterine cavity

Myoma is one of the most common gynecological pathologies of a non-inflammatory nature, which, according to many modern experts, does not belong to true tumors.

This is a benign, hormonally controlled hyperplasia of the muscular layer of the uterine wall of mesenchymal origin, which develops as a result of somatic cell mutation that occurs under the influence of various damaging factors.

It is presented in the form of a tumor, consisting of intertwined muscle and connective tissue fibers. In clinical practice, uterine fibroids and cervical fibroids are found.

What it is?

A uterine fibroid is a benign tumor that occurs in the muscular layer of the uterus - the myometrium. It is one of the most common diseases in women, reaching a frequency of 12 - 25% of all gynecological diseases.

The highest incidence of uterine fibroids occurs in the late reproductive period and before menopause. There is an opinion that the true prevalence of fibroids is much higher and reaches more than 70% both in Russia and abroad.

Causes of uterine fibroids

Myoma is a polyetiological disease, the following risk factors can play a role in the development of which:

hormonal imbalance;
inflammatory pathology of the female genital area;
the use of intrauterine contraceptives, such as spirals;
complicated course of labor;
performing abortions;
adenomyosis;
obesity;
disease of the thyroid gland, adrenal glands, organs of the hypothalamic-pituitary system.

Myoma is a hormone-dependent tumor, as evidenced by the following facts:

receptors for sex hormones are found in the tumor tissue;
as a rule, after the onset of menopause and a sharp decline in the level of sex hormones, tumors undergo a reverse development;
most often, fibroids appear in women of reproductive age, in whose body there is a high content of estrogen;
after menopause, fibroids may appear in women who take estrogen-containing drugs.

Classification

Depending on the localization of fibroids, there are several terms in clinical practice:

Pediatric uterine myoma is not a separate gradation, since the pedicle may have submucosal and subserous myoma. Within the definition, the size of the leg, fibroids on a wide or narrow base can be noted.
Interstitial, or intramuscular myoma - the neoplasm is located in the muscular wall of the uterus.
Submucous, or submucosal myoma - the tumor grows right inside the uterus under the mucous membrane and goes into the lumen of the uterus.
Subserious myoma - the neoplasm is located on the outside of the surface of the uterus and is separated by a membrane that separates the uterus and abdominal organs.

The first signs of uterine fibroids

In the initial stage, small uterine fibroids are not accompanied by noticeable symptoms. You can find it during the next gynecological examination.

As the uterine fibroid grows, the first signs may appear:

long, heavy and irregular menstruation;
constipation;
infertility;
bleeding;
anemia;
frequent urination;
heaviness and constant pain in the lower abdomen;
bloody discharge during intercourse;
back pain;
an increase in the abdomen not associated with significant weight gain;
frequent miscarriages.

Why is uterine myoma on the leg dangerous? When the "leg" is twisted, inflammation and rupture of the tumor occurs. This causes severe bleeding, severe pain in the lower abdomen, and fever. This condition can be fatal.

Symptoms

With large sizes of nodes, there is a violation of the function of neighboring organs: constipation, impaired emptying of the bladder, frequent urination. In some cases, tumor nodes can cause compression of the ureter with further impairment of the outflow of urine from the kidney, which leads to the death of the kidney. Symptoms of compression of adjacent organs more often appear with large nodes and low localization of nodes.

Interstitial uterine fibroids (with intermuscular nodes) leads to longer, heavy and painful periods. Especially often profuse, prolonged and painful menstruation is observed with a combination of uterine fibroids and adenomyosis. Also, with intermuscular growth of the node, part of it can grow towards the uterine cavity. With this localization of fibroids, the same symptoms are noted as with the submucous growth of the node, and their severity depends on the size of the submucous fragment of the node.
For the submucosal location of the node (submucous myoma), abundant menstruation is most characteristic, and at large sizes, when the node begins to occupy a large area of \u200b\u200bthe uterine cavity, spotting from the genital tract loses its cyclicity, and sometimes does not stop at all. With such an arrangement of the node, the patient almost always develops anemia due to profuse bleeding from the genital tract. Submucous myoma can give cramping pains, most often occurring on the days of menstruation. The submucous node is a kind of "foreign" body for the uterus, from which it is trying to free itself. Sometimes such nodes can even "be born" on their own. This process is accompanied by very severe cramping pains and bleeding.
Subserous (subperitoneal) fibroids are often clinically painful. Pains are localized in the lower abdomen and / or lower back. Their appearance is associated with the tension of the ligamentous apparatus of the uterus and the pressure of the growing fibroids on the nerve plexuses of the small pelvis. In case of impaired blood circulation in the node, the pains are acute and very intense.

Painful sensations accompany the development of fibroids in every third woman and may have a different origin. With interstitial nodes of small size, painful menstruation is noted. Constant aching pains are observed with pronounced growth of nodes. With necrosis of the node, the pain syndrome is pronounced, there may be an increase in body temperature, and intoxication. Also, an emergency situation may arise if the patient has subserous nodes "on the leg". With a thin "leg" the knot is twisted; power is disturbed in the node. This situation is often manifested by an acute condition: severe pain syndrome, with the possible development of peritonitis. In such a situation, urgent surgical intervention is required.

Diagnostics

The diagnostic process for suspected myomatous formation involves the following measures:

Taking anamnesis. Particular attention is paid to the age criteria of the patient, since such myomatous pathology is found mainly in women of reproductive age. As a rule, women have complaints about menstruation, which can become longer, profuse, painful, irregular.
Ultrasound diagnostics of low-volume organs helps to accurately identify myomatous formation, determine its parameters, location.
Gynecological examination. It is performed on the gynecological chair with the necessary instruments. The size of the uterine body, the location of the ovaries, the shape and mobility of the neck, etc. are taken into account.
Diagnostic curettage. It is usually done to detect endometrial changes and to exclude cervical or uterine cancer.
Hysterographic examination. Hysterography refers to a radiopaque technique that allows you to visually see the uterine cavity. For this, a contrast agent is injected into the body of the uterus, and then a picture is taken.
Laparoscopy. This technique belongs to surgical methods. A laparoscope is inserted through punctures in the peritoneum and displays an image of the organ under study on the monitor. During the procedure, it is possible to obtain biomaterial for histology or to remove small tumors, etc.
Hysteroscopic examination. Helps to visualize the uterine cavity. It is performed using special equipment that is inserted into the uterus. This method is not only diagnostic, but also therapeutic. In this way, various polyps are removed, and a biomaterial is obtained for histological examination.

The approach to the treatment of uterine fibroids is determined in accordance with the stage of formation.

How to treat uterine fibroids?

There are two main treatments for uterine fibroids:

Conservative treatment - with medications and non-invasive procedures.
Surgical treatment - through surgery.

The choice of treatment method depends on the severity of the clinical symptoms of uterine fibroids, the size of the myomatous node, the woman's age, and the intention to have children in the future.

The conservative method is based on the use of hormonal drugs by mouth and injection, as well as symptomatic therapy (pain relief, treatment of anemia, reduction of blood loss, etc.). Conservative therapy is effective only for curbing tumor growth. It is impossible to eliminate uterine fibroids conservatively. Therefore, the non-surgical method of treatment is used mainly in women of older childbearing age.

At the same time, the growth of the tumor is inhibited until the onset of the menopausal period. At this time, the likelihood of spontaneous resorption of the tumor is high.

Treatment of fibroids without surgery

Non-surgical treatment of uterine fibroids is a complex of measures, including adherence to an appropriate diet, the use of immunomodulators, herbal medicine, permitted physiotherapy procedures, and hormonal drugs.

The course of treatment consists of the following stages:

Anti-inflammatory therapy of infectious processes in the gynecological sphere;
Activation of the immune system with special drugs;
Correction of diet and diet;
Normalization of the endocrine system;
Formation of an even psycho-emotional background;
Elimination of bleeding;
Treatment of anemia;
Bringing the menstrual cycle back to normal.

At home, the treatment of uterine fibroids without surgery consists in the use of the following drugs:

Antiprogestogens. Mifepristone (RU-486) \u200b\u200bis often used as a preparatory therapy before surgery or for the treatment of fibroids. This drug not only eliminates the symptoms of pathology, but also helps to reduce the size of the formation.
Agonists of gonadotropin-releasing hormone. The drugs in this group include: triptorelin - (Decapeptil, Differelin, Decapeptil depot), buserelin, goserelin (Zoladex), leuprorelin (Lukrin depot). The disadvantage of using these agents for the treatment of uterine fibroids is that after the end of therapy, the nodes can recover in size, and prolonged use of these drugs is not permissible, since it can lead to the development of osteoporosis and other consequences for the female body due to a lack of estrogen. Within six months of using these funds, the size of fibroids can be reduced by 50%, and the intensity of the symptoms of fibroids can also decrease. Often these drugs are used to shrink uterine fibroids before surgery to reduce blood loss during surgery.
Combined oral contraceptives. These include the following combinations: desogestrel with ethinyl estradiol (Mersilon, Marvelon, Novinet), ethinyl estradiol with norgestrel (Ovidon, Rigevidon). These remedies effectively help reduce the symptoms of uterine fibroids, such as lower abdominal pain, bleeding. However, for the treatment of uterine fibroids in order to reduce its size, tablets of this group are not a priority, since they do not always lead to a decrease in the nodes. Under the influence of such therapy, only the nodes, the initial size of which did not exceed 1.5 cm, can decrease in size.
Gestagens. The use of such funds today is a controversial issue, since some doctors believe that the use of such drugs, and in particular dydrogesterone ("Duphaston"), with uterine myoma is unacceptable. Others believe that the use of this drug is fully justified, since it is the lack of progesterone that is the reason for the growth of fibroids. The effectiveness of therapy with such agents as linestrenol ("Orgametril", "Escluton"), medoxyprogesterone acetate ("Provera", "Depo-Provera"), nor-ethisterone ("Norkolut", "Primolut-Nor") with uterine myoma has not been proven therefore, many gynecologists do not recommend these drugs. However, the use of these funds in combination with endometrial hyperplasia and uterine fibroids is justified. The growth of fibroids occurs not simply from a deficiency or an overabundance of a hormone, but rather from an imbalance between hormones, therefore, the use of such drugs should not be carried out everywhere, but if indicated.
Antigonadotropins. Danazol (Vero-Danazol, Danazol, Danoval, Danol, Danogen), gestrinone (Nemestran). In uterine fibroids, treatment with these drugs is rarely used, since they cannot reduce the size of the nodes, but only help to reduce the intensity of the symptoms of fibroids, moreover, they have a number of undesirable side effects, such as the occurrence of acne, voice changes, hair growth on the body and face. These drugs for fibroids can be used only with low efficacy of other treatments.

FUS ablation of fibroids

A method of treating fibroids, based on heating the tissues of the nodes with a high-intensity focused ultrasound, due to the transfer of a large amount of energy to a clearly localized area, after which the destruction of the tissue of the node occurs - thermal necrosis. The principle of operation is very similar to the concentration of sunlight with a magnifying glass. The pinnacle of the development of the method today is the combination of a focused ultrasound source (emitter mounted in a table) and an MRI machine. Ultrasound is performed through the anterior abdominal wall. The MRI scanner monitors the localization and, most importantly, the heating temperature in real time.

The method allows for the destruction of a well-defined area without damaging healthy tissue. The area between the "treated" and healthy tissue is only a few rows of cells. Thus, focused ultrasound has now more than ever approached the concept of “ideal surgical instrument”. The procedure does not require the introduction of instruments into the body cavity, pain relief and hospitalization, but it is not possible in all cases and requires the correct selection of patients. The substrate for exposure to focused ultrasound is the connective tissue located in the fibroid.

The connective tissue stores energy well and allows reaching the temperature required for thermal necrosis. Thus, the so-called fibroids, which account for 70% of all myomas, respond very well to the FUS method. Leiomyomas, or cell fibroids, are absolutely not suitable for FUS treatment due to the lack of a substrate for exposure and a high-intensity blood supply, which does not allow sufficient heating of the tissue.

During the testing of the method and its introduction into clinical practice, the wrong selection of patients was the cause of frequent relapses and was mistakenly interpreted as ineffectiveness of the method. To assess the possibility of FUS ablation, the patient must undergo an MRI scan, which determines the type of myoma. Recently, numerous works of various authors, based on retrospective studies of treated patients, have shown a high efficiency of the method, which is not inferior in terms of indicators to other methods of treating uterine fibroids, provided it is used correctly.

The indications for the use of FUS-ablation in relation to uterine fibroids are standard indications for organ-saving treatment for uterine fibroids. Depending on the clinical tasks set by the gynecologist, the technology can be used in four tactical options. 1. Organ-saving treatment of uterine fibroids. 2. Prevention of clinical manifestations of uterine fibroids (which makes it possible to abandon the expectant outpatient practice in relation to the growth of myoma nodes). 3. Preparation of the myoma node for transcervical myomectomy (as a result of FUS destruction, the size of the node and the intensity of blood flow decrease, which significantly reduces the risk of possible complications and facilitates the operation); 4. In order to delay surgical treatment.

Unlike other methods, FUS-MRI ablation of uterine fibroids is a non-invasive, organ-saving method, without hospitalization, without pain, keeps the woman the highest chances in comparison with other methods of a successful pregnancy, has the lowest percentage of complications among all the methods of treatment of uterine fibroids (currently less than 0.05%). The method has been recognized in many countries CE (Europe), FDA (USA), MHLW (Japan), CFDA (China), ANVISA (Brazil), Canada FDA, KFDA (Korea), RF, Taiwan.

Uterine artery embolization (UAE)

This is the introduction of special plastic balls into the uterine arteries in order to stop the blood supply to certain parts of the uterus and fibroids. The UAE procedure has very limited indications for use and is used mainly in women over 40 years of age with submucous myomatous nodes and severe uterine bleeding.

The use of uterine artery embolization methods in women of reproductive age, according to the recommendations of the European and American Societies of Obstetricians and Gynecologists, is prohibited. In the literature there are a huge number of publications illustrating the consequences of an unsuccessful uterine artery embolization. As a rule, these are young nulliparous women aged 25–35 years who have lost the opportunity to have children as a result of the UAE procedure for small fibroids that did not require treatment at all.

When is the operation to remove the uterus for fibroids indicated?

Indications for radical surgical treatment of uterine fibroids:

Tumor sizes from 12 weeks (a bulky tumor squeezes adjacent organs, blood vessels, interfering with their normal functioning);
Rapid growth of the myomatous node (from 4 weeks per year);
Myoma is the cause of massive bleeding;
Severe pain syndrome;
Torsion of the legs and necrotization of the myomatous node;
The birth of a submucosal myomatous node;
The combination of endometriosis and fibroids;
Suspected malignancy of fibroids.

Depending on the size, location and type of fibroids, the doctor chooses the most convenient type of surgery to eliminate it. Myomectomy today is performed in three ways:

laparoscopy - through a small hole in the abdomen;
through the vagina using a special instrument - hysteroscopy;
lane operation - in an open way, through an incision in the lower abdomen (very rare);
if sparing operations are impossible, and it is impossible to stop the growth of fibroids in other ways, treatment implies a complete resection of the uterus - hysterectomy.

Hysterectomy and laparotomy are the most popular methods of surgery, since they have a number of advantages: quick recovery after surgery, preservation of the ability to become pregnant and carry a child in the future, and almost complete absence of traces from the operation.

Prevention

Prevention of uterine fibroids consists in adherence to diet, sleep and rest, reduction of stressful situations. An important method for the prevention of uterine fibroids is timely pregnancy and childbirth (up to 25 years), as well as preventive examinations by a gynecologist.