Nutrition after hysterectomy cancer. Consequences for the female body after removal of the uterus with fibroids Causes and risk factors for uterine cancer

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Uterine cancer is common malignancy body of the uterus in women. It is also called endometrial cancer

Uterine cancer occupies 1st place in the structure of female oncological diseases of the reproductive system, cervical cancer ranks 2nd. Among all female malignant tumors, endometrial cancer is second only to breast cancer.

Uterine cancer most often affects women after menopause (over 50 years of age), with the peak incidence observed in women aged 65-69 years. Approximately 5-6% of cancer cases in women are uterine cancer. The most common symptom of endometrial cancer is the appearance of bloody discharge from the vagina outside of menstruation, which should always be a reason to consult a gynecologist.

In most cases, uterine cancer begins in the cells that make up the inner lining of the uterus - the endometrium, which is why uterine cancer is often called endometrial cancer. Less commonly, a malignant tumor forms from the muscle tissue of the uterus. This tumor is called a uterine sarcoma, and its treatment may differ from that of endometrial cancer. This article mainly describes endometrial cancer.

The exact cause of uterine cancer is unclear, but there are factors that may increase your risk of developing the disease. One of them is hormonal imbalance. In particular, the risk of developing uterine cancer increases with increasing levels of the hormone estrogen in the body. Hormonal imbalance can be caused by a number of reasons, including menopause, obesity, diabetes and hormone replacement therapy. The risk of developing uterine cancer also increases slightly with long-term use of a breast cancer drug called tamoxifen.

Symptoms of uterine cancer

The first signs of uterine cancer are watery leucorrhoea and bloody discharge from the vagina outside of menstruation. Gradually, the discharge becomes more abundant, more reminiscent of uterine bleeding. As a rule, any bloody vaginal discharge in menopausal women is suspicious for cancerous changes.

Possible signs of uterine cancer in women reproductive age are:

• heavier periods than usual;
• vaginal bleeding between periods.

More rare symptoms of endometrial cancer may include pain in the lower abdomen and discomfort during sexual intercourse.

If the cancer reaches an advanced stage, it may manifest itself as:

• pain in the back, legs or pelvic area;
• lack of appetite;
• fatigue;
• nausea and general malaise.

Vaginal leucorrhoea, and especially bloody discharge not associated with menstruation, should be a reason for mandatory consultation with a gynecologist. These symptoms are characteristic of many diseases: polyps or fibroids of the uterus, sexually transmitted infections, cancer of the uterus and other parts of the female reproductive system.

Causes and risk factors for uterine cancer

The body is made up of millions of different cells. Cancer develops when some of them begin to multiply indefinitely, forming a voluminous neoplasm - a tumor. A malignant tumor can affect any part of the body where a failure occurs in the system regulating cell division and growth.

Cancer of the uterus is prone to rapid growth and spread to neighboring organs and tissues. Typically, cancer cells spread throughout the body through the lymphatic or circulatory system. Lymphatic system- this is a set of nodes and channels distributed throughout the body and interconnected like circulatory system. Through lymphatic and blood vessels, tumor cells can spread to any part of the body, including bones, blood and organs. This is called metastasis.

Factors that increase the risk of developing uterine cancer:

• Age. The risk of developing uterine cancer increases with age; in most cases, the disease is diagnosed in women over 50 years of age.
• Estrogen. The risk of developing uterine cancer is related to the level of estrogen in the body. This is one of the hormones that regulate the female reproductive system. Estrogen stimulates the release of the egg from the ovary, the division and growth of endometrial cells. Progesterone prepares the lining of the uterus to receive an egg from the ovary. Normally, estrogen levels are kept in check by progesterone. But the hormonal balance in the body can be disrupted. For example, after menopause, the body stops producing progesterone but still produces small amounts of estrogen. This estrogen causes endometrial cells to divide, which can increase the risk of developing uterine cancer.
• Hormone replacement therapy. Because of the link between estrogen and uterine cancer, estrogen hormone replacement therapy should only be given to women who have had their uterus removed. In other cases, a combination of estrogen and progesterone must be given to reduce the risk of uterine cancer.
• Overweight or obesity. Since estrogen can be produced by fat tissue, being overweight or obese increases estrogen levels in the body. This significantly increases the risk of developing uterine cancer. The risk of developing uterine cancer in overweight women is 3 times higher than in women of normal weight. In case of obesity, it is 6 times higher than in women with normal weight. Therefore, it is important to know how to calculate body mass index.
• Lack of childbirth. Women who have not given birth are at higher risk of developing uterine cancer. This may be because the increase in progesterone and decrease in estrogen during pregnancy protects the lining of the uterus.
• Tamoxifen. Women who have taken tamoxifen (a hormonal drug to treat breast cancer) may have an increased risk of developing uterine cancer. However, the benefits of tamoxifen treatment outweigh this risk.
• Diabetes. Women with diabetes mellitus are twice as likely to develop uterine cancer than others. Diabetes increases insulin levels in the body, which in turn can stimulate estrogen production.
• Polycystic ovary syndrome (PCOS). Women with polycystic ovary syndrome (PCOS) are more susceptible to developing uterine cancer because they have higher levels of estrogen in their bodies. In women with PCOS, cysts form on the ovaries, which can cause symptoms such as irregular or light periods, amenorrhea, as well as problems conceiving, obesity, acne and excess hair growth (hirsutism).
• Endometrial hyperplasia. Endometrial hyperplasia is a thickening of the lining of the uterus. Women with this condition have an increased risk of developing uterine cancer.

Diagnosis of uterine cancer

The primary diagnosis of uterine cancer is carried out by a gynecologist. He performs a gynecological examination and may perform a number of other tests if necessary. If you suspect uterine cancer, your gynecologist will refer you for a consultation with a gynecologist-oncologist, who you can select by clicking on the link. In addition, additional tests and examinations will be required.

Blood for tumor markers.

To diagnose uterine cancer, a blood test is sometimes performed because the cancer releases certain chemicals into the blood, called tumor markers.

However, the results of blood tests for tumor markers are not always accurate and reliable. The presence of tumor markers in the blood does not mean for sure that you have uterine cancer, and in some women with uterine cancer, these substances are not found in the blood.

Transvaginal ultrasound

You may also have a transvaginal ultrasound (ultrasound). This is a type of diagnosis that uses a small scanning device in the form of a probe. It is inserted into the vagina to obtain a detailed image of the inside of the uterus. This procedure may be slightly uncomfortable, but is usually not painful.

Transvaginal ultrasound can detect thickening of the uterine mucosa, which may indicate the presence of a cancerous tumor.

Uterine biopsy

If a transvaginal ultrasound shows thickening of the uterine walls, you will most likely be prescribed a biopsy to clarify the diagnosis. A biopsy involves taking a small sample of cells from the lining of the uterus (endometrium). This sample is then tested in a laboratory for the presence of cancer cells.

A biopsy is performed in various ways:

• aspiration biopsy - a small flexible tube is inserted into the uterus through the vagina, which absorbs endometrial cells;
• hysteroscopy with biopsy - a small optical device is inserted into the uterus through the vagina, with which the doctor can examine the uterine mucosa and use a special surgical instrument to take a tissue sample from a suspicious area of ​​the mucosa.

As a rule, if uterine cancer is suspected, complete removal of the endometrium is performed during hysteroscopy - curettage. This is a simple surgical procedure performed under general anesthesia. The removed tissue is then sent to a laboratory for analysis.

Additional studies for uterine cancer

To determine the stage of cancer, tumor size, the presence of metastases (daughter tumors) and develop optimal treatment tactics, additional studies are prescribed:

• a chest X-ray to check if the cancer has spread to the lungs;
• magnetic resonance imaging (MRI) to identify metastases and clarify the size of the tumor;
• computed tomography (CT) scan, which uses a series of X-rays to create a detailed image of the inside of the body to check whether the cancer has spread to other organs;
• additional blood tests to check the general condition of the body and the functioning of certain organs.

Stages of uterine cancer

There are the following stages of endometrial cancer:

• stage 1- tumor within the body of the uterus;
• stage 2- cancer has spread to the cervix;
• stage 3- the neoplasm has spread beyond the uterus, damaging the surrounding tissues or lymph nodes;
• stage 4- cancer has spread to the soft tissue of the abdomen or to other organs, e.g. bladder, intestines, liver or lungs.

The chances of a cure for uterine cancer depend on the stage at which the disease is diagnosed. If uterine cancer is diagnosed at stages 1 or 2, you have a 70–80% chance of living another five years. Many women with stage 1 cancer are completely cured.

If the disease is diagnosed at stage 3, you have a 40-50% chance of living another five years. In approximately 25% of cases, uterine cancer is diagnosed at the fourth stage. By this time, the chances of living at least another five years are only 20–30%.

Treatment of uterine cancer

The main method for endometrial cancer is removal of the uterus, ovaries and fallopian tubes. Sometimes, depending on the stage and extent of the cancer, a combination treatment is used: after surgery, a course of radiation or chemotherapy is prescribed to kill any remaining cancer cells, if any.

In rare cases, in young women who have not yet reached menopause, the uterus is left in place to preserve reproductive function. Then uterine cancer is treated with hormone therapy.

In late, incurable stages of the tumor, chemotherapy is usually used. In this case, the goal of treatment is to achieve remission, when the cancer tumor decreases in size, thereby improving well-being and quality of life. But even in advanced cases of cancer, surgical treatment is sometimes performed to remove as many tumor cells as possible. In addition, radiation, hormonal or chemotherapy are prescribed to relieve pain, reduce the size of the remaining tumor and slow its growth.

Surgery for uterine cancer

The main method of treating stage 1 uterine cancer is extirpation of the uterus with appendages- complete removal of the uterus, cervix, ovaries and fallopian tubes. The surgeon may also take samples of cells from lymph nodes in the pelvis and abdomen, as well as other surrounding tissue. If cancer cells are found in them, the operation is complemented by removal of the lymph nodes.

Most often, an extirpation involves making one large incision in the abdomen so that the surgeon can access the uterus and remove it. This is called laparotomy. Sometimes it is possible to remove the uterus and appendages through small pinpoint incisions - laparoscopic access. During laparoscopic extirpation of the uterus and appendages, several small incisions are made through which a special optical device (laparoscope) and other surgical instruments are inserted. This allows the surgeon to see what is happening inside the abdomen and remove the uterus through the vagina.

Recovery after laparoscopic surgery is much faster, since the intervention is less traumatic for the body.

After surgery, even while in bed, it is recommended to start moving as soon as possible. This is important for improving blood circulation and preventing blood clots from blocking blood vessels. Your doctor at the hospital should show you exercises that will help you avoid complications.

Another possible treatment method With most early stages cancer of the uterine body is endoscopic endometrial ablation. This is the most gentle method of surgical treatment of a malignant tumor of the uterus. Ablation is used in pre- and postmenopausal women, when hysterectomy is contraindicated for health reasons and the woman does not plan to have children. The operation is performed without incisions. Special instruments are inserted through the vagina and cervix, which, using electric current or laser energy, destroy the entire endometrium along with cancer cells.

For stage 2 and 3 uterine cancer, extended hysterectomy is performed, that is, the uterus, cervix, upper part of the vagina, fallopian tubes, ovaries and fatty tissue are removed from lymph nodes surrounding these organs. After surgery, radiation or chemotherapy is often required to reduce the risk of tumor recurrence.

If the tumor has reached a large size and cannot be completely removed, cytoreductive surgery is performed - removing the maximum possible volume of cancer cells. The purpose of such an operation is to relieve symptoms, prolong life and improve its quality.

Radiation therapy for uterine cancer

Radiation therapy is used in combination with surgery to shrink a tumor before surgery or to prevent cancer from recurring after a hysterectomy. Radiation is sometimes used in cases where surgery is not possible.

Two types of radiation therapy are used to treat uterine cancer:

• contact radiation therapy (brachytherapy), when a plastic applicator with a radioactive source is inserted into the uterus and irradiation occurs with a large dose of directly affected tissue, with minimal impact on healthy organs;
• external beam radiotherapy, when the pelvic area is irradiated using a special device that focuses the rays at the location of the tumor, the effect extends to the surrounding tissue.

You will need to come to the hospital for external beam radiation therapy sessions five days a week, with a break on the weekends. The session lasts several minutes. The course of radiation therapy lasts about four weeks, depending on the stage of the cancer and the location of the tumor in the uterus.

In addition to external beam radiation therapy, some women also undergo contact radiation therapy (brachytherapy). There are different types of brachytherapy with low, medium or high dose radiation. At a low dose, radiation occurs more slowly, so the device can remain in the uterus longer. Contact radiation therapy is usually performed in a hospital setting. Discuss this with your doctor.

Radiation therapy has side effects: skin irritation and redness, hair loss, severe fatigue. Radiation therapy to the pelvic area can affect bowel function and cause nausea and diarrhea. Most side effects will go away once treatment is completed, but about 5% of women develop chronic side effects such as diarrhea and anal bleeding.

Chemotherapy for endometrial cancer

Chemotherapy is used more often after surgery to reduce the risk of cancer coming back as much as possible. Chemotherapy also treats late stages of cancer, when it is not possible to completely remove the tumor. Then this treatment method helps slow down the growth of the tumor, reduce the severity of symptoms, prolong life and improve its quality.

Typically, chemotherapy is carried out in cycles, periods of treatment - courses of chemotherapy, alternated with periods of rest so that the body can recover. Medicines are most often administered intravenously. Treatment is usually carried out in a hospital, but chemotherapy at home is sometimes allowed. This should be discussed with your doctor.

Side effects of chemotherapy:

• nausea;
• vomit;
• hair loss;
• fatigue.

The risk of blood poisoning (sepsis) also increases because chemotherapy weakens the body's ability to fight infections. Side effects should go away when you finish treatment.

Hormonal therapy for uterine cancer

Since the development of endometrial cancer may be associated with the influence of estrogen, in some cases hormonal therapy is used for treatment. Usually, for these purposes, synthetic progesterone or hormones that affect the function of the reproductive system are prescribed. Medicines are often administered intramuscularly at varying frequencies, depending on the treatment regimen. Sometimes they switch to tablet forms of hormones.

Hormone therapy is mainly used to treat early uterine cancer in young women for whom it is important to preserve reproductive function. If treatment is successful and the tumor has disappeared, women are given another hormone therapy regimen to restore their menstrual cycle. This takes about 6 months.

Hormone therapy is sometimes used as preparatory stage for surgery to reduce the size of the tumor. Less commonly, this type of treatment is prescribed at a later stage or if the cancer has grown again.

Treatment may have side effects, including mild nausea, mild muscle cramps, and weight gain. During therapy, menstruation stops and artificial menopause develops. Discuss this with your doctor.

Clinical trials

Much progress has been made in the treatment of uterine cancer. The life expectancy of women diagnosed with uterine cancer increases every year. It was possible to reduce the number of side effects from treatment. This is made possible in part by clinical trials, where new treatments and combinations of treatments are compared with standard ones.

For some cancer patients, participation in clinical trials offers a chance for a cure because the research uses new drugs that may be very effective in treating cancer. As a rule, these drugs are expensive, but are prescribed free of charge if you participate in the study.

If you are offered participation in a clinical trial, you will need to carefully read the study information and provide written consent. You can refuse or stop participating in the trial; this will not affect your treatment.

There is a unified database of clinical trials that are currently being conducted or planned to be conducted in Russia in the Oncology profile. With this information you can.

Living with uterine cancer

Surgery for uterine cancer and other treatment methods are difficult to tolerate. During the recovery period, which can take from one and a half to three months, you should not lift anything heavy (for example, children or heavy bags) or do housework that involves heavy physical exertion. It is recommended that you stop driving for 3-8 weeks after your hysterectomy.

At the end of the course of treatment, you need to undergo regular scheduled examinations. All women treated for uterine cancer are monitored by an oncologist. During scheduled visits to the doctor, the woman undergoes the necessary tests and sometimes undergoes instrumental studies (ultrasound, MRI, etc.) to monitor the tumor.

Sex and social adaptation after hysterectomy

Uterine cancer and its treatment can affect your sex life in the following ways:

• Premature onset of menopause: removal of the ovaries can provoke premature decline of a woman’s reproductive function and a failure in the production of sex hormones. Symptoms of menopause include vaginal dryness and loss of sex drive.
• Vaginal changes: After radiation treatment for uterine cancer, the vagina may become narrower and less elastic. Sometimes this is an obstacle to intimacy. The use of vaginal dilators can help - special plastic cones that need to be inserted into the vagina to stretch its walls. You can stretch the vagina while having sex, or using your fingers or a vibrator.
• Decreased libido: After treatment for uterine cancer, many women lose interest in sex. Treatment can cause severe fatigue, diagnosis can cause nervous shock, and the inability to have children can cause confusion and depression.

Therefore, a temporary loss of interest in sexual activity is quite natural. Try to discuss your feelings with your partner. If you notice that problems in your sex life do not go away over time, find a good psychotherapist. Your doctor may prescribe you a course of antidepressants or suggest psychotherapy sessions. There are cancer support groups where you can get advice from someone who has been through the same thing as you.

To get advice, moral support, help in solving legal and even medical issues, you can visit the portal “Movement Against Cancer” or “Project CO-Action”, which provides comprehensive support to people with oncological diseases. All-Russian 24-hour hotline for psychological assistance to cancer patients and their loved ones 8-800-100-01-91 And 8-800-200-2-200 from 9 to 21 o'clock.

Benefits for cancer patients

Paid sick leave is issued for the entire period of treatment and rehabilitation. If, after treatment, work limitations remain or the woman can no longer perform her previous job (for example, related to hazardous working conditions), she is sent for a medical examination to register disability. In the future, a cash disability benefit will be provided.

Cash benefits are also paid to unemployed citizens caring for a seriously ill person. Your attending physician should provide you with more detailed information.

Patients with cancer have the right to receive free medicines from the list of preferential medicines. To do this, you will need a prescription from your doctor. Sometimes a prescription is issued by a medical commission.

Prevention of uterine cancer

Unfortunately, there are no reliable ways to definitely protect yourself from uterine cancer. However, there are many factors known that, by avoiding them, can significantly reduce the risk of endometrial cancer.

The most effective way to prevent uterine cancer is to maintain normal weight. The best way to prevent excess weight or obesity - eat right and exercise regularly.

A diet low in fat and high content fiber, including whole grains and at least five servings of vegetables and fruits per day (totaling about 400-500 grams per day). Some research suggests that a diet rich in soy products may help prevent uterine cancer. Soy contains isoflavonoids that protect the lining of the uterus. In addition to soy itself, you can eat tofu cheese. However, reliable evidence for this hypothesis is still insufficient.

For most people, at least 150 minutes (two and a half hours) of moderate-intensity aerobic activity (such as cycling or brisk walking) per week is recommended. It is best to distribute this load throughout the week into at least five separate workouts. If you have never exercised or haven't exercised for a long time, take a medical checkup before starting training.

Research results have shown that long-term use of oral contraceptives may reduce the risk of developing uterine cancer. Other types of birth control, such as the contraceptive implant and intrauterine system, release progestogen (synthetic progesterone). It may also reduce the risk of developing uterine cancer.

Which doctor should I see if I have uterine cancer?

Using the NaPravku service you can find a gynecologist-oncologist or oncologist. If necessary, you can call an oncologist at home. On our website you can choose an oncology clinic or oncology center by reading reviews and other information about them.

Localization and translation prepared by Napopravku.ru. NHS Choices provided the original content for free. It is available from www.nhs.uk. NHS Choices has not reviewed, and takes no responsibility for, the localization or translation of its original content

Copyright notice: “Department of Health original content 2019”

All site materials have been checked by doctors. However, even the most reliable article does not allow us to take into account all the features of the disease in a particular person. Therefore, the information posted on our website cannot replace a visit to the doctor, but only complements it. The articles have been prepared for informational purposes and are advisory in nature.

This is a disease caused by malignancy of the tissue cells of the mucous membrane or walls of the uterus - the endometrium or myometrium. The inner layer of the walls of this organ is built from endometrial cells, on which a fertilized egg develops, and if this does not happen, the layer is torn off and removed through the vagina to the outside during the next menstruation. Myometrium is the building material of the muscle tissue of the uterus itself and its cervix, with the help of which the organ makes contractile movements.

Minimum required knowledge about tumors

Cancer of the body or cervix occurs when the normal process of cell growth is disrupted and dead cells are replaced by new, healthy ones. A failure and cell division occurs, which becomes uncontrolled - their number begins to rapidly increase and form into tumor tissue. A neoplasm occurs, most often in the cervix, which can be either benign or malignant, giving metastases.

If benign neoplasms are relatively harmless and their timely treatment, for the most part, leads to a complete and final recovery - relapses occur extremely rarely, then malignant tumors, especially the cervix, often lead to surgery to remove the woman’s reproductive organ. And even after such an intervention, not all patients live long.

Neoplasms with malignant histology often lead to irreparable consequences and even death of the patient. Treatment is complicated by the fact that such tumors are prone to relapse and often affect neighboring organs and tissues, and sometimes quite distant ones. The spread (metastasis) of the tumor occurs by the transfer of its cells through the lymphatic and blood channels. Metastases can occur anywhere, in the liver, lungs and even in bone tissue and in the brain - the brain and spinal cord. Having established themselves on the organ, malignant cells begin to actively divide and form an additional focus - metastasis. If timely measures are not taken, such metastases quickly affect almost all organs, and in such a situation, even surgery is often powerless. Knowing this, it becomes clear that early diagnosis of cervical cancer is of paramount importance, especially for women at risk.

Categories of people at increased risk of this disease

First of all, women whose close relatives had similar problems at a young age, under 40, need to be attentive. The following conditions increase the risk of uterine cancer:

• Endometrial hyperplasia is the excessive growth of endometrial cells on the inner surface of the uterus and its cervix. This type of tumor is not malignant in nature, but is prone to degeneration into it. External manifestations of hyperplasia are painful and excessively heavy periods with bloody discharge between them, and after menopause periodic bleeding;
• Excess weight also increases the risk of cancer of the endometrial cells of the uterus;
• Early, before 12 years and late after 55 years of menstruation indicate a physiology predisposed to disorders of cellular genesis and the appearance of a malignant focus in the uterus;
• Long-term use of hormonal drugs, such as estrogen, for replacement treatment menopause or tamoxifen, in the treatment of breast cancer;
• Radiation therapy focused on the pelvis;
• Not proper nutrition. Women whose diet is dominated by fatty foods of animal origin get sick more often than vegetarians.

Belonging to a risk group is far from a reason to panic and rush to the doctors, but it is still worth reconsidering your lifestyle. It may be worth changing your diet - add plant products, play sports, and give up bad habits, at least twice a year, undergo an examination by a gynecologist and, at the slightest suspicion of oncology, seek help immediately.

Signs of a cancerous tumor in the uterus

Most often, the primary sign of a tumor in the uterus is vaginal discharge that is atypical for a woman. At first, they are mostly watery with a small amount of blood, and as the tumor develops, the discharge turns into full-fledged bleeding. As additional symptoms we note:

• Impaired urination - the process causes difficulties and becomes painful;
• Pain in the pelvic area;
• Discomfort that turns into pain during sexual intercourse.

The difficulty of early diagnosis lies in the similarity of the symptoms of uterine cancer with the manifestations of other pathologies, so if you notice something similar in yourself, be sure to undergo an examination. Even if the symptoms are not cancer, but another disease, early diagnosis will not hurt at all, on the contrary.

Diagnostics, treatment, rehabilitation

Any treatment begins with a quality diagnosis, which should include the following series of studies:

• Gynecological examination and palpation;
• Ultrasonic;
• Hysteroscopic;
• Biopsy.

We will not go into the details of each, we will only note that the most informative, and therefore important, is considered to be a biopsy. Only it allows a clear differentiation of the tumor according to its histological identity, and this makes it possible to determine the approximate rate of development of the oncological process. Tumors of high differentiation grow most rapidly and vice versa.

In addition to differentiating the tumor, it is extremely important to determine the degree of development of the pathology. To do this, determine the extent of the affected area, the presence and number of metastases (if any) of the primary tumor.

There are five stages of tumor development, we will describe them briefly and in the order of development:

• 0 - Cancer cells were found only on the inner lining of the uterus;
• 1 – The tumor has grown into the endometrium;
• 2 – Damage to the cervix is ​​observed;
• 3 – Tumor growth is significant. All layers of the reproductive organ, its neck, are affected, metastases have appeared in the vagina and local lymph nodes;
• 4- The most severe degree of damage - in addition to local pelvic organs, distant lymph nodes and organs are affected by metastases, body temperature is increased.

Therapeutic measures

Treatment of uterine cancer, like any other malignant tumor, can be successful only with the complex use of known methods - surgery, radiation, chemical and hormonal therapy. The number of methods and their combinations are selected by the doctor depending on the indications for each patient individually.

Surgery

It is believed that without an operation to surgically remove the tumor focus, it is extremely difficult, and sometimes impossible, to achieve positive results, therefore, most often, to combat uterine cancer, a hysterectomy is performed - complete removal of the uterine body.

Depending on the indications, the operation can be extended to the ovaries with fallopian tubes, the vaginal area and regional lymph nodes affected by metastases of the primary tumor.

The operation is relatively simple and the patient is often discharged from the hospital within a week after the operation, and 1 to 2 months are enough for rehabilitation and return to a normal lifestyle. Sometimes postoperative side effects occur, for example, nausea, increased fatigue and weakness, problems with urination, but this is a temporary phenomenon, and everything returns to normal over time.

Patients who undergo hysterectomy during their childbearing years lose the ability to become pregnant and bear a child. After the operation, they experience hot flashes, increased sweating (especially at night) and unusual vaginal dryness for some time. This is due to a significant decrease in the amount of female hormones.

When lymph nodes are removed, swelling of the lower extremities often occurs - lymphedema. To relieve this symptom, therapeutic massages and creams are used.

Radiation therapy

Radiation therapy is used both before surgery to minimize the size and activity of the tumor, and after, to reduce the risk of relapse. Radiation is also used in cases of severely advanced disease, when surgical intervention is impossible or not advisable.

Radiation therapy is divided into 2 types according to the site of application - external and internal. In the first case, irradiation is carried out into the pelvic area from outside. The course of treatment, as a rule, lasts from one to several weeks - the tumor is irradiated 5 times a week, for several minutes. In the second case, a special micro-emitter is used, inserted into the vagina - closer to the tumor site.

Combining radiation and chemotherapy gives good results.

Radiation therapy has proven its effectiveness in the fight against cancer over time, but it has a significant drawback - serious consequences for the body:

• Nausea;
• Vomit;
• Diarrhea and, on the contrary, constipation;
• Urinary disorders;
• Local baldness;
• Radioactive burns of the irradiated tissue area;
• Prolonged weakness and fatigue.

If the scope of the operation is limited to removal of the uterus, there is a high probability of disruption of the functionality of the ovaries and cessation of the menstrual cycle. Unfortunately, these problems do not always normalize, especially in women over 40. These phenomena are accompanied by symptoms typical of menopause.

With properly organized rehabilitation measures, in the vast majority of cases, these symptoms disappear over time.

Chemical therapy

Chemotherapy involves the use of special drugs that have a destructive effect on cancer cells. It is carried out in patients with cancer stages 2, 3 and 4, as a treatment that reduces the likelihood of relapse or together with surgery. Like radiation, chemotherapy is also used if surgery is impossible or if there is uncertainty about complete removal of all tumor foci. At the last stages - 3 and 4 stages of cancer, it is combined with radiation therapy for a more severe effect on cancer cells.

Chemotherapy is carried out cyclically, with a regularity determined by the doctor, by intravenous administration drug into the blood. Depending on the patient’s condition, treatment is carried out both on an outpatient basis and in inpatient conditions under constant supervision.

Cytostatics are drugs used in chemotherapy that destroy cancer cells, and healthy ones also suffer. In addition, chemotherapy introduces a fairly decent dose of toxins into the body, which cannot but lead to unpleasant side effects:

• Susceptibility to infectious diseases;
• Bleeding;
• Hair coloring and hair loss;
• Constipation, diarrhea;
• Loss of appetite;
• Nausea and vomiting.

All this is accompanied by weakness, chronic fatigue and apathy.

Hormone therapy

This type of treatment is effective only if hormonal tumors are detected - those that require certain hormones for their vital functions and die in the presence of others. As a rule, hormonal therapy is used to treat an extensively metastatic tumor, to reduce the rate of progression of the disease, or to treat the early stages of uterine cancer, provided that removal of the uterus is not acceptable - the woman wants to preserve the opportunity to have a child.

Side effects depend on the hormone used. If progesterone is used, the patient may gain significant weight and experience swelling and tenderness in the breasts.

Diet during treatment

Proper nutrition during treatment for uterine cancer helps the body recover faster. It is necessary to maximize the consumption of vegetables and fruits, and, on the contrary, exclude food products containing animal fats. They are replaced with fish meat, which is rich in fatty acids, and they have properties that inhibit cancer cells. Must be included in your diet dairy products and green tea.

Your doctor or specialist nutritionist will prescribe a specific diet.

Where to get treatment?

Israeli medicine is rightfully considered the best, but one should not neglect domestic specialists. For example, at the nuclear medicine center in Kazan, they use a unique method complex treatment any forms of cancer of the uterus and its cervix with subsequent rehabilitation. For this purpose, modern unique installations are used, of which there are only two in the world.

The treatment here is so successful that women from all over the country and even foreigners come to Kazan. The Kazan Center for Nuclear Medicine, in addition to the highest level of services provided, has one more advantage - for Russian women, examination and treatment are absolutely free, but for foreigners who are not averse to going to Kazan treatment center, are forced to pay for their treatment. This interest of foreign citizens is due not only to the cost of treatment, which in their countries is significantly higher than in the Kazan Nuclear Medicine Center, but also to its high quality.

Forecasts for the course of the disease

The main question is how long do women with uterine or cervical cancer live? The answer depends primarily on the stage of the disease and the histology of the cancer cells.

Zero – the stage of appearance of cancer cells, the least dangerous – a complete cure is almost always possible. Such patients live after anti-cancer therapy, live as long as they want. At the first stage of the disease, at least 8 women out of 10 complex therapy, live more than five years. The second stage leaves only 6 out of 10 patients a chance of five-year survival; the third stage is treated very poorly, only a third survive for 5 years. But how long do patients with stage 4, the last stage of uterine cancer live, is a complex and practically unpredictable question. It all depends on large quantity factors - how old the patient is, what is the general physical condition of the body - its susceptibility to radiation and chemotherapy, what is the degree of differentiation of the tumor. And even with the most favorable combination of all these factors, patients with stage 4 uterine cancer have a low chance of five-year survival - no more than 7%.

Video on the topic

Depending on the degree of tumor development, removal of uterine cancer is impossible without a hysterectomy (removal of the uterus itself). There are the following types of hysterectomy:

1. Radical removal of the uterus (hysterectomy). With this method, the uterus, cervix and appendages are removed. The upper part of the vagina and lymph nodes located in the pelvis are also removed;
2. Total hysterectomy. Involves removal of the cervix and body of the uterus;
3. Supravaginal amputation. The cervix remains intact in the pelvis. The fallopian tubes and ovaries also remain.
Doctors prescribe each of these methods for a certain stage of cancer development. for carcinoma of the body and cervix, total resection is performed; the body of the uterus is removed if there are abundant uterine bleeding, pelvic pain and there are voluminous fibroids; if there is a high probability of the tumor spreading to the ovaries, then they and the uterus itself are removed; in the presence of cervical cancer, when the endometrium is affected, all organs responsible for reproduction are removed.
For women over 40 years old, i.e. after active reproductive age, radical methods are definitely used. For younger women, they try to preserve their reproductive organs in the absence of poorly differentiated types of cancer.

How is the uterus removed?

There are several main methods in which it is most convenient to remove the uterus.
1. Laparoscopic. Several incisions are made on the abdomen and an optical device is inserted that can transmit a picture of the insides to the monitor. The surgeon uses special thin instruments to perform the operation.
2. Laparotomy (abdominal hysterectomy). The surgeon, through a large longitudinal or transverse incision in the abdomen, can see the uterus and other organs and perform the operation. Indications for this method of removal are: a large area of ​​damage to the uterus and other organs; large size of the uterus; the presence of extensive adhesions; emergency intervention.
3. Vaginal method. A laparoscope is inserted into the vagina and surgery is performed.
The most optimal way to access the uterus is not big size is an incision in the upper part of the vagina, which facilitates the intersection of the uterine ligaments, ligation of blood vessels, fallopian tubes and ligaments.

Once the uterus is removed, uterine cancer is no longer possible and the risk of developing ovarian cancer is also significantly reduced.
Indications for hysterectomy surgery
The uterus will have to be removed in the following cases: the presence of uterine fibroids; prolapse or severe prolapse of the uterus; adenomyosis, growth of the endometrium; failure of menstruation due to changes in the endometrium; chronic pain in the pelvis or lower abdomen; benign tumor of the uterus and ovaries; the presence of malignant neoplasms; pedunculated myomatous node with the possibility of torsion; death of the uterine fibroid node.

Preparing for surgery.

Each surgical intervention is preceded by a thorough examination. A planned operation to remove the uterus will be possible only if the following procedures are performed: a satisfactory vaginal smear; negative culture for microflora; negative test for sexually transmitted infections; good tests blood and urine; varicose veins in the legs were treated and vascular diseases and heart pathologies.
If there are large fibroids, additional hormonal therapy will be performed.
On the eve of the operation, the patient’s blood type and Rh factor are determined and a supply of their own blood is made. A woman should be on a certain diet, taking only liquid foods to avoid constipation after surgery. The evening before surgery, the patient must cleanse herself with an enema. After six in the evening and in the morning next day You can't eat food. It is recommended to take in the evening and morning sedative in the form of an injection or in the form of a tablet.

Contraindications for surgery

Laparoscopy cannot be done if there is uterine prolapse, it is large, or there are ovarian cysts large sizes.
The vaginal method is prohibited if the uterus is large, if there is cancer that can grow into the pelvic organs, if there are adhesions after caesarean section and in the presence of inflammation of other internal organs.
Laparotomy is not used in the presence of any acute or exacerbation chronic disease, at pathological processes accompanied by elevated temperature during menstruation.

Progress of the operation

For surgery to remove the uterus, it is necessary to do general anesthesia. In rare cases, spinal or combined (spinal and intravenous) anesthesia is used.
With the laparoscopic method, the patient is placed on his back and the area is treated with alcohol and iodine. The surgeon makes several small incisions. An optical device is lowered into one, and air is pumped into the other into the peritoneal area.

Controlling the entire process with his own vision, the surgeon inserts instruments through the incision and removes the uterus, ligating the vessels and ligaments.
With the laparotomy method, the patient also lies on his back, and the surface is treated with alcohol and iodine. An incision is made in the linea alba area of ​​the abdomen. All tissues are carefully cut layer by layer until the uterus is reached and it and other affected organs are removed. Be sure to make sure that there is no bleeding from small vessels and sew up the incision.
Vaginal surgery is also performed on the back with legs bent and spread apart. Speculums are inserted into the vagina. An incision is made in the upper part of the vagina, through which the uterus is removed, the blood vessels and the entire ligamentous uterine apparatus are ligated.

What to expect after hysterectomy?

After the removal of one uterus, the so-called “surgical menopause” will occur. The ovaries will continue to produce sex hormones as before. If age-related menopause has not yet occurred, then the following can be observed: the estrogen produced will preserve the integrity of the woman’s bone tissue, improve the functioning of the heart and the whole vascular system; libido will be preserved thanks to the testosterone produced; the presence of PMS will persist if it is present before surgery; inability to get pregnant.
If a woman was already in menopause, then she will not notice any changes at all. Only women who have not reached menopause and have had both the uterus and ovaries removed will feel them. These may be: excess weight, hot flashes, brittle bones (osteoporosis), sagging skin.

What to do after surgery?

Before getting out of bed for the first time, you need to take measures to prevent the development of varicose veins: bandage your legs, put on special stockings/socks. The abdomen must be wrapped in a bandage. For the first five days after the operation, the woman lives on painkillers, which are administered in the form of injections, and after that they are left only in the form of tablets. The patient is discharged 3-5 days after surgery

Pain and discomfort persist differently depending on the type of surgery performed: with abdominal surgery, recovery occurs within 6 weeks. During this time, you should not carry weights weighing more than 3 kg, have sex, take baths, or swim in ponds. with laparoscopic method painful sensations appear within 2 weeks. The same rules of behavior should be followed.

Possible complications

Complications are possible after any surgical intervention. During a hysterectomy, the following may occur: bleeding of varying intensity; formation of hematomas at the suture site; injury to neighboring organs (intestines, bladder); thrombosis in the veins; discomfort when urinating; infection surgical suture; vaginal prolapse; symptoms of menopause during removal of the uterus and ovaries; infertility; recurrence of endometriosis on the uterine stump. This entails removal of the stump.
The patient should pay attention to the following symptoms and tell her doctor about them: weakness for a longer period, increased body temperature, bleeding, difficulty breathing, fainting, rapid heartbeat or irregular heartbeat.

How to live after hysterectomy surgery?

The recovery process takes place after 1.5-2 months after surgery. Most women experience a surge of strength, feel joy in life, they are no longer afraid of dying, because... no more tumor. The pain has disappeared, there is no bleeding. Libido is restored and the desire to have sex arises, which may be even stronger than before the operation. There is no fear of getting pregnant. However, many women are also depressed by the lack of the main reproductive organ, which gave them the ability to give birth to children. The patient's family needs to be given strong moral support to help them cope with such a loss.

After the uterus is removed, the cancer can still come back. For timely diagnosis, it is necessary to regularly undergo smears and visit a gynecologist.
Basic advice for future lifestyle Sexual activity can be resumed 1.5-2 months after removal of the uterus. Sex shouldn't be painful or uncomfortable.

Exercise your lower organs with Kegel exercises. This will prevent you from experiencing vaginal prolapse, constipation and urinary problems. Take medications to prevent osteoporosis and atherosclerosis. Follow a diet, give up unhealthy fatty, spicy, fried foods and sweets. Visit more fresh air, relax, engage in light sports.
Remember that by having surgery, you saved your life. It is quite possible to cope with the unpleasant consequences that appear and get used to them. The main thing is that now you are healthy and can to the fullest Enjoying life.

Doctor of Medical Sciences, Professor Afanasyev Maxim Stanislavovich, oncologist, surgeon, oncogynecologist, expert in the treatment of dysplasia and cervical cancer

Historically, medicine has established the opinion that the uterus is needed only for bearing a child. Therefore, if a woman does not plan to give birth, she can safely resort to surgery.

Is this really true or not? Why, for example, in March 2015, Angelina Jolie had both ovaries and fallopian tubes removed, but left an “unnecessary” uterus? Let's find out together whether hysterectomy is dangerous. And if it’s dangerous, then with what.

From the surgeon’s point of view, a radical operation solves the issue “at its root”: no organ, no problem. But in fact, surgeons’ recommendations cannot always be perceived as objective. They often do not follow up with patients after discharge, do not conduct examinations six months, a year, 2 years after removal of the uterus, and do not record complaints. Surgeons only operate and rarely face the consequences of the operation, so they often have a false idea about the safety of this operation.

Meanwhile, scientists from different countries independently conducted a series of observations. They found that within five years after hysterectomy, most women developed:

1. (previously absent) pelvic pain of varying intensity,

2. problems with the intestines,

3. urinary incontinence,

4. vaginal prolapse and prolapse,

5. depression and depression, up to serious disorders psyche,

6. emotional and physiological problems in relationships with your spouse,

7. Some women who were operated on for severe dysplasia or in situ cancer experienced a recurrence of the disease - damage to the stump area and vaginal vault.

8. fatigue,

9. persistent increase in blood pressure and other serious cardiovascular problems.

The problem is not invented, because according to the Scientific Center for Obstetrics, Gynecology and Perinatology of the Russian Academy of Medical Sciences, various operations to remove the uterus account for from 32 to 38.2% of all abdominal gynecological operations. In Russia, this is about 1,000,000 uterus removed annually!

The problem also has another side. Since all of these complications develop gradually, over the course of a year or several years after surgical intervention, women do not associate the deterioration in their quality of life with the previous operation.

I am writing this material so that you can evaluate for yourselfall the pros and cons of the operation, weigh the pros and cons,and make your choice consciously.

My practice shows that there are no extra organs. Even for older women, hysterectomy has negative health consequences, and I will discuss them in detail in the second part of this article.

Diagnoses that are no longer indications for hysterectomy

Thanks to the introduction of high-tech methods, some of the indications for genital removal have ceased to be absolute indications. Here is a list of diagnoses for which removal of the uterus in women can be replaced by other treatment methods and the organ can be saved.

1. Symptomatic, enlarged, rapidly growing uterine fibroids are today treated by embolization of the uterine arteries: the vessels feeding the fibroids are blocked. Subsequently, the fibroid gradually resolves.

2. Adenomyosis, or internal endometriosis, can be eliminated using a therapeutic method (PDT).

Endometriosis causes cell proliferation inner shell uterus in atypical places. PDT specifically destroys these cells without affecting healthy tissue.

Photodynamic therapy is an organ-preserving treatment method that is included in the federal standard of care (see).

3. Precancerous condition of the endometrium -, – are also treatable using PDT. To date, I have successfully treated 2 patients with this pathology.

In cases where hyperplasia is predominantly viral in nature, treatment with PDT can eliminate the cause of the disease. In the treatment of cervical pathologies, the complete destruction of the human papillomavirus after one PDT session is confirmed in 94% of patients, and in 100% of patients after a second PDT session.

4. Precancerous conditions and oncological formations in the cervix. , and even microinvasive cancer can be completely cured using photodynamic therapy in 1 or 2 sessions.

The PDT method eliminates not only the disease itself, but also its cause – the human papillomavirus.

That's why correctly and completely Photodynamic therapy performed is the only method that ensures lifelong recovery and minimal risk of relapse (reinfection is possible only in case of re-infection with HPV).

There is one more good news. Previously, a combination of age and several gynecological diagnoses was a compelling reason for organ removal. For example, a combination of cervical condylomas and uterine fibroids, or cervical dysplasia with adenomyosis against the background of a completed labor function.

To justify the removal of an organ, the surgeon usually does not give rational arguments, but refers to his own experience or established opinion. But today (even if the attending physician tells you otherwise) a combination of several diagnoses is no longer a direct indication for removal of the uterus. Modern medicine considers each diagnosis as independent, and for each treatment tactics are determined individually.

For example, dysplasia and adenomyosis regress after photodynamic therapy. And the presence of multiple fibroids is not a reason for oncological alertness. Numerous observations in recent years show that fibroids are in no way associated with cancer and do not degenerate into cancerous tumor and is not even a risk factor.

In surgery, there is a concept of risks of therapeutic effects. The task of a good doctor is to minimize risks. When a doctor decides on treatment tactics, he is obliged to evaluate the indications, weigh the possible negative consequences of different treatment methods, and choose the most gentle and effective one.

By law, doctors must inform about all possible treatment methods, but in practice this does not happen. Therefore, against the backdrop of the surgeon’s urgent recommendations for organ removal, I strongly advise you to consult several specialists or write me to evaluate the possibility of performing organ-conserving treatment that is suitable for you.

Unfortunately, not all diseases of the uterus can be treated with minimally invasive and therapeutic methods, and in some cases it is still better to remove the uterus. Such indications for removal are called absolute - that is, not requiring discussion.

Absolute indications for hysterectomy

1. Uterine fibroids with necrotic changes in the node. Preservation of an organ with such a diagnosis poses a threat to life.

2. Prolonged uterine bleeding that cannot be stopped by any other means. This condition is fraught with the loss of a large volume of blood and poses a serious danger to life.

3. Combination of large uterine fibroids and cicatricial deformation of the cervix.

4. Uterine prolapse.

5. Cancer, starting from stage I.

6. Gigantic sizes tumors.

Depending on the indications, operations on the uterus are performed using different methods and in different volumes. First, we will get acquainted with the types of surgical interventions. Then I will dwell in detail on the consequences that every woman will experience to one degree or another after the removal of this organ.

Types of hysterectomy operations

In medical practice, abdominal and endoscopic removal of the uterus is performed.

• Abdominal surgery (laparotomy) is performed through an incision on the anterior abdominal wall.
  The method is considered traumatic, but it provides great access and in some cases there is simply no alternative. For example, if the uterus has reached a large size due to fibroids.
• The second method is endoscopic surgery (laparoscopy). In this case, the surgeon removes the uterus through punctures in the anterior abdominal wall. Laparoscopic hysterectomy is much less traumatic and allows for faster recovery after surgery.
• Vaginal hysterectomy is the removal of the uterus through the vagina.

Consequences after abdominal hysterectomy surgery

Abdominal surgery to remove the uterus through a large incision is one of the most traumatic procedures. In addition to the complications caused directly by the removal of the uterus, such an operation has other negative consequences.

1. After the operation, a noticeable scar remains.

2. High probability of hernia formation in the scar area.

3. Open surgery usually leads to the development of extensive adhesions in the pelvic area.

4. Rehabilitation and restoration (including performance) requires a lot of time, in some cases up to 45 days.

Removal of the uterus without the cervix. Consequences of supravaginal amputation of the uterus without appendages

Whether the cervix is ​​left or removed during a hysterectomy depends on the condition of the cervix and the risks associated with retaining it.

If the cervix is ​​left, this is the most favorable situation possible.

On the one hand, due to the preserved ovaries, the hormonal system continues to function more or less normally. But why do they leave the cervix when removing the uterus? Preserving the cervix allows you to maintain the length of the vagina, and after restoration the woman will be able to lead a full sex life.

Removal of the uterus without ovaries. Consequences of hysterectomy without appendages

Removal of the uterus without appendages, but with the cervix, is a more traumatic operation.

By leaving the ovaries, the surgeon allows the woman to maintain normal hormonal levels. If the operation is performed at a young age, the ovaries can avoid menopause and all associated health consequences.

But even after removal of the uterus without appendages, the anatomical relationship of the organs is disrupted. As a result, their function is impaired.

In addition, complete removal of the uterus, even with preservation of the ovaries, leads to shortening of the vagina. In many cases, this is not critical for sex life. But the anatomy of the organ is different for everyone, and not all women manage to adapt.

Removal of the uterus with appendages

This is the most traumatic operation that requires a lot of recovery time.

It requires serious hormonal correction and usually causes all the most severe consequences, especially if performed at the age of 40-50 years - that is, before the onset of natural menopause.

I will tell you more about the most common consequences of hysterectomy below. The most unpleasant thing is that all these consequences are irreversible and practically impossible to correct.

Meanwhile, a series of recent scientific research in this area says the opposite. Even if the ovaries are preserved, removal of the uterus is an operation with a high risk of endocrine disorders.

The reason is simple. The uterus is connected to the ovaries and tubes by a system of ligaments, nerve fibers and blood vessels. Any operation on the uterus leads to serious disruption of the blood supply to the ovaries, up to partial necrosis. Needless to say, in literally suffocating ovaries, the production of hormones is disrupted.

Hormonal imbalances manifest themselves in a whole string of unpleasant symptoms, the most harmless of which is a decrease in libido.

In the vast majority of cases, the ovaries are not able to completely restore or compensate for normal blood supply. Accordingly, hormonal balance is not restored female body.

Consequence 2. Ovarian cysts after removal of the uterus

This is a fairly common complication in cases where the ovaries are preserved after removal of the uterus. This is how the negative impact of the operation itself manifests itself.

To understand the nature of the cyst, you must first understand how the ovaries work.

In fact, the cyst is a natural process that occurs every month in the ovary under the influence of hormones and is called a follicular cyst. If the egg is not fertilized, the cyst bursts and menstruation begins.

Now let's see what happens to the ovaries after removal of the uterus.

The uterus itself does not produce hormones. And many surgeons assure that after its removal the hormonal levels will not change. But they forget to say how closely the uterus is connected to other organs. When separating the ovaries from the uterus, the surgeon inevitably disrupts the blood supply and injures them. As a result, the functioning of the ovaries is disrupted, and their hormonal activity decreases.

Unlike the uterus, the ovaries produce hormones. Disturbances in the functioning of the ovaries lead to disruption of hormonal levels and the process of follicle maturation. The cyst does not resolve, but continues to grow.

It takes about 6 months to restore the full functioning of the ovaries and level out hormonal levels. But not always everything ends well, and the enlarged cyst resolves. Often, repeated surgery is required to remove an overgrown cyst - with large tumors there is a risk of rupture and bleeding.

If, several months after removal of the uterus, pain appears in the lower abdomen, which increases over time, you should visit a gynecologist. The most probable cause, why does the ovary hurt, it’s an overgrown cyst.

The likelihood of developing this complication is only 50% dependent on the skill of the surgeon. Every woman's anatomy is unique. It is not possible to predict the location of the ovaries and their behavior before surgery, so no one can predict the development of a cyst after removal of the uterus.

Consequence 3. Adhesions after hysterectomy

Extensive adhesions after removal of the uterus often lead to the development of chronic pelvic pain. The characteristic symptoms of these pains are that they intensify with bloating, indigestion, peristalsis, sudden movements, and prolonged walking.

Adhesions after surgery to remove the uterus form gradually. Accordingly, pain appears only after some time.

At the initial stage, postoperative adhesions in the pelvis are treated conservatively; if ineffective, laparoscopic excision of adhesions is resorted to.

Consequence 4. Weight after hysterectomy

Body weight after surgery can behave differently: some women gain weight, sometimes even gain weight, while others manage to lose weight.

The most common scenario after removal of reproductive organs is rapid weight gain, or a woman’s belly grows.

1. One of the reasons why women gain weight is due to metabolic disorders and the resulting fluid retention in the body. Therefore, strictly monitor how much water you drink and how much you excrete.

2. After removal of the uterus and ovaries, the hormonal levels change, which leads to a slowdown in the breakdown of fat, and the woman begins to gain excess weight.

In this case, a gentle diet will help to remove the belly. Meals should be fractional, small portions 6-7 times a day.

Should you worry if you have lost weight after having your hysterectomy? If the reason for the operation was a giant tumor or fibroid, there is no need to worry, you lost weight after removing the uterus.

If there was no mass formation, but you are losing weight, most likely it is a hormonal imbalance. To return your weight to normal, you will need hormone therapy.

Consequence 5. Sex after hysterectomy

Women who have undergone vaginal hysterectomy should remain in sexual rest for at least 2 months until the internal sutures heal. In all other cases, sex can be had 1-1.5 months after the operation.

Sex life after removal of the uterus undergoes changes.

In general, women are concerned about vaginal dryness, burning after intercourse, discomfort, and pain. This occurs due to a drop in estrogen levels, which causes the genital mucosa to become thinner and begin to produce less lubricant. Hormonal imbalance reduces libido and interest in sexual life decreases.

• Removal of the uterus and appendages most strongly affects the intimate side of life, since the lack of female hormones leads to frigidity.
• Removal of the uterine body has little effect on intimate life. Vaginal dryness and decreased libido may occur.
• Removal of the uterus and cervix leads to shortening of the vagina, which makes sex difficult after surgery.

Consequence 6. Orgasm after hysterectomy

Does a woman have an orgasm after a hysterectomy?

On the one hand, all sensitive points - the G-spot and the clitoris - are preserved, and theoretically a woman retains the ability to experience orgasm even after removal of the organ.

But in reality, not every woman gets an orgasm after surgery.

Thus, when the ovaries are removed, the content of sex hormones in the body drops sharply, and many develop sexual coldness. A decrease in the production of sex hormones occurs even if the ovaries are preserved - for many reasons, after surgery, their activity is disrupted.

The best prognosis for orgasms is for those who still have a cervix.

The consequences after removal of the uterus and cervix are manifested in a shortening of the vagina by about a third. Full sexual intercourse often becomes impossible. Studies carried out in this area have shown that the cervix has great value in achieving vaginal orgasms, and when the cervix is ​​removed, its achievement becomes extremely difficult.

Consequence 7. Pain after hysterectomy

Pain is one of the main complaints after surgery.

1. B postoperative period pain in the lower abdomen may indicate a problem in the suture area or inflammation. In the first case, the stomach hurts along the seam. In the second case, the main symptom is joined heat.

2. If the lower abdomen hurts and swelling appears, you can suspect a hernia - a defect through which the peritoneum and intestinal loops extend under the skin.

3. Severe pain after surgery to remove the uterus, high temperature, and poor health indicate pelvioperitonitis, hematoma or bleeding. Repeat surgery may be required to resolve the situation.

4. Pain in the heart indicates the possibility of developing cardiovascular diseases.

A large Swedish study of 180,000 women found that hysterectomy significantly increases the risk of cardiovascular disease. coronary disease and stroke. Removing the ovaries further aggravates the situation.

5. If you are concerned about swelling of the legs or an increase in local skin temperature, you need to rule out thrombophlebitis of the veins of the pelvis or lower extremities.

6. Pain in the back, lower back, right side or left can be a symptom of adhesive disease, cyst on the ovary and much more - it is better to consult a doctor.

Consequence 8. Prolapse after hysterectomy

After removal of the uterus, the anatomical location of organs is disrupted, muscles, nerves and blood vessels are injured, and the blood supply to the pelvic area is disrupted. The frame that supports the organs in a certain position ceases to perform its functions.

All this leads to displacement and prolapse of internal organs - primarily the intestines and bladder. Extensive adhesions aggravate the problem.

This is manifested by numerous increasing problems with the intestines and urinary incontinence with physical activity, coughing.

Consequence 9. Prolapse after hysterectomy

The same mechanisms cause the so-called genital prolapse - drooping of the vaginal walls and even their loss.

If in the postoperative period a woman begins to lift weights without waiting full recovery, then the situation gets worse. Intra-abdominal pressure increases, the walls of the vagina are “pushed” out. For this reason, lifting weights is contraindicated even for healthy women.

When lowering, a woman has a feeling foreign object in the perineal area. Pain bothers me. Sex life becomes painful.

To reduce the symptoms of prolapse of the vaginal walls after removal of the uterus, special gymnastics are indicated. For example, Kegel exercises. Constipation also increases intra-abdominal pressure, so to prevent the process you will have to learn to monitor your intestinal function: bowel movements should be daily and stool should be soft.

Unfortunately, vaginal prolapse after hysterectomy cannot be treated.

Consequence 10. Intestines after hysterectomy

Intestinal problems after surgery are affected not only by the changed anatomy of the pelvis, but also by a massive adhesive process.

Intestinal function is disrupted, constipation, flatulence, various defecation disorders, and pain in the lower abdomen occur. To avoid intestinal problems, you must follow a diet.

You will have to learn to eat often, 6 - 8 times a day, in small portions.

What can you eat? Everything, with the exception of heavy food, products, causing bloating abdomen, stool retention.

Improves the condition of the pelvic organs and regular exercise.

Consequence 12. Urinary incontinence after hysterectomy

This syndrome develops in almost 100% of cases as a consequence of a violation of the integrity of the ligamentous and muscular framework during surgery. The bladder prolapses and the woman loses control of urination.

To restore bladder function, doctors recommend performing Kegel exercises, but even with exercise, the condition usually progresses.

Consequence 13. Relapse after hysterectomy

Uterine surgery is performed for various indications.

Unfortunately, the operation does not protect against relapse if the uterus was removed due to one of those diseases that are caused by the human papillomavirus, namely:

• leukoplakia of the cervix,
• stage 1A cervical or uterine cancer
• microinvasive cervical cancer, etc.

Regardless of the technique of execution, surgery does not guarantee 100% recovery, it only removes the outbreak. Traces of the human papillomavirus, which is the cause of all these diseases, remain in the vaginal mucosa. Once activated, the virus causes a relapse.

Of course, if there is no organ, then a relapse of the disease cannot occur either in the uterus or in its cervix. The cervical stump and the mucous membrane of the vaginal vault are subject to relapses - dysplasia of the vaginal stump develops.

Unfortunately, relapses are very difficult to treat with classical methods. Medicine can only offer such patients traumatic methods. Removing the vagina is an extremely complex and traumatic operation, and the risks of radiation therapy are comparable to the risks of the disease itself.

According to various sources, relapses after surgery occur in 30 - 70% of cases. That is why, for the purpose of prevention, the Herzen Institute recommends performing photodynamic therapy of the vagina and cervical stump even after surgical removal uterus Only eliminating the papilloma virus protects against the return of the disease.

This is the story of my patient Natalya, who faced a relapse of cancer of the vaginal stump after removal of the uterus.

“Well, I’ll start my sad story in order, with a happy ending. After giving birth at 38 years old and my daughter turning 1.5 years old, I had to go to work and I decided to see a gynecologist. In September 2012, there was no sign of sadness, but the tests were not reassuring - stage 1 cervical cancer. It was of course shock, panic, tears, sleepless nights. In oncology I passed all the tests, where the human papillomavirus genotype 16.18 was discovered.

The only thing our doctors offered me was expiration of the cervix and uterus, but I asked to leave the ovaries.

The postoperative period was very difficult both physically and mentally. In general, a vaginal stump remained, no matter how sad it may sound. In 2014, after 2 years, tests again show a not very good picture - then after six months, grade 2. They treated her with everything - all kinds of suppositories, antivirals, ointments.

In short, a lot of money was spent, and after a year and a half of treatment for this dysplasia, it went into the third stage and again cancer. What did our doctors offer me this time: photodynamics.

After reading about her, I was delighted and gave myself into their hands. So what do you think was the result of their innovative technologies? And nothing has changed! Everything remained in its place. But I read so much about this method, studied various articles, I was especially attracted to the photodynamic method of Dr. Afanasyev M.S., and having compared the method and technology of treatment, I was surprised that everything that this doctor writes and tells was significantly different from how they did it me in our clinic. Starting from the ratio of the drug per kilogram of my weight, the methodology itself, the questions they asked me. After photodynamics, I was forced to wear glasses for almost a month, sit at home with the curtains closed, and not lean out into the street. I had no doubt that they simply did not know how to do this procedure! I contacted Dr. Afanasyev M.S., bombarded him with questions, told my story and he offered his help. I thought and doubted for a long time.

My doctor offered me radiation therapy, but knowing the consequences and the quality of life after this therapy, I still chose photodynamics again, but that Maxim Stanislavovich would do it for me.

Having gathered new strength, I flew to Moscow. The first impression of the clinic was, of course, pleasant, you feel like a person whom everyone cares about, attentiveness and responsiveness are the main qualities of these employees.

About the PDT procedure and recovery

The procedure itself took place under anesthesia, went away quickly, and in the evening I went to see my sister who was staying with me. I only wore glasses for three days. After 40 days I went for an initial examination to my clinic, but I had an eroded spot, apparently the healing was slow, but despite everything this - tests were good! The doctor prescribed healing suppositories. And when I came back after 3 weeks, the doctor gave me…….., everything healed, and I was very surprised - how did that happen! After all, during the entire practice of conducting photodynamics using their technology, there was not a single positive result! Now I will go for another examination in April. I am sure that everything will always be fine for me now!

This is my story. And I’m telling it to you so that you don’t give up, and during treatment choose the most gentle method of treatment, and not remove everything at once, apparently this is easier for our doctors. If I had found out about Maxim Stanislavovich earlier, I would have avoided these tears, a terrible operation, the consequences of which will strain my whole life! So think about it! No amount of money is worth our health! And most importantly, if you have the human papillomavirus of this particular genotype, which provokes cervical cancer under certain circumstances, you need to remove this cause. This is exactly what photodynamics does, but the technology and the doctor who does it must be masters of their craft. Who have extensive experience, scientific works and positive results in this area. And I think the only doctor who observes all this is Maxim Stanislavovich. Thank you very much Maxim Stanislavovich!!!”

The consequences described above after removal of the uterus concern different women V varying degrees. Young women of childbearing age have the hardest time undergoing hysterectomy.

Consequences of hysterectomy after 50 years

Surgery during menopause also does not greatly affect the health and well-being of a woman.

And if the operation was performed according to indications, then you made the right choice.

Consequences of hysterectomy after 40 years

If a woman did not have menopause before the operation, then during the recovery period it will be very difficult for her. The consequences of surgery during active childbearing years are experienced much more acutely than at the age of natural menopause.

If the operation was caused by a huge fibroid or bleeding, removal of the uterus provides significant relief. Unfortunately, over time, almost all the long-term consequences that we discussed above develop.

On medical language this condition is called post-hysterectomy and post-variectomy syndrome. It manifests itself as mood swings, hot flashes, arrhythmia, dizziness, weakness, and headache. The woman does not tolerate stress well and begins to get tired.

Within just a few months, sexual desire decreases and pain develops in the pelvic area. The skeletal system suffers - the level of minerals drops, and osteoporosis develops.

If hormonal levels are not corrected, aging will begin immediately after surgery: 5 years after hysterectomy, 55–69% of women operated on at the age of 39–46 years have a hormonal profile consistent with the postmenopausal one.

Surgery to remove uterine cancer is not necessary in its early stages

Uterine cancer is adenocarcinoma and carcinoma is a malignant process. The choice of treatment method and extent of intervention depends on the stage of the disease.

Earlier initial stages cancer (, microinvasive cancer) and precancerous diseases (,) were indications for removal of the uterus. Unfortunately, cancer surgery does not eliminate the cause of the disease - the human papillomavirus - and therefore has a high rate of relapses.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

Surgery for uterine cancer is a surgical method of removing a tumor. In some cases, amputation of the organ is required, which allows saving the patient’s life, although at the cost of loss of reproductive functions. Usually the operation is accompanied by the removal of the cervix and nearby lymph nodes, which makes it possible to stop the spread of the cancer.

Stages of cancer development and indications for surgery

The uterus is a hollow organ, the anatomy of which is divided into a body, a fundus (the convex upper part) and a cervix (a narrowed canal through which contact with the vagina and the environment occurs).

From the inside, it is expelled by a special type of mucous epithelium - the endometrium. With an excess of estrogens and a number of other factors, the endometrium can grow (a phenomenon called hyperplasia) and over time undergo a malignant transformation. The mucous membrane of the cervix is ​​also very susceptible to degeneration. Sometimes the cancer does not affect the epithelium (about 20% of cases).

Most often, hyperplastic processes begin after menopause, but in recent years their occurrence among women of reproductive age has increased sharply. Removing uterine cancer separately from the organ is impossible. The malignant tumor must be excised along with all surrounding tissue.

Cervical cancer (CC)

Cervical cancer is usually isolated separately. This is due to the high incidence of this disease. Its treatment depends on the extent of the process. Based on this indicator, cancer is distinguished:

• Pre-invasive(limited to epithelium);
• Microinvasive(the tumor penetrates the mucosa and is up to 1 cm in diameter);
• Invasive(the tumor has spread to surrounding tissues).

At the first stage The doctor's decision regarding the extent of the operation can vary greatly depending on his personal experience and a woman's desire to have children. So I.V. Duda in his book “Gynecology” writes: “ Total hysterectomy (removal of the uterus) with appendages may be indicated for Ca in situ (pre-invasive cancer) in perimenopausal women“.

Second stage may also allow organ-preserving operations, but they are associated with greater risk. Already at this stage, it is possible for the tumor to penetrate the lymphatic and blood nodes, and, consequently, the spread of metastases. The risk in this case is higher, so surgery for cervical cancer by total removal is practiced more often. It gives high remission rates. From 95 to 100% of women live 5 years or more after undergoing surgery, as well as a course of chemotherapy or radiotherapy.

Invasive cancer It is usually treated in a combined way - removal of the cervix (in the last stages, together with the uterus, appendages and/or lymph nodes) in combination with radiation exposure. Survival for more than 5 years in this case depends on the extent of the tumor, the presence of metastases and is 40-85%.

Endometrial cancer (cancer of the uterus)

This kind malignant degeneration often occurs together with cervical cancer. It is an indication for hysterectomy. Only at the first stage (the tumor does not extend beyond the body of the organ) a subtotal hysterectomy (partial removal) is possible.

In all other cases, for cancer of the uterine body, complete amputation is performed, with the exception of general contraindications to surgery from other organ systems (impaired circulatory, cardiovascular systems). Surgical treatment is carried out in conjunction with radiation and hormonal therapy.

Sarcoma of the uterus

It is a rare nonepithelial malignant tumor. It is severe and difficult to treat. In the first stages (I – III), combination therapy is carried out. The affected organ must be removed. At the last, IV stage, large-scale irradiation is first carried out.

The surgical tactics depend on the aggressiveness of the tumor. Some types require not only removal of the uterus, appendages, ovaries, but also part of the vagina (Wertheim operation). The prognosis is less favorable than for other forms of cancer.

Surgery

Preparation for the event

After the doctor has decided on the need for surgical intervention, he must discuss all its consequences with the patient. The extent of removal and the use of organ-preserving operations are influenced by the desire of the patient and/or her husband to have children, her age, and state of health. The doctor must assure the patient that no matter what decision is made, the fact of surgical intervention will remain secret. For many women, it is important that the sexual partner is not aware of the absence of some organs of the reproductive system.

After discussion, as a rule, a date for the operation is set. Within the specified period, the patient must undergo a series of tests and examinations that will help the doctor clarify the diagnosis and determine whether there are any contraindications for surgical intervention. Perhaps during this period the woman will be advised to take sedatives and sedatives to relieve psycho-emotional stress.

In 1-3 days, the doctor, having studied all the tests, issues his final verdict on the method of performing the operation and its volume. Selects anesthesia taking into account the wishes of the patient. This may be general anesthesia, which is carried out using an intratracheal tube, or epidural (pain relief is delivered through an injection into the spine). The patient signs a document indicating her consent to the operation, and also gives permission to carry out a more extensive intervention, if necessary.

Before the procedure, the patient needs to take a shower, remove pubic hair, preferably refuse food and cleanse the intestines (using an enema or laxative). It is extremely important to get enough sleep before surgery. If the patient spends this night in the hospital, then it is better to use sleeping pills.

Types of surgery

The only way surgical treatment for malignant tumors of the uterine body is its removal. It can be done as follows:

• Amputation of the uterine body only (the cervix remains);
• Amputation of the entire uterus (extirpation);
• Removal of the uterus along with fallopian tubes, appendages and/or ovaries
• Wertheim's operation is the most traumatic method; it removes not only the uterus with appendages, surrounding tissue and lymph nodes, but also upper third vagina.

types of surgical intervention

The removal operation may depend on the access method:

• Abdominal (abdominal), carried out through an incision on the abdominal wall;
• Laparoscopic - through small punctures in the abdomen and/or side;
• Vaginal.

For cervical cancer, the following can be done:

• Its complete removal;
• Conization (excision of an area of ​​degenerated tissue).

Abdominal cavity hysterectomy

The surgeon makes an incision in the lower abdomen. It can run horizontally or vertically. After this, he performs an inspection of the internal organs with his hand, paying attention to the uterus and appendages. The organ is fixed and, if possible, removed from the abdominal cavity. A mirror is placed in the wound for a more detailed examination. The bladder moves down. Vessels, fallopian tubes and ligaments are pinched with clamps and intersected between them. As the incisions are made, sutures are placed as necessary.

The greatest difficulty requires the separation of the uterus from the cervix or from the vagina. The transition site is clamped with Kocher clamps. The surgeon makes an incision between them. The cervical stump is sutured and tied to the vascular bundles and ligaments using ligatures (threads). If necessary, the appendages, ovaries, and fallopian tubes are removed. The technique is similar - the vessels and ligaments are compressed, excised, after which the organ itself is removed.

Before suturing, the surgeon examines the condition of all internal organs. After layer-by-layer suturing of the tissue, an antiseptic bandage is applied to the wound. The vagina is dried using tampons.

Vaginal hysterectomy

Such an operation can be indicated for women who have given birth, since their vagina is sufficiently dilated and allows all manipulations to be carried out freely. This is how total removal (of both the cervix and uterine body) is usually performed. The operation is not performed when possible complications that require revision of the abdominal cavity (for example, suspected ovarian tumor). For a large uterus, abdominal surgery is also recommended.

First, the surgeon makes a circular incision in the vagina. It is usually performed 5-6 cm from the entrance or deeper. Instruments are inserted through it, and the bladder is separated from the cervix. After this, the doctor makes a posterior incision in the vaginal wall, grabs the uterus with forceps and dislocates it into the lumen.

Clamps are applied to large vessels and ligaments, between which the surgeon makes incisions. The uterus is removed. All tissues and stumps are sutured. An experienced physician may use a single suture. This reduces the operation time and eliminates vascular compression. The uterine ligaments may be attached to the vaginal vault.

Laparoscopic hysterectomy

The operation can only be laparoscopic, when the organ itself is removed through punctures, or combined with vaginal access. In the second case, the uterus is removed through natural openings, and the vessels and ligaments are excised through punctures in the abdomen. The progress of the operation is monitored through a video camera, which is lowered into abdominal cavity.

Total laparoscopy is performed through 4 punctures. The surgeon operates with a uterine manipulator. It is a tube with a ring that makes it easy to move and rotate organs. To create sufficient space, a pneumothorax is applied - gas is pumped into the abdominal cavity through the first puncture made.

At the first stage of the operation, the surgeon disconnects the bladder and crosses the uterine ligaments with their subsequent coagulation (sealing by destruction of proteins). After this, the ureter is separated and moved to prevent injury. The surgeon continues to cut the ligaments and also cuts and coagulates the fallopian tubes unless removal is indicated.

Removal of the cervix

Usually the transvaginal method is used when only the cervix is ​​affected. The doctor removes the organ by making a wedge-shaped or cone-shaped incision. Sutures are applied sequentially with excision to avoid excessive blood loss.

The role of the new canal can be played by a flap from the vaginal epithelium, which the surgeon cuts out in advance, or by the vaginal vault. Sometimes the doctor will leave long threads to tighten the stitch if necessary.

Conization of the cervix

This is an organ-preserving operation that allows you to remove the affected epithelium, but preserve the mucosa itself. As a rule, it is carried out not with a scalpel, but with the help of a loop through which an electric current is passed. The most appropriate access is vaginal.

loop conization of the cervix

The operation lasts only 15 minutes. During this procedure, the doctor places a loop a few centimeters above the affected area and removes it. The more tissue is excised, the lower the risk of recurrence. Therefore, removal occurs with the capture of a healthy part of the epithelium.

Postoperative period

For the first few hours, the woman may be under the influence of anesthesia. To further monitor the integrity of the organs of the excretory system, a catheter remains in the ureter for some time. When the patient comes to her senses, nurse checks her condition, and the patient is sent to the ward. There may be a feeling of nausea, during which you are allowed to drink a small amount of water.

After 1-2 days you are allowed to get out of bed and walk. Doctors are sure that early physical activity has a beneficial effect on a woman’s condition. The total period of hospitalization is up to 7 days. During this period, it is possible to prescribe painkillers and anti-inflammatory drugs. The doctor usually prescribes hormonal drugs later, based on the woman’s condition.

After discharge, the patient needs to give up hard work, sex life, and sports for 4-6 weeks. Usually at this time she is on sick leave. It is also advisable to avoid heavy foods that cause bloating during the recovery period.

Many women experience the following symptoms in the first month and a half, which are not a cause for concern:

1. Aching pain in the suture area.
2. Numbness and itching around the scar.
3. Brown bloody discharge from the vagina.

Relapse (recurrence) of cancer is possible in the presence of unremoved metastases (foci) of the tumor or when tumor cells disperse during surgery. Modern diagnostic and treatment methods make it possible to minimize the risk of such developments.

Cost of surgery, hysterectomy under compulsory medical insurance

All types of surgery performed in connection with cancer are free of charge. Contacting a private clinic is solely the patient’s decision.

The cost of the operation in Moscow starts from 50,000 rubles. The cheapest is abdominal surgery. The price is 50,000 – 70,000 rubles. Vaginal amputation will be only slightly more expensive - 10,000 - 15,000 rubles. The most expensive are laparoscopic methods. The average price in the capital is 100,000 rubles. Conization of the cervix is ​​the cheapest - it costs from 10,000 rubles.

The complexity of the operation also affects the price. It is determined by the size of the tumor, which corresponds to a particular stage of pregnancy. The smaller the uterus, the cheaper the operation.