How does the radiation go after the removal of the uterus. How is radiation therapy performed after removal of the uterus with appendages. Laparoscopic removal of the uterus

In gynecology, in the treatment of uterine bleeding, in recent years, various conservative methods of influencing the uterus have been used, for example, hysteroresectsocopic removal of the myoma node and endometrial ablation, thermoablation of the endometrium, hormonal suppression of bleeding. However, they are often ineffective. In this regard, the operation to remove the uterus (hysterectomy), performed both in a planned and in an emergency manner, remains one of the most common abdominal interventions and ranks second after appendectomy.

The frequency of this operation in the total number of gynecological surgical interventions on the abdominal cavity is 25-38%, with an average age of women operated on for gynecological diseases of 40.5 years and for obstetric complications - 35 years. Unfortunately, instead of trying conservative treatment, there is a tendency among many gynecologists to recommend a woman with fibroids to remove the uterus after 40 years, arguing that her reproductive function has already been realized and the organ no longer performs any function.

Indications for removal of the uterus

The indications for hysterectomy are:

• Multiple uterine fibroids or a single one more than 12 weeks in size with a tendency to rapid growth, accompanied by repeated, profuse, prolonged uterine bleeding.
• The presence of fibroids in women over 50. Although they are not prone to malignancy, cancer develops on their background much more often. Therefore, removal of the uterus after 50 years, according to many authors, is desirable in order to prevent the development of cancer. However, such an operation at about this age is almost always associated with subsequent severe psychoemotional and vegetative-vascular disorders as a manifestation of posthysterectomy syndrome.
• Myoma node necrosis.
• with a high risk of torsion on the stem.
• growing into the myometrium.
• Widespread polyposis and persistent profuse menstruation, complicated by anemia.
• and 3-4 degrees.
• , or ovaries and related radiation therapy. Most often, the removal of the uterus and ovaries after 60 years is carried out precisely for cancer. In this age period, the operation contributes to a more pronounced development of osteoporosis and a more severe course of somatic pathology.
• The prolapse of the uterus of 3-4 degrees or its complete prolapse.
• Chronic pelvic pain that does not respond to other treatments.
• Rupture of the uterus during pregnancy and childbirth, placental accreta, development of consumption coagulopathy during childbirth, purulent.
• Uncompensated uterine hypotension during labor or in the immediate postpartum period, accompanied by profuse bleeding.
• Sex reassignment.

Despite the fact that the technical performance of hysterectomy has been greatly improved, this method of treatment is still technically difficult and is characterized by frequent complications during and after surgery. Complications are damage to the intestines, bladder, ureters, the formation of extensive hematomas in the parametric area, bleeding, and others.

In addition, such consequences of removing the uterus for the body are not uncommon, such as:

• long-term restoration of bowel function after surgery;
• development (menopause after removal of the uterus) is the most frequent negative consequence;
• development or more severe course of endocrine and metabolic and immune disorders, coronary heart disease, hypertension, neuropsychiatric disorders, osteoporosis.

In this regard, an individual approach to the choice of the volume and type of surgical intervention is of great importance.

Types and methods of removing the uterus

Depending on the volume of the operation, the following types are distinguished:

1. Subtotal, or amputation - removal of the uterus without appendages or with them, but preserving the cervix.
2. Total, or extirpation of the uterus - removal of the body and cervix with or without appendages.
3. Pangysterectomy - removal of the uterus and ovaries with fallopian tubes.
4. Radical - pangysterectomy in combination with resection of the upper 1/3 of the vagina, with the removal of a part of the omentum, as well as the surrounding pelvic tissue and regional lymph nodes.

Currently, abdominal surgery to remove the uterus is carried out, depending on the access option, in the following ways:

• abdominal, or laparotomic (midline incision of the tissues of the anterior abdominal wall from the umbilical to the suprapubic region or a transverse incision above the bosom);
• vaginal (removal of the uterus through the vagina);
• laparoscopic (through punctures);
• combined.

Laparotomy (a) and laparoscopic (b) access options for surgery to remove the uterus

Abdominal access

It is used most often and for a very long time. It is about 65% when performing operations of this type, in Sweden - 95%, in the USA - 70%, in the UK - 95%. The main advantage of the method is the possibility of performing a surgical intervention under any conditions - both in planned and in case of emergency surgery, as well as in the presence of other (extragenital) pathology.

At the same time, the laparotomy method also has a large number of disadvantages. The main ones are the serious trauma of the operation itself, a long hospital stay after the operation (up to 1 - 2 weeks), long-term rehabilitation and unsatisfactory cosmetic consequences.

The postoperative period, both short and distant, is also characterized by a high frequency of complications:

• long-term physical and psychological recovery after removal of the uterus;
• adhesive disease develops more often;
• bowel function is restored for a long time and the lower abdomen hurts;
• high, in comparison with other types of access, the likelihood of infection and increased temperature;

The mortality rate for laparotomy access per 10,000 operations averages 6.7-8.6 people.

Vaginal removal

It is another traditional approach used to remove the uterus. It is carried out by means of a small radial dissection of the vaginal mucosa in its upper parts (at the level of the fornices) - posterior and possibly anterior colpotomy.

The indisputable advantages of this access are:

• significantly less trauma and the number of complications during surgery, compared with the abdominal method;
• minimal blood loss;
• short duration of pain and better health after surgery;
• rapid activation of a woman and rapid restoration of bowel function;
• short period of hospital stay (3-5 days);
• good cosmetic result, due to the absence of an incision in the skin of the anterior abdominal wall, which allows a woman to hide the very fact of surgery from her partner.

The terms of the rehabilitation period with the vaginal method are much shorter. In addition, the incidence of near-term complications and their absence in the late postoperative periods are also low, and the mortality rate is, on average, 3 times less than with the abdominal approach.

At the same time, vaginal removal of the uterus also has a number of significant disadvantages:

• the lack of a sufficient area of ​​the operating field for visual inspection of the abdominal cavity and manipulations, which significantly complicates the complete removal of the uterus in endometriosis and cancer, due to the technical difficulty of detecting endometriotic foci and tumor boundaries;
• high risk of intraoperative complications in terms of injury to blood vessels, bladder and rectum;
• difficulties, if necessary, to stop bleeding;
• the presence of relative contraindications, which include, in addition to endometriosis and cancer, significant sizes of tumor formation and previous operations on the abdominal organs, especially on the organs of the lower floor, which can lead to changes in the anatomical location of the pelvic organs;
• technical difficulties associated with bringing down the uterus in obesity, adhesions and nulliparous women.

Due to such restrictions, in Russia, the vaginal access is used mainly for operations for prolapse or prolapse of an organ, as well as for gender reassignment.

Laparoscopic access

In recent years, it has become increasingly popular for any gynecological operations in the small pelvis, including hysterectomy. Its benefits are largely identical to the vaginal approach. These include a low degree of trauma with a satisfactory cosmetic effect, the possibility of dissection of adhesions under visual control, a short recovery period in the hospital (no more than 5 days), a low incidence of complications in the near and their absence in the long-term postoperative period.

However, the risks of such intraoperative complications as the possibility of damage to the ureters and bladder, blood vessels and large intestine remain. The disadvantages are also the limitations associated with the oncological process and the large size of the tumor-like formation, as well as with extragenital pathology in the form of even compensated heart and respiratory failure.

Combined method or assisted vaginal hysterectomy

It consists in the simultaneous use of vaginal and laparoscopic approaches. The method makes it possible to exclude the important disadvantages of each of these two methods and to carry out surgical intervention in women with:

• endometriosis;
• adhesions in the small pelvis;
• pathological processes in the fallopian tubes and ovaries;
• myomatous nodes of significant size;
• a history of surgical interventions on the abdominal organs, especially the small pelvis;
• Difficulty bringing down the uterus, including nulliparous women.

The main relative contraindications forcing to give preference to the laparotomy access are:

1. Common foci of endometriosis, especially posterior endometriosis with invasion into the wall of the rectum.
2. Pronounced adhesion process, causing difficulties in dissection of adhesions when using the laparoscopic technique.
3. Volumetric ovarian formations, the malignant nature of which cannot be reliably excluded.

Preparing for surgery

The preparatory period for planned surgery consists in conducting possible examinations at the prehospital stage - clinical and biochemical blood tests, urinalysis, coagulogram, determination of blood group and Rh factor, studies for the presence of antibodies to hepatitis viruses and sexually transmitted infections, including including syphilis and HIV infection, ultrasound, chest fluorography and ECG, bacteriological and cytological examination of smears from the genital tract, extended colposcopy.

In the hospital, if necessary, they are additionally carried out with separate, repeated ultrasound, MRI, sigmoidoscopy and other studies.

1-2 weeks before the operation, if there is a risk of complications in the form of thrombosis and thromboebolias (varicose veins, pulmonary and cardiovascular diseases, overweight, etc.), a consultation with specialized specialists and taking appropriate medications, as well as rheological agents and antiplatelet agents.

In addition, in order to prevent or reduce the severity of symptoms of posthysterectomy syndrome, which develops after removal of the uterus in an average of 90% of women under 60 years of age (mostly) and has varying degrees of severity, surgery is planned for the first phase of the menstrual cycle (if any) ...

1-2 weeks before the removal of the uterus, psychotherapeutic procedures are carried out in the form of 5-6 conversations with a psychotherapist or psychologist, aimed at reducing the feeling of uncertainty, uncertainty and fear of the operation and its consequences. Phytotherapeutic, homeopathic and other sedatives are prescribed, therapy for concomitant gynecological pathology is carried out, and it is recommended to quit smoking and drinking alcoholic beverages.

These measures can significantly facilitate the course of the postoperative period and reduce the severity of psychosomatic and vegetative manifestations provoked by the operation.

In the hospital in the evening on the eve of the operation, food should be excluded, only liquids are allowed - loosely brewed tea and still water. In the evening, a laxative and a cleansing enema are prescribed, before bedtime, a sedative is taken. In the morning of the day of the operation, it is prohibited to take any liquid, the intake of any drugs is canceled and the cleansing enema is repeated.

Before the operation, put on compression tights, stockings or bandage the lower extremities with elastic bandages, which remain until the woman is fully activated after the operation. This is necessary in order to improve the outflow of venous blood from the veins of the lower extremities and to prevent thrombophlebitis and thromboembolism.

Equally important is the provision of adequate anesthesia during the operation. The choice of the type of pain relief is carried out by the anesthesiologist, depending on the expected volume of the operation, its duration, concomitant diseases, the possibility of bleeding, etc., as well as in agreement with the operating surgeon and taking into account the wishes of the patient.

Anesthesia during removal of the uterus can be general endotracheal combined with the use of muscle relaxants, as well as its combination (at the discretion of the anesthesiologist) with epidural analgesia. In addition, it is possible to use epidural anesthesia (without general anesthesia) in combination with intravenous drug sedation. The insertion of a catheter into the epidural space can be prolonged and used for postoperative pain relief and faster recovery of bowel function.

The principle of the technique of performing the operation

Preference is given to laparoscopic or assisted vaginal subtotal or total hysterectomy with preservation of the appendages on at least one side (if possible), which, among other advantages, helps to reduce the severity of posthysterectomy syndrome.

How is the operation going?

Surgical intervention with combined access consists of 3 stages - two laparoscopic and vaginal.

The first stage is:

• introduction into the abdominal cavity (after insufflation of gas into it) through small incisions of manipulators and a laparoscope containing an illumination system and a video camera;
• conducting laparoscopic diagnostics;
• severing existing adhesions and excreting the ureters, if necessary;
• the imposition of ligatures and the intersection of the round uterine ligaments;
• mobilization (discharge) of the bladder;
• the imposition of ligatures and the intersection of the fallopian tubes and the own ligaments of the uterus or in the removal of the ovaries and fallopian tubes.

The second stage consists of:

• dissection of the anterior wall of the vagina;
• transection of the vesicouterine ligaments after displacement of the bladder;
• incision of the mucous membrane of the posterior wall of the vagina and the imposition of hemostatic sutures on it and on the peritoneum;
• the imposition of ligatures on the sacro-uterine and cardinal ligaments, as well as on the vessels of the uterus, followed by the intersection of these structures;
• removing the uterus into the area of ​​the wound and cutting it off or dividing it into fragments (with a large volume) and removing them.
• suturing the stumps and the vaginal mucosa.

At the third stage, laparoscopic control is again performed, during which small bleeding vessels (if any) are ligated and the pelvic cavity is drained.

How long does the operation to remove the uterus take?

It depends on the method of access, the type of hysterectomy and the amount of surgery, the presence of adhesions, the size of the uterus, and many other factors. But the average duration of the entire operation is, as a rule, 1-3 hours.

The main technical principles for removing the uterus with laparotomy and laparoscopic approaches are the same. The main difference is that in the first case, the uterus with or without appendages is removed through an incision in the abdominal wall, and in the second, the uterus is divided into fragments in the abdominal cavity using an electromechanical instrument (morcellator), which are then removed through a laparoscopic tube (tube ).

Rehabilitation period

Moderate and minor spotting after removal of the uterus is possible for no more than 2 weeks. In order to prevent infectious complications, antibiotics are prescribed.

In the first days after surgery, bowel dysfunctions almost always develop, mainly associated with pain and low physical activity. Therefore, the fight against pain is of great importance, especially on the first day. For this purpose, injectable non-narcotic analgesic drugs are regularly administered. Prolonged epidural analgesia has a good analgesic and improves intestinal peristalsis effect.

In the first 1-1.5 days, physiotherapy procedures, physiotherapy exercises and early activation of women are carried out - by the end of the first or at the beginning of the second day, they are advised to get out of bed and move around the department. 3-4 hours after the operation, in the absence of nausea and vomiting, it is allowed to drink still water and "weak" tea in small quantities, and from the second day - to eat.

The diet should include easily digestible foods and dishes - soups with chopped vegetables and grated cereals, dairy products, boiled low-fat fish and meat. Excluded are foods and dishes rich in fiber, fatty fish and meat (pork, lamb), flour and confectionery products, including rye bread (wheat bread is allowed on the 3rd - 4th day in limited quantities), chocolate. From the 5th to the 6th day, the 15th (common) table is allowed.

One of the negative consequences of any abdominal surgery is the adhesion process. It most often proceeds without any clinical manifestations, but sometimes it can cause serious complications. The main pathological symptoms of adhesion formation after removal of the uterus are chronic pelvic pain and, even more seriously, adhesive disease.

The latter can occur in the form of chronic or acute adhesive intestinal obstruction due to a violation of the passage of feces through the large intestine. In the first case, it is manifested by periodic cramping pains, gas retention and frequent constipation, moderate bloating. This condition can be resolved by conservative methods, but often requires routine surgical treatment.

Acute intestinal obstruction is accompanied by cramping pain and bloating, absence of stool and gas discharge, nausea and repeated vomiting, dehydration, tachycardia and, at first, an increase and then a decrease in blood pressure, a decrease in the amount of urine, etc. In acute adhesive intestinal obstruction, it must be urgently resolved by surgical treatment and intensive therapy. Surgical treatment consists of dissection of adhesions and, often, bowel resection.

Due to the weakening of the muscles of the anterior abdominal wall after any surgical intervention on the abdominal cavity, it is recommended to use a special gynecological bandage.

How long to wear the bandage after the removal of the uterus?

Wearing a bandage at a young age is necessary for 2 - 3 weeks, and after 45-50 years and with poorly developed abdominal muscles - up to 2 months.

It promotes faster wound healing, reduced pain, improved bowel function, and reduced the likelihood of hernia formation. The bandage is used only during the daytime, and later - with prolonged walking or moderate physical exertion.

Since the anatomical arrangement of the pelvic organs changes after the operation, and the tone and elasticity of the pelvic floor muscles are lost, consequences such as prolapse of the pelvic organs are possible. This leads to constant constipation, urinary incontinence, deterioration of sex life, vaginal prolapse and also to the development of adhesions.

In order to prevent these phenomena, it is recommended to strengthen and tone the muscles of the pelvic floor. You can feel them by stopping the started urination or the act of defecation, or by trying to squeeze the finger inserted into the vagina with its walls. Exercises are based on similar compression of the pelvic floor muscles for 5-30 seconds, followed by their relaxation for the same duration. Each of the exercises is repeated in 3 sets, 10 times each.

The set of exercises is performed in different starting positions:

1. The legs are set shoulder-width apart, and the hands are on the buttocks, as if supporting the latter.
2. In the kneeling position, tilt the body to the floor and rest your head on your arms bent at the elbows.
3. Lie on your stomach, put your head on bent arms and bend one leg at the knee joint.
4. Lie on your back, bend your legs at the knee joints and spread the knees to the sides so that the heels rest on the floor. Put one hand under the buttock, the other on the lower abdomen. While squeezing the muscles of the pelvic floor, pull the arms up a little.
5. Position - sitting on the floor with crossed legs.
6. Put your legs a little wider than your shoulders and rest your arms straight on your knees. The back is straight.

The muscles of the pelvic floor in all initial positions are squeezed inward and upward, followed by their relaxation.

Sexual life after removal of the uterus

In the first two months, abstinence from sexual intercourse is recommended to avoid infection and other postoperative complications. At the same time, regardless of them, the removal of the uterus, especially at reproductive age, in itself very often becomes the cause of a significant decrease in the quality of life due to the development of hormonal, metabolic, psychoneurotic, autonomic and vascular disorders. They are interconnected, exacerbate each other and affect directly the sexual life, which, in turn, increases the degree of their severity.

The frequency of these disorders especially depends on the volume of the operation performed and, not least, on the quality of preparation for it, the management of the postoperative period and treatment in a more distant period. Anxiety-depressive syndrome, which proceeds in stages, is noted in every third woman who underwent removal of the uterus. The timing of its maximum manifestation is the early postoperative period, the next 3 months after it and 12 months after the operation.

Removal of the uterus, especially total with unilateral, and even more so with bilateral removal of the appendages, as well as carried out in the second phase of the menstrual cycle, leads to a significant and rapid decrease in the content of progesterone and estradiol in the blood in more than 65% of women. The most pronounced disorders of the synthesis and secretion of sex hormones are detected by the seventh day after the operation. The restoration of these disorders, if at least one ovary was preserved, is noted only after 3 or more months.

In addition, due to hormonal disorders, not only sexual desire decreases, but many women (every 4th - 6th) develop atrophy processes in the vaginal mucosa, which leads to their dryness and urogenital disorders. This also adversely affects sexuality.

What drugs should be taken to reduce the severity of negative consequences and improve the quality of life?

Given the staged nature of the disorders, it is advisable to use sedative and neuroleptic drugs, antidepressants in the first six months. In the future, their reception should be continued, but intermittent courses.

For prophylactic purposes, they must be prescribed in the most probable periods of the year of exacerbations of the pathological process - in autumn and spring. In addition, in order to prevent the manifestations or reduce the severity of posthysterectomy syndrome in many cases, especially after hysterectomy with ovaries, it is necessary to use hormone replacement therapy.

All drugs, their dosages and the duration of treatment courses should be determined only by a doctor of the appropriate profile (gynecologist, psychotherapist, therapist) or in conjunction with other specialists.

Uterine cancer - This is a malignant lesion of the uterine endometrium, which is accompanied by atypical and uncontrolled growth of mutated cells. Cancer of the female genital organs ranks fourth in the frequency of diagnostics of malignant neoplasms.

Classification of cancerous lesions of the uterus

1. The initial stage is characterized by limited tumor growth within the body of the uterus.
2. The second stage is the spread of the pathological process to the cervix.
3. The third stage - the cancer grows through the wall of the organ and forms vaginal metastases.
4. The fourth stage - the malignant neoplasm spreads outside the uterus. In the pelvic organs are formed.

Uterine cancer - radiation

In the oncological practice of treating uterine cancer, the most effective method is the irradiation of cancerous tissues with ionizing radiation. Doctors prescribe this technique as an independent effect on the tumor, and as a method of preoperative preparation of the patient.

Types of radiation therapy

• External radiological therapy:

It is carried out through several layers of healthy tissues. This method of therapy is carried out in cases of deep location of a malignant neoplasm. The disadvantage of external exposure to radiological rays is the irradiation of healthy tissues, which causes their damage.

• Contact radiology:

Such treatment includes the introduction of a special catheter to the site of the malignant neoplasm. Internal exposure to ionizing radiation causes minimal harm to physiologically unchanged tissues.

• Combination therapy:

The combined use of internal and external radiology is indicated in severe forms of oncology.

Cervical cancer radiation - indications for

1. Patients with the first and second stages of uterine cancer undergo radiation therapy before surgical removal of the female genital organs.
2. The oncological tumor has spread to regional lymph nodes and distant organs.
3. Palliative therapy of advanced stages of the disease.
4. Postoperative prevention of relapse.

Cancer of the body of the uterus irradiation - contraindications

• feverish state of the body;
• cancerous bleeding and multiple secondary lesions;
• general severe diseases of the cardiovascular, nervous and endocrine systems;
• a reduced number of leukocytes and red blood cells.

Preparing for radiation therapy

Radiological treatment involves a thorough patient preparation process. Before carrying out the manipulation, oncologists refer the patient to computer and magnetic resonance therapy to clarify the localization of the tumor. Finally, the radiologist determines the required radiation dose and the angle of injection of the high-activity rays.

The patient is required to strictly adhere to medical instructions and be immobile during the procedure.

Irradiation technique

The duration of the procedure for irradiation of uterine cancer is several minutes. Radiation therapy is carried out in a specially designated room, which is designed taking into account radiological safety requirements. During the manipulation, the patient lies on a couch and a source of ionizing radiation is brought directly to the affected area. The rest of the body is covered with protective tissue that prevents X-rays from entering.

The radiologist monitors the progress of the radiation through the window of a neighboring room. A course of radiation therapy includes several courses of radiation exposure.

Potential Effects of Irradiation

Those who have undergone radiation therapy may have the following consequences for a cancer patient:

• general intoxication of the body, which is manifested by nausea and vomiting;
• disorders of the digestive system in the form of stool disorder and dyspepsia;
• redness, burning and itching of the skin in the zone of action of ionizing radiation;
• dryness of the mucous membrane of the female genital organs.

Recommendations for Patients Undergoing Radiological Therapy

1. The patient needs to rest for at least three hours after each course of radiation.
2. To prevent skin burns, it is advisable to treat the epidermis with herbal pharmaceutical preparations.
3. During the period of radiological treatment, it is not recommended to use cosmetic and perfumery products to prevent allergic reactions.
4. Various thermal procedures are contraindicated after exposure to X-rays.
5. Patients are advised to stay outdoors more.
6. must be balanced in vitamins and minerals.

Uterine cancer radiation - prognosis

The prognosis of radiation therapy in the early stages of uterine cancer in the absence of multiple metastases is considered favorable, since in most cases it promotes complete healing.

In the later stages of oncology of the female reproductive system, the radiological technique is not able to rid the patient of a cancerous tumor. During this period, all therapeutic efforts are aimed at stabilizing malignant growth and relieving individual symptoms of the disease.

Collapse

Surgical surgery to remove a cancerous uterus is often complemented by radiation therapy. Ionizing rays do not harm healthy structures. Radiation therapy after removal of the uterus with appendages is considered a gentle way to destroy the remaining atypical structures and metastases. The procedure can be supplemented with chemotherapy and is prescribed at any stage of tumor development.

Why is it used and how is it done?

Radiation therapy is indicated in the following cases:

• to remove abnormal structures at the initial stages of the oncological process;
• for the comprehensive fight against uterine cancer;
• after removal of the uterus to prevent recurrence of the disease;
• with advanced stages of uterine cancer, when surgery is ineffective.

Irradiation leads to malfunctioning of the ovaries, which causes the premature termination of menstruation. Therefore, radiation treatment of patients is carried out with caution. In some cases, before the intervention, the ovaries are moved from the irradiated area to another location. This reduces the risk of injury during the procedure.

The operation is performed sequentially:

1. The patient lies down on a medical table, which has the ability to move in different directions. It is important that the woman remains stationary during the session. Otherwise, the rays will not reach the tumor and can damage healthy tissue.
2. Women who cannot stay in one position for a long time are fixed with special belts.
3. After the last session of radiation therapy, the patient undergoes additional diagnostic tests.
4. The doctor consults the patient about the peculiarities of the recovery period and gives recommendations for correcting nutrition and lifestyle.

During the procedure, women do not feel pain and discomfort

Types of radiation therapy

After surgery, ionizing radiation is prescribed for distant metastases and residual cancer cells. The operation can also be indicated with a high risk of recurrence of the pathology after a hysterectomy. Intervention is performed remotely, intracavitary, contact.

In the first case, the radiation is at a certain distance from the lesion focus. In the contact form of the procedure, the apparatus is attached to the patient's skin. With the intracavitary method, atypical cells are removed by introducing a special apparatus to the lesion.

Diagnostic measures are required before radiation therapy. They allow you to accurately calculate the required radiation dose. The doctor informs the patient about the consequences of the intervention and prescribes drugs that will be taken during the rehabilitation period.

A balanced diet and the implementation of all the recommendations of a specialist will help you recover faster after surgery.

Preparing for the procedure

The specialist describes the treatment plan in detail, calculating the radiation dose for the full course of therapy and separately for each session. The doctor determines the duration of the course of treatment and the duration of one procedure. Before starting radiation therapy, perform the following preparatory procedures:

• In the hospital, the patient is offered disposable clothing. If a woman wants to stay in her clothes, then she should take care of some nuances:

1. things should not fit the body or hinder movement;
2. the jacket must have an open collar.

• If necessary, the patient is fixed to the table with belts, mattresses and other fasteners. These measures are necessary in order to completely restrict the movement of the patient during the intervention.
• Healthy tissues and organs are covered with special protective blocks to protect them from radiation exposure.
• Before the procedure, the doctor can take a control image to assess the correct position of the woman in relation to the medical device.

The first session of radiation therapy will be the longest. The duration of each subsequent procedure is gradually reduced.

Before treatment, patients should adhere to several basic rules:

• do not dry your head with a hairdryer;
• hide the irradiated places under clothes when leaving the house;
• stop using cosmetics and sunscreens for a while;
• minimize physical activity;
• try to go outside after sunset;
• consume enough fluids.

10 days before treatment, the patient needs to adjust the diet. At this time, pickled foods, carbonated and alcoholic drinks, spices, and spicy dishes are completely excluded. A week before radiation therapy, doctors recommend that the woman do breathing exercises and increase the rest time.

List of other preparatory activities

Radiation consequences

Radiation therapy provokes a number of negative consequences. These include:

1. Intoxication of the body, manifested by weakness and nausea.
2. Stool disorder in the form of chronic diarrhea.
3. Irritation of the skin in the irradiated area and the appearance of red rashes on it.
4. Increased dryness of the vaginal mucous membranes.

Forecast

After removing the genital organ, a woman will have to forget about reproductive function forever. But the operation, carried out in conjunction with radiation therapy, gives a high probability of complete recovery. The success of treatment largely depends on the stage of the identified disease. The best results from treatment are achieved at the early stages of the development of the pathological process. Complete healing from cancer is possible after 5-6 sessions of radiation therapy.

Radiation therapy equipment

It will be difficult to stop the spread of abnormal cells at stage 3 of cancer development with the help of complex therapy, and at stage 4 it will be impossible. Radiation therapy in advanced cases is necessary to minimize pain and slow down the division of cancer cells.

After the treatment, the woman is shown physiotherapy measures:

• balneotherapy;
• radio wave baths;
• acupuncture.

If radiation therapy provoked health problems, then the woman is given a disability group. Sexual activity is allowed only 2 months after the intervention.

Oncologists say that radiation therapy does not affect the psychological state and sexual desire of a woman. Sexual intercourse after surgery is not contraindicated, but it is advisable to consult a gynecologist before starting sexual relations.

Radiation therapy after a hysterectomy is one way to reduce the risk of problems recurring. The procedure can be carried out remotely, intracavitary and contact. The method of intervention and the duration of therapy are determined by the doctor based on the characteristics of the course of oncology.

Radical intervention very often saves the life of a cancer patient. The method of operation is considered on an individual basis and is discussed with the patient in advance. In modern oncology clinics, doctors perform the following types of operations for women diagnosed with cervical cancer:

This surgical procedure consists in the excision of a cone-shaped tissue particle of the cervix and cervical canal. The removed material is sent to a histological laboratory to determine the exact type of tumor.

Radical removal of the uterus is carried out simultaneously with the excision of the cervix. The general variant of radical intervention involves an incision of the anterior abdominal wall.

In modern clinics, patients are usually offered to undergo laparoscopic surgery. In such cases, microsurgical instruments are inserted into the abdominal cavity through several point incisions to the woman. In this case, the specialist controls the progress of the operation on the monitor screen.

Manipulation involves the removal of the uterus, cervix, a small area of ​​the external genitalia, and ligaments. In some cases, the fallopian tubes, ovaries, and regional lymph nodes are excised.

A modified version of such an operation is aimed at the complete removal of the cervix and uterus, the upper region of the external genitalia and nearby soft tissues. During the operation, the surgeon also resects the lymph nodes located in the small pelvis.

Bilateral removal of uterine appendages

The doctor resects both ovaries and fallopian tubes.

Such a cardinal surgical intervention consists in removing the lower part of the large intestine, bladder, uterus, its appendages and regional lymph nodes.

In the course of such manipulation, the specialist uses deep freezing of the tissue for its subsequent removal. Local exposure to liquid nitrogen causes the death and rejection of cancer cells.

This is a surgical procedure in which a surgeon uses a laser beam to cut tissue from cancer. This method of operation provides bloodless dissection of uterine tissues.

Cycle of electrosurgical interventions

The goal is to remove the mutated cells with a low-intensity electrical current. During the procedure, electrical impulses act on the uterine tissue as a point and, like a scalpel, separate cancerous and normal cells.

Indications

Conization of the cervix is ​​a diagnostic procedure. Currently, it can be performed using laser technology, cryotherapy or electrocoagulation. The indication for this type of intervention is the need to establish a final diagnosis and determine the degree of aggressiveness of a malignant neoplasm.

Removal (extirpation) of the uterus and its appendages is recommended at the initial stages of the oncological process.

Extirpation of the uterus and regional lymph nodes is also indicated in the initial stages of cancer in the absence of data on local metastases.

Patients with cancer of the uterus stage 1-2 operate in a radical way, excising the uterus, its appendages and nearby lymph nodes. And in the later stages, treatment measures are already only palliative in nature.

The expediency of a surgical operation

According to experts, a radical operation for cancerous lesions of the cervix is ​​most appropriate at stages 1 and 2, when there are no metastases in the lymphatic system and distant organs.

Surgical operation at stages 3 and 4 of cancer is carried out according to the palliative type, it is aimed at eliminating individual symptoms of the disease.

Contraindications

Radical intervention for cervical cancer has the following contraindications:

1. Acute cardiovascular failure.
2. Pathology of the blood coagulation system.
3. Inflammatory and infectious diseases of the abdominal cavity and peritonitis.

Preliminary analyzes and examinations

Before the surgery, the patient undergoes the following examinations:

• gynecological examination and colposcopy;
• collection of smears for microscopic examination of microflora;
• general and detailed blood count;
• research for tumor markers;
• ultrasound examination of the pelvic organs;
• computed and magnetic resonance imaging to clarify the localization and prevalence of the oncological process;
• biopsy - in most cases, the final diagnosis is carried out after conization in the process of histological analysis of the removed tissues.

Surgical technique

Radical intervention is performed under general anesthesia. After dissecting the skin, the surgeon crosses the blood vessels that feed the uterus and its appendages. Then the cancerous tumor is removed together with the uterus and cervix. The operation ends with suturing of the skin and uterus.

Time and price

The duration of the conization is a minute. The price of such a procedure in private gynecological clinics is US $.

Radical removal of the uterus and its appendages can cost US $, depending on the complexity of the operation and the technique of the radical intervention. In this case, the patient is under anesthesia for min.

Recovery period

Radical surgery for cervical cancer, which takes place under general anesthesia, requires the patient to comply with certain standards:

• 1-2 days of strict bed rest.
• Removal of stitches takes place in 5-6 days.
• The patient is discharged from the hospital for 8-12 days.
• Shower is allowed two weeks after surgery. After water procedures, the wound surface should be treated with iodine solution or other antiseptic.

Possible consequences

The most common consequences of radical removal of the uterus are represented by the following types:

1. Inflammation of the skin in the area of ​​the surgical suture.
2. Postoperative bleeding.
3. Inflammatory disease of the urethra and bladder.
4. Thromboembolism, which is dangerous as a sudden blockage of the lumen of blood vessels.

Forecast

Intervention on early cervical cancer, in which the operation is carried out in a radical way, has a favorable prognosis. The recovery of patients at stages 1-2 occurs in 90% of clinical cases. In the later stages, hysterectomy is palliative and aims to improve the quality of life as much as possible.

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The information on the site is presented solely for informational purposes! It is not recommended to use the described methods and recipes for treating cancer independently and without consulting a doctor!

Operation for cervical cancer, how is it going?

Surgery for cancer of the uterus is an operative method to remove a tumor.

In some cases, complete removal of the organ is necessary, which allows the patient to survive, albeit at the cost of loss of reproductive functions. The operation is accompanied by the removal of the uterine neck and regional lymph nodes, which stops the development of a cancerous growth.

Operation from type and stage

The uterus is a hollow organ, in the anatomy of which the body (convex upper part) and the cervix (narrowed canal, due to which there is contact with the environment and the vagina) are distinguished.

In the middle, the uterus is expelled by the endometrium, a type of epithelium. With an excessive amount of estrogen and a number of other factors, the endometrium can grow and after a certain time undergo a transformation of a malignant nature. The mucous membrane of the cervix also has the possibility of degeneration. In some cases (approximately 20%), the malignant process does not affect the epithelium.

Similar transformations occur after menopause, but in recent years there has been a tendency towards an increase in the development of tumors among women of reproductive age. Removal of the neoplasm of the uterus separately from the organ is not possible. Cancer is excised along with all its surrounding tissues.

Oncology of the cervix is ​​distinguished separately. The fact is associated with a high incidence of the disease. Treatment depends on the prevalence of the process.

Based on this, types of cancer are distinguished:

• Pre-invasive (epithelial limitation);
• Microinvasive (the neoplasm is able to penetrate the mucous membrane, the size of the tumor is up to one centimeter in diameter);
• Invasive (the malignant process spreads to the surrounding tissue).

Intervention depending on the stages:

• 1st stage. This stage allows organ-preserving surgery.
• 2nd stage. Organ preservation is possible, but it is associated with great risks. At this stage, there is a possibility of the neoplasm penetrating into the lymph nodes and blood vessels, therefore, metastases are formed. The risk of retaining the uterus is high, so total removal is usually used. Such surgical treatment gives a high rate of remission. Up to one hundred percent of women can live five or more years after the surgery, as well as the corresponding courses of radiation and chemotherapy.
• With invasive cancer, treatment occurs in a combined way - excision of the cervix (in the later stages, together with the uterus, appendages and lymph nodes) in combination with radiotherapy. Survival over the next five years depends on the prevalence of the neoplasm, the presence of metastases and is about 40-80%.

• Endometrial cancer often develops along with cervical cancer. His treatment is to remove the uterus. The exception is the first stage, when the tumor has not yet gone beyond the body of the organ. In this case, it is possible to perform a subtotal hysterectomy (partial removal). In all other cases, with cancer of the endometrium (body of the uterus), complete amputation is performed, with the exception of general contraindications to surgical intervention on the part of other organ systems (disorders of the circulatory and cardiovascular systems). Surgical treatment should be carried out in combination with radio and hormonal therapy.

• Uterine sarcoma is a rare non-epithelial malignant tumor. The disease is characterized by severe course and treatment. In the first stages, combined therapy is carried out. And the affected organ is subject to amputation. In the last stages, large-scale irradiation is carried out, followed by removal of the organ. The surgical strategy depends on the aggressiveness of the neoplasm. Some types involve not only the removal of the uterus, ovaries and appendages, but also part of the vagina. This treatment tactic is called Wertheim's operation. The prognosis, unfortunately, is less favorable than with other forms of oncology.

Preparing for surgery

After the specialist has made a decision and the need for surgery, he is obliged to discuss with the patient all the consequences that entail. The following factors can affect the volume of excision, the use of organ-preserving operations: the desire of the patient or her spouse to have children, the state of health and the age of the patient.

After discussions, a date for the operation is set. Until the specified date, the patient needs to undergo a series of examinations and pass the necessary tests. All this will help the attending physician to clarify the diagnosis, determine the presence or absence of contraindications for surgical treatment. During this period, the patient is prescribed to take sedatives, sedatives to relieve psycho-emotional stress.

A few days before the expected date of the operation, the specialist, having studied the patient's analyzes, announces the final verdict on the method of the operation and its volume. Anesthesia is selected taking into account the wishes of the patient.

There are two types of anesthesia for surgery: general anesthesia using an intratracheal tube, or epidural (pain relievers are delivered by injection into the spine).

The patient must necessarily sign a document of consent for the operation, as well as give permission for a larger intervention, if necessary.

Removal of the uterus for cancers in the body of the organ is the only method of surgical treatment. To be done as follows:

• amputation of the entire body of the uterus;
• amputation of the entire uterus (extirpation);
• removal of the uterus, fallopian tubes, appendages and / or ovaries;
• carrying out Wertheim's operation. This method is traumatic, it removes not only the uterus with appendages, surrounding tissue and lymph nodes, but also the upper third of the vagina.

The removal operation may depend on the access method:

• cavity (abdominal), carried out by incision of the abdominal wall;
• laparoscopic - carried out by punctures in the abdomen and / or side;
• vaginal.

Surgery for cervical cancer is performed:

1. Complete removal of the organ.
2. Conization (performed by excision of the area of ​​the degenerated tissue).

The specialist makes an incision in the lower abdomen - horizontal or vertical. Next, an audit of the internal organs is carried out, paying attention to the uterus and appendages.

After fixation, the organ is removed from the abdominal cavity. The fallopian tubes, vessels and ligaments are clamped with clamps and crossed between them.

Before stitching, a specialist is obliged to examine the condition of the internal organs.

Vaginal hysterectomy

This operation is indicated mainly for women who have given birth, because their vagina is sufficiently expanded, allowing free conduct of all manipulations. With this intervention, a total removal (of the body of the uterus and cervix) is usually performed. Surgery for cervical cancer is contraindicated for all kinds of complications that require revision of the abdominal cavity (for example, suspected ovarian cancer). With a large uterus, abdominal surgery is recommended.

The intervention can only be laparoscopic, when the organ itself is removed through the punctures, or combined with a vaginal access. In the second case, the uterus is removed through a natural opening, and the removal of blood vessels and ligaments is carried out through punctures in the abdomen. The operation is monitored through a video camera lowered into the abdominal cavity.

Removal of the cervix

In case of damage to one cervix, the transvaginal method is used. The surgeon separates the organ by making a tapered or wedge-shaped incision. And the sutures are applied in a sequential order with excision in order to avoid profuse blood loss.

Conization of the cervix

It is an organ-preserving operation that allows you to remove the affected epithelium, while preserving the mucous membrane. The operation is performed using a loop, not a scalpel, through which an electric current is passed. Vaginal access is advisable. The more tissue is removed, the less chance of recurrence. Therefore, during surgery, the healthy part of the epithelium is also captured.

Postoperative period

Most women experience symptoms of aching pain, numbness, itching around the scar, and bloody vaginal discharge in the first two months. These symptoms are not a cause for concern.

Recurrence of oncology is possible in the presence of unrecovered metastases of the neoplasm or in the dispersion of malignant cells during the operation itself. But thanks to modern methods of diagnosis and treatment, the risk of such a development of events is minimized.

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Surgical treatment for cervical cancer

Oncological diseases rank second in mortality after cardiovascular pathologies. In women, a common localization of a malignant tumor is the cervix. For a successful fight against pathology, it is important to identify it at an early stage of development, as well as choose the correct method of therapy.

Fight cancer

Treatment for cervical cancer can be of several types:

The choice of technique depends on many factors:

• stages of pathology progress;
• histological and morphological type of tumor;
• the exact location of the localization;
• individual characteristics of the organism.

As a rule, removal of cervical cancer with surgery is possible only in the first and second stages of the disease. If the tumor has a locally advanced process and is at the third or fourth stage, radiation therapy is used, possibly in combination with chemotherapy. Surgical intervention in this case is ineffective, since it is not possible to completely remove the tumor.

Operative treatment

The operation to remove cervical cancer can be performed by different methods, but the main task of each of them is the complete destruction of all atypical cells and affected tissues. If at least one cancer cell remains, a relapse of the pathology becomes inevitable. For this reason, the combined method of surgery with radiation is popular. The latter procedure is performed after surgery to kill any remaining individual cancer cells.

Cryosurgery

This technique can be applied only at the earliest stage in the development of the oncological process, namely the zero. Also, the neoplasm should not be invasive, only in this case cryosurgery or the method of freezing with liquid nitrogen will be effective.

The procedure consists in placing a metal probe on the walls of the cervix and supplying liquid nitrogen through it. As a result of such manipulations, atypical cells are frozen.

Radiation therapy

This technique, like cryosurgery, can only be used at the zero, precancerous stage. With invasive cancer, the method will not work. A stream of laser beams is directed to the pathological tissue and thus the affected mucosa is burned out. Also, the technique is used to obtain material for the histological analysis of the neoplasm.

Conization

This implies the removal of the cone-shaped portion of the cervix. Such an operation can be performed using a surgical scalpel, thin wire with current, or cryoconization.

As the main treatment, conization can be carried out at the first stage of the disease, while enabling the woman to maintain fertility. Also, conization is performed to clarify the diagnosis, using biopsy and histological analysis, thereby determining the further type of treatment.

The procedure can be performed if the invasion of the pathological tissue does not exceed 1 mm. The operation is organ-preserving and causes minimal harm to a woman.

Hysterectomy

Cervical cancer, hysterectomy operation consists in removing the uterus and its cervix, but at the same time tissues and organs located nearby are preserved.

• lymph nodes of the small pelvis;
• ovaries;
• the fallopian tubes;
• sacro-uterine ligaments.

Hysterectomy can be of three types:

1. open - performed using an incision in the front of the peritoneum;
2. vaginal - when the uterus is removed through the vagina;
3. laparoscopic hysterectomy is performed by puncturing the peritoneum with special instruments.

In this video you will learn about laparoscopic removal of cervical cancer

Such an operation is performed at the first stage and, unfortunately, leads to infertility. With the laparoscopic or vaginal method, a woman's recovery is faster than with open surgery. As a rule, the rehabilitation period is positive, side effects rarely occur in the form of early infection after surgery or bleeding.

Removal of the uterus and its cervix does not affect sex life and the ability to achieve orgasm, the vagina and clitoris remain intact.

Radical hysterectomy

This type of surgery is performed in the first and second stages of cancer. It consists in excision of the uterus, cervix, upper third of the vagina, sacro-uterine ligaments. The fallopian tubes and ovaries, as a rule, remain preserved if there is no indication for their removal. Most often, surgery is performed using an incision in the anterior wall of the peritoneum.

Trachelectomy

It is characterized by the removal of the cervix. Trachelectomy for cervical cancer can be performed in the first or second stage instead of hysterectomy. This operation preserves the body of the uterus, which does not exclude the possibility of a woman becoming pregnant.

Radical trachelectomy consists in removing the cervix together with regional lymph nodes. The upper part of the vagina can be removed, but the body of the uterus remains intact. The percentage of recurrence after this method is negligible. In half of the cases, a woman manages to carry a child and give birth to it using a cesarean section.

Exenteration of the pelvic organs

Unfortunately, after surgery, any of its types, a relapse may occur, when cancer cells reappear with the same localization. In this case, it is necessary to carry out exenteration of the pelvic organs. During the operation, all the same organs are removed as in radical hysterectomy, but in addition, it is possible to remove the bladder, rectum, part of the colon and vagina.

Recovery after such an operation is long, it takes at least six months. Removal of the colon, bladder and vagina requires additional surgery. From part of the intestine, surgeons create a new bladder, and new pathways for urine to drain. Plastic surgery is performed for the vagina.

Life after surgery

The main task of surgery is to perform the operation so that there is no recurrence of tumor growth. Since surgery is carried out only at the first or second stage, when the malignant process is limited, relapse occurs quite rarely. Its occurrence is more typical for later stages.

Of the consequences. Removing the uterus makes it impossible for a woman to have children in the future. But at the first stage, surgeons try as much as possible to carry out organ-preserving operations for women of childbearing age.

The five-year survival threshold for early treatment of the disease is high. If one of the types of operations, suitable for an individual case, is carried out at the first stage, about 90% of women achieve recovery. If surgery is performed in the second stage, the survival rate is about 75%.

Only the attending physician can make a decision on carrying out this or that type of operation, after carrying out all the necessary diagnostic procedures. It is important to remember that the main thing that depends on the patient is the timeliness of the visit to the gynecologist. A profile examination will reveal the disease at the first, and maybe even precancerous, stage zero and avoid the progress of the pathology.

Video: diagnosis and l aparoscopic removal of uterine cancer

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Surgery for uterine cancer: indications, methods of carrying out, consequences

Surgery for uterine cancer is a surgical method to remove a neoplasm. In some cases, amputation of the organ is required, which allows the patient to survive, albeit 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.

Cancer stages and indications for surgery

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

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 undergo malignant transformation over time. The mucous membrane of the neck is also very susceptible to degeneration. Sometimes cancer does not affect the epithelium (in about 20% of cases).

Most often, hyperplastic processes begin after menopause, but in recent years their occurrence among women of reproductive age has increased dramatically. Removal of uterine cancer separately from the organ is not possible. A malignant tumor must be excised along with all surrounding tissues.

Cervical cancer (cervical cancer)

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:

• Preinvasive (limited to the epithelium);
• Microinvasive (the tumor penetrates into the mucous membrane and is up to 1 cm in diameter);
• Invasive (the tumor has spread to surrounding tissue)

At the first stage, the doctor's decision regarding the scope of the operation can vary greatly depending on his personal experience and the 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 women in the perimenopausal period."

The second stage can also allow organ-preserving surgeries, however, they are associated with great risk. Already at this stage, the tumor can penetrate into the lymph and blood nodes, and, consequently, the spread of metastases. The risk in this case is higher, therefore, surgery for cervical cancer by total removal is practiced more often. It gives high rates of remission. From 95 to 100% of women live 5 years or more after surgery, as well as a course of chemotherapy or radiotherapy.

Invasive cancer is usually treated in a combined way - removal of the cervix, (in the latter stages, together with the uterus, appendages and / or lymph nodes) in combination with radiation exposure. The survival rate 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 body of the uterus)

This type of malignant transformation often occurs in conjunction with cervical cancer. It is an indication for the removal of the uterus. Only at the first stage (the tumor does not go beyond the body of the organ) is a subtotal hysterectomy (partial removal) possible.

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

Sarcoma of the uterus

It is a rare non-epithelial malignant tumor. She proceeds hard and is treated with difficulty. In the first stages (I - III), combined therapy is carried out. The affected organ must be removed. At the last, IV stage, large-scale irradiation is first carried out.

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

Surgical intervention

Preparation for conducting

After the doctor has decided on the need for surgical intervention, he should discuss with the patient all its consequences. The volume of removal, the use of organ-preserving surgeries is 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 whatever decision is made, the fact of the 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, a date for the operation is usually set. Within the specified period, the patient must pass a number of tests and undergo examinations that will help the doctor clarify the diagnosis and determine if there are any contraindications for surgical intervention. Perhaps during this period, a woman will be advised to take sedatives, sedatives to relieve psycho-emotional stress.

For 1-3 days, the doctor, having studied all the analyzes, issues his final verdict on the method of the operation and its volume. Chooses anesthesia taking into account the wishes of the patient. This can be general anesthesia, which is performed using an intratracheal tube, or an epidural (pain reliever is delivered through an injection into the spine). The patient signs a document confirming her consent to the operation, and also gives permission for a larger intervention, if necessary.

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

Types of surgery

The only way of surgical treatment for malignant tumors of the body of the uterus is to remove it. It can be done as follows:

• Amputation of only the body of the uterus (the cervix remains);
• Amputation of the entire uterus (extirpation);
• Removal of the uterus along with the 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 the upper third of the vagina.

types of surgery

The removal operation may depend on the access method:

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

For cervical cancer, the following can be performed:

• Its complete removal;
• Conization (excision of a portion of the degenerated tissue).

Abdominal cavity removal of the uterus

The surgeon makes an incision in the lower abdomen. It can run horizontally or vertically. After that, with his hand, he conducts an audit of internal organs, 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 clamped with clamps and intersect between them. As the incisions are made, sutures are applied as needed.

The greatest difficulty is the separation of the uterus from the cervix or from the vagina. The place of transition is pinched by Kocher clamps. The surgeon makes an incision between them. The stump of the cervix is ​​sutured and tied to the vascular bundles and ligaments with the help of ligatures (threads). If necessary, the appendages, ovaries, 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 tissues, an antiseptic dressing is applied to the wound. The vagina is dried with tampons.

Vaginal hysterectomy

Such an operation can be indicated for women who have given birth, since their vagina is sufficiently expanded and allows free carrying out of all manipulations. Thus, a total removal (of both the cervix and the body of the uterus) is usually performed. The operation is not performed in case of possible complications that require revision of the abdominal cavity (for example, suspected ovarian tumor). If the uterus is large, abdominal surgery is also recommended.

First, the surgeon makes a circular incision in the vagina. It is usually produced 5-6 cm from the entrance or deeper. Through it, instruments are introduced, the bladder is separated from the cervix. After that, 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 doctor can use a single suture. This shortens the operation time and eliminates the occlusion of the vessels. The ligaments of the uterus can be attached to the fornix of the vagina.

Laparoscopic removal of the uterus

The operation can only be laparoscopic, when the organ itself is removed through the punctures, or combined with a 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 operation is monitored through a video camera, which is lowered into the abdominal cavity.

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

At the first stage of the operation, the surgeon disconnects the bladder and crosses the uterine ligaments, followed by their coagulation (sealing by breaking down proteins). After that, the ureter is separated and shifted to prevent injury. The surgeon continues to transect the ligaments, he also cuts and coagulates the fallopian tubes if removal is not indicated.

Removal of the cervix

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

The role of a new canal can be played by a flap from the vaginal epithelium, which the surgeon cuts out in advance, or the fornices of the vagina. Sometimes the doctor leaves behind long threads to tighten the suture if necessary.

Conization of the cervix

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

loop conization of the cervix

The operation takes only 15 minutes. During it, the doctor puts 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, a woman may be under the influence of anesthesia. For additional control of the integrity of the organs of the excretory system, a catheter remains in the ureter for some time. When the patient regains consciousness, the nurse checks her condition, and the patient goes to the ward. There may be a feeling of nausea, which is allowed to drink a small amount of water.

After 1-2 days, it is 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 hospitalization period is up to 7 days. During this period, it is possible to prescribe painkillers and anti-inflammatory drugs. The doctor prescribes hormonal drugs, as a rule, later, based on the woman's condition.

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

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

Recurrence (re-emergence) of cancer is possible in the presence of unreleased metastases (foci) of the tumor or when neoplasm cells scatter during surgery. Modern methods of diagnosis and treatment can minimize the risk of such a development of events.

The cost of the operation, removal of the uterus according to the compulsory medical insurance

All types of surgical interventions performed in connection with oncological diseases are free of charge. Contacting a private clinic is solely the decision of the patient.

The cost of an operation in Moscow starts with a cut. The cheapest is abdominal surgery. The price is rubles. Vaginal amputation will be only slightly more expensive - by –RUB. The most expensive are laparoscopic methods. The average price in the capital is rubles. Conization of the cervix will be the cheapest - it costs bran.

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

In the modern world, there is a disease that is not so easy to defeat, especially if it is not detected at the initial stage - it is cancer. It is treated in various ways, one of which is surgery. And when it seems that the disease is gone, and everything is over, it suddenly returns. Why does cancer recur after surgery, what are the symptoms and how to prevent the return of the disease, we will talk further.

What is cancer recurrence

Oncology relapse is a return after a period of remission.

It is customary to distinguish between the relapse of the whole and the tumor.

The reason for the recurrence of a neoplasm may be activation that remained after treatment and surgery and were inactive for some time. This can be a fairly long period of time.

It is believed that the disease has re-emerged if metastases appear within a certain period of time after the tumor has been removed. They can be found not only in the tumor area, but also in tissues, in distant organs, lymph nodes.

No one can guarantee that a relapse will not happen after recovery. But there are factors that can help the doctor determine the likelihood of a return of the disease and inform the patient about it.

Recurrent disease factors

Let us single out several factors on which the occurrence of a recurrent malignant process will depend:

• Where is the tumor located? If this is a skin cancer in the first stage, then a recurrence of the disease is practically impossible, but a recurrence of breast cancer of the inner quadrant or rectal oncology is more likely.
• At what stage is the disease. So, in the early stages of the disease, when the malignant cells did not penetrate the tissue barrier and did not spread through the circulatory and lymphatic systems, a complete cure is possible without relapses of the disease.
• What is the histological structure of the superficial, as a rule, do not form a recurrent malignant formation. And infiltrative cancer often has relapses even after surgery.
• What method and scope of treatment were used. The most effective is the combined method of therapy. It gives a higher percentage of cure.
• What is the patient's age. It is known that cancer recurrence at a young age is a very rare phenomenon, which cannot be said about people of an older age group. It is also known that secondary cancers grow very rapidly and aggressively.

Reasons for cancer recurrence after surgery

One of the methods of treatment is the surgical removal of the malignant tumor. However, even after such an intervention and a course of chemotherapy, a relapse of the pathology is possible. The reasons for the return of the disease can be called the following:

• One of the reasons is not completely removed cancer cells during surgery. This is possible due to the fact that they began to form not in one, but in several places of the affected organ.
• Providing inadequate treatment or using ineffective methods.
• Heavy physical activity.
• Injuries to the operated part of the body.
• Use of narcotic drugs, smoking and addiction to strong alcoholic beverages.
• Chronic pathologies.
• Infectious diseases.
• Malfunctions of the endocrine system.

Relapse at the initial stage is almost asymptomatic, but one of the manifestations is the identification of nodular formations of pathological tissues at the site of surgery. Therefore, it is necessary to undergo regular examinations, since the symptoms at an early stage are minimal.

Diagnosing a relapse

In order to determine how much the pathological formations have increased, doctors may prescribe the following tests:

• X-ray examination.
• Ultrasound examination.
• Laboratory tests.
• Biopsy of pathological tissues.

Where can relapse occur?

The recurrence of a malignant neoplasm does not always occur in the place where it was first detected and removed.

Where re-development of the tumor is most often found:

• Local relapse. Cancer appears in the same tissues or very close to them. At the same time, the process did not spread to nearby organs and tissues.
• Regional relapse. Malignant cells are found in and tissue near the site of removal of the cancer.
• Distant relapse. Pathological changes were found in remote areas from the main primary cancer.

Consider the symptoms of cancer recurrence of certain diseases.

Symptoms of a recurring ovarian oncology

Even a 100% cure does not guarantee that the disease will never return. If surgery for ovarian cancer has been postponed, then there is some likelihood that a relapse of ovarian cancer may occur.

For early detection, you should pay attention to the following symptoms:

• Malaise and weakness appear more and more often.
• There is a feeling of pain and heaviness in the lower abdomen.
• Rapid fatigue.
• There is a violation of the menstrual cycle.
• There are malfunctions in the work of the pelvic organs.
• Violation of urination and defecation.
• Metastatic pleurisy or ascites appears.

Symptoms of recurrent uterine cancer

As mentioned earlier, the first symptoms of a repeated return of the disease are so negligible that you can even ignore it. However, you need to know what the symptoms may be if it is a recurrence of uterine cancer:

• Breakdown, apathy.
• Dizziness.
• Dyspeptic disorders.
• An increase in body temperature to 38 degrees and above.
• Recurrent pain in the lower back and small pelvis, worse at night.
• Bloody or watery discharge.

Common symptoms of re-oncology after surgery

Let us highlight several common signs that are characteristic of the recurrence of an oncological disease:

• Constant feeling of tiredness.
• Headaches, dizziness.
• Disorder of the digestive system.
• Intestinal and bladder dysfunctions.
• Lumps or growths in any part of the body.
• Unusual discharge or bleeding.
• Frequent pain.
• Changes in the size and nature of moles, birthmarks.
• Persistent cough or hoarseness.

I would like to note once again that most often cancer relapses in the initial stages are not very noticeable for patients. Therefore, it is necessary to be regularly monitored by specialists and be tested for cancer cells.

How is recurrent disease after surgery treated?

Currently, medicine is successfully fighting cancer in the early stages, and treating a relapse at an early stage can give a person a better chance of recovery.

Relapse after cancer removal can be early or late. An early relapse occurs 2-4 months after surgery, and a late relapse occurs after 2-4 years or more.

Scientists have found that after the operation, cancer cells begin to actively progress in 4-6 months, so it is advisable to carry out specific therapy as soon as the primary signs of oncology were found in the operated organ.

What is anticancer therapy:

• Surgery. Excision of a malignant formation if tumor cells have not penetrated into other tissues.
• Radiation therapy.
• Chemotherapy.
• Treatment with immunotherapy.
• Considering the type and stage of cancer, radiofrequency ablation, cryosurgery, or hormonal therapy are performed.

As a rule, more than one method of treatment is used, but several, which give good results. Chemotherapy is often used in conjunction with radiation therapy.

It should be noted that cancer relapses, as a rule, cannot be treated with the use of the same methods and drugs that were used in the treatment of primary education. Malignant cells can be resistant to chemotherapy, so it can no longer be used in case of relapse.

Radiation therapy is used when the tumor cannot be surgically removed and metastases have already formed. And also this type of treatment is complementary to chemotherapy.

Ways to prevent relapse

To prevent relapse after cancer, several recommendations must be followed:

• Constantly monitored by an oncologist. Undergo a medical examination at least 2 times a year. Conduct laboratory tests, monitor the condition of the lymph nodes, and also conduct an examination for the presence of seals, neoplasms.
• Adhere to a healthy lifestyle. Do not smoke, do not abuse strong alcoholic beverages.
• Observe proper nutrition. The diet should be rich and balanced.
• Taking vitamins and nutritional supplements is recommended, but only after consulting a doctor.
• Moderate physical activity and sports are recommended. The correct alternation of work and rest, an active lifestyle.

As you know, cancer relapses occur in a more aggressive and transient form. To prevent this, it is necessary to adhere to the advice of doctors, lead a healthy lifestyle, and if the fear of the return of the disease still visits, seek psychological help.

The consequences of removal of uterine cancer is a topic of concern to women who are faced with oncology of the genital organ. Often chemotherapy and radiation treatment do not give the expected results, the disease progresses, and the doctor is forced to take drastic measures - to remove the uterus along with the appendages. The operation does not always proceed without complications, but the correct organization of the rehabilitation period will help to reduce the risk of their development to a minimum.

The first complications arise in the early rehabilitation period.

May appear:

1. The development of an inflammatory process at the seam site. The patient notes hyperemia of the skin, their swelling, and sometimes suppuration. In case of untimely seeking help from a doctor, suture threads may diverge.
2. Problems with urination. Women complain of pain, cramps, or discomfort when emptying their bladder. Such a complication of hysterectomy in uterine cancer develops with mechanical damage to the urethra during the operation.
3. Painful sensations of varying intensity.
4. The development of the adhesive process in the pelvic area.
5. Formation of fistulas. The appearance is due to poor-quality or improper ligature application, or their infection. The situation is corrected only with the help of a second operation to remove the fistula.
6. The appearance of hematomas in the suture area, the formation of which is associated with a violation of the integrity of the capillaries.

Please note! The most dangerous complication is a relapse of the disease, as well as the appearance of metastases after removal of a cancerous tumor of the uterus. To avoid such consequences, after the operation, the patient is prescribed a course of radiation and chemotherapy.

Radiation treatment after pangysterectomy

Radiation therapy after the removal of the cancer of the uterus is prescribed with the aim of eliminating the remaining cells and tissues of the malignant tumor. In parallel, this therapeutic approach prevents the recurrence of the disease.

The main feature of this method of treatment is the use of ionizing rays that affect a specific point on the patient's body. In this case, on the pelvic organs, where the surgery was performed.

Radiation therapy after surgery to remove the uterus is not given to women with:

• thrombocytopenia;
• tuberculosis;
• radiation sickness;
• fever;
• intense bleeding caused by the breakdown of the cancer;
• myocardial infarction;
• anemia;
• renal or hepatic impairment;
• multiple metastases.

This procedure can be performed in 4 ways:

1. Remote. In this case, the rays act directly on the place where the malignant neoplasms were located, but at a distance from the skin.
2. Intracavitary. This type of radiation treatment involves the use of a special intravaginal device, and is prescribed if necessary to eliminate the remaining malignant tissue.
3. Contact. Such radiation therapy involves contact of the radioactive drug with the skin. Before the first procedure, the radiologist instructs the woman in detail about the specifics of the manipulation, as well as about possible sensations during the session.
4. Internal. Before manipulation, the required dose of drugs prescribed by the oncologist is injected into the uterus, after which radiation is performed. This approach helps to suppress the growth of malignant cells and prevent the recurrence of cancer.

The duration of the radiation therapy session after tumor removal is set individually for each patient. But, as a rule, the duration of the manipulation does not exceed half an hour.

Menstrual cycle and intimate life

Period after surgery to remove uterine cancer depend on the surgical technique. If the treatment was conservative (with stage 1-2 cancer), then gradually the woman's menstrual cycle will improve.

It may be irregular at first, and menstrual flow is scanty. The appearance of large blood clots of burgundy, brown or even black color is possible.

Sometimes the onset of menstruation is observed 2 times a month or 1 time in 2 months. Such anomalies must be treated with understanding, since an operation to remove a cancerous tumor is a severe stress for the body. It can take several months for the menstrual cycle to fully recover.

Menstruation after complete removal of the uterus (in elderly patients, as well as with cancer occurring in the last stages) does not resume. During surgical treatment, as a rule, the entire genital organ, together with the appendages, is amputated. Under such circumstances, there is simply nothing to form the egg and the endometrium, so menstruation does not occur.

Intimate life after removal of a tumor with uterine cancer is possible only after completing a full course of rehabilitation. The type of operation is also important.

Often, surgical interventions provoke vaginal bleeding. In this case, the resumption of sexual relations is possible only after the elimination of this symptom.

As for the libido in women who have undergone surgery to remove a cancerous tumor from the uterine cavity, it depends on whether the ovaries have been preserved (responsible for the production of female sex hormones). These biologically active substances regulate sexual desire, and also affect the possibility of conception.

An intimate life is allowed to lead even after a hysterectomy. If the patient has fully recovered from the operation, underwent the prescribed hormonal, chemotherapy or radiation treatment, and she did not have postoperative complications, in the future she will be able to have a full sexual relationship.

Features of the recovery period after removal of uterine cancer

Each patient who has undergone surgery to remove a cancerous tumor from the uterine cavity, or panhysterectomy, must comply with all the rules regarding rehabilitation. During this period, a woman's life consists of "can" and "no".

What is prohibited after removal of uterine cancer?

To avoid complications, a woman who has undergone surgery to remove a malignant tumor of the genital organ is strictly prohibited:

• smoking;
• carry or lift weights;
• perform strength physical exercises;
• eat junk food: smoked meats, salted foods; spicy, fatty, fried foods; baked goods, sweets, pastries;
  drink tonic drinks - coffee, strong tea, store "energy drinks", etc.

Alcohol is allowed in small doses - 200 g per day. But the patient is allowed to take only dry red wine. The rest of the alcoholic drinks are taboo!

What can be done in the postoperative period?

Women who have undergone surgery to remove uterine cancers do not have to give up sports. During rehabilitation, walking in the fresh air and race walking will be useful.

When the body recovers a little, the patient can consult with the oncologist about the possibility of attending yoga sessions. Swimming also helps the body recover from the stress of surgery more quickly, but it is only signed up for it with the permission of the attending physician.

It will be useful to use freshly squeezed home-made juices - vegetable, fruit, berry. Infusions from chaga powder, as well as a drink based on kombucha will be good means of preventing recurrence of cancer.

Sick leave and disability

The duration of the sick leave after the operation is set by the oncologist for each patient individually. To begin with, the patient is given 10 days to recover (this period includes hospital stay). If necessary, the oncologist has the right to prolong the sick leave for up to 30 days.

Sometimes the patient needs more time to recover, because after the operation, radiation therapy or a combination is prescribed (together with the use of chemotherapy drugs). In this case, the sick leave can be extended for 1, 2 or more months, but only by decision of the medical board.

Women with cancer of the uterine body are given a disability, the group of which depends on the severity of the disease and the methods used to treat it. In oncology of 1 - 2 stages with a successful outcome of therapy, the patient is able to work in a position with minimal oncogenic risk. With a significant disability, or when it is impossible to find a safe job, the patient is given a 3rd disability group.

A pronounced limitation of the vital activity of patients with cancer of the uterine body is manifested when the disease progresses to 3 - 4 stages of development with the ineffectiveness of the treatment. In this case, the patient is given group 2 disability. It is also available for women whose prognosis for recovery is considered unfavorable or uncertain.

Surgical treatment of cancer of the uterine body makes certain adjustments in the lives of women, creates restrictions, and sometimes even causes serious complications. To restore full-fledged life activity with a favorable outcome of therapy, it is important to undergo a complete rehabilitation course, observing the recommendations given by the attending oncologist.

Patients who have undergone a dangerous illness should be observed by a doctor every six months and undergo preventive diagnostic procedures. This is the only way to avoid a relapse of the disease or fix alarming changes in a woman's body at the very beginning of the onset.

Exposure of the tumor to ionizing rays makes it possible to achieve a positive effect, since tumor cells are quite sensitive. For healthy cells, radiation therapy, even after removal of the uterus with appendages, practically does not cause damage. This is the most gentle method, in contrast to surgery, which is carried out everywhere today and the consequences are minimal. Radiation therapy after removal of the uterus is currently one of the most effective.

Irradiation is often carried out in combination with chemotherapy and is indicated for at any stage of the oncological process. The method of radiation therapy can be prescribed after the removal of the uterus and epididymis. While surgery can be completely ineffective.

Radiation hysterectomy is mainly performed after surgery in order to eliminate the remaining, other abnormal structures in the structure of cells in women with uterine cancer. The method of radiation therapy is based on the therapeutic effect, despite the training with ionizing rays, the harm from which is insignificant. Although this radiation is contraindicated if women have:

• radiation sickness;
• thrombocytopenia;
• feverish condition;
• decay of the tumor;
• severe bleeding against the background of tumor decay;
• myocardial infarction;
• tuberculosis;
• diabetes mellitus;
• hepatic, renal failure;
• Stage 4 cancer;
• anemia;
• multiple metastases.

How is radiation exposure done?

Radiation is usually prescribed:

• at stages 1-2 of cancer after surgery to remove the uterus;
• when the tumor spreads to regional lymph nodes;
• at the time of palliative therapy;
• at stage 4 cancer, if the operation did not bring significant results;
• for prophylaxis to prevent relapse.

Types of radiation therapy

It is possible to carry out external, intracavitary, contact or internal radiation therapy.

1. Remote therapy is carried out by exposing the affected area to rays, but at a certain distance from the skin without touching it.
2. Intracavitary therapy is carried out with the aim of destroying the tumor, for which a special device is inserted into the uterine cavity.
3. Contact therapy is carried out by contacting the radioactive drug with the skin. Before the procedure, the doctor will tell you in detail about this technique and what a woman may feel at the time of the procedure.
4. Internal therapy consists in the introduction of initially defined drugs into the uterine cavity and followed by the introduction of ionizing rays in order to suppress the malignant tumor.

The main goal of therapy is to maximize the impact on the site of the lesion, to shorten the recovery period for the body. When the radiation is carried out, it is important for women:

• normalize nutrition;
• walking more in the fresh air;
• follow all doctor's orders.

How to prepare

Preparatory procedures for radiological treatment include:

• referral of the patient to an MRI scan in order to clarify the location of the tumor;
• the doctor's appointment of the necessary doses for irradiation, taking into account the obtained test results.

The duration of the procedure is no more than 35 minutes. It is carried out in a specially designated room in compliance with all technological requirements for safety purposes. Women are encouraged to lie down on the couch and remain motionless while the ionization source is brought in.

Nothing should interfere with the free passage of X-rays. For convenience and separation from the lesion site, healthy areas of the body are covered with protective fabric.

What can be the consequences after irradiation

Many patients after receiving radiation therapy complain of the following consequences:

• nausea, vomiting;
• severe intoxication of the body;
• indigestion;
• upset stool;
• signs of dyspepsia;
• the appearance of burning and itching on the integument of the skin in the part;
• dryness in the vaginal mucosa and genitals.

Doctors, however, say that such consequences take place and recommend that women somehow survive this period, pay more attention to rest, do what they love. It is important to get a good night's sleep and gain strength after a course of radiation therapy. In addition, at home, you need to treat the lesion site with herbal preparations in order to avoid burns at the time of treatment. At the same time, do not use cosmetic and perfumery products until the wounds are completely healed after surgery.

Consequences in the form of allergic reactions after the procedure are possible. Therefore, you should not take hot hot baths for a week. It is better to refuse to visit a bathhouse or a sauna for a while.

What is the forecast

After the removal of the uterus with the appendages, the woman, of course, will have to forget about childbirth, but radiation therapy at the early 1-2 stage of cancer gives quite positive prognosis. Perhaps even a complete cure from the delivery of radio waves and staged up to 5 sessions.

But, unfortunately, it is no longer possible to stop the uterine tumor process at stages 3-4. All such efforts can be directed only to relieve unpleasant in patients, to stabilize the growth of a malignant tumor.

After the treatment process, women, in order to quickly experience the effects of radiation exposure on the body, are shown spa treatment during the rehabilitation period, as well as a course of massage, physiotherapy, balneotherapy, acupuncture, radon baths.

If irradiation has been carried out and serious complications have arisen, then, most likely, a disability group will be assigned, if the operation has led to a significant loss of working capacity.

In addition, it will be possible to begin sexual activity no earlier than 8 weeks after the radiation therapy. Still, at first, women need to take care, gain strength, heal the wounds left in the postoperative period. Although doctors say that radiation therapy after removal of the uterus along with the appendages, the operation does not affect the sexuality and psychological activity of the woman.

Having sex is not at all contraindicated, but first it is advisable to visit a gynecologist for an examination, who will tell you when you can start having sex and how long you need to wait for the healing of wounds and scars.

Page 23 of 28

1. TREATMENT OF PATIENTS WITH UTERINE BODY CANCER

Currently, the most common method of treating patients with cancer of the body of the uterus is surgery, but the scope of surgery is still a subject of discussion. The opinions of various authors regarding the advisability of simple or extended extirpation of the uterus do not coincide.
The question of the optimal method of surgical intervention with the choice of its path has not been fully resolved. Most surgeons operate using an abdominal approach to remove the uterus, but there are still many who advocate a vaginal approach.
In favor of extended extirpation of the uterus, evidence from the literature testifies. When examining the pelvic lymph nodes removed from patients with cancer of the body of the uterus, Ya. V. Bokhman often found tumor metastases in them. More often they were detected in the hypogastric and obturator, less often in the iliac lymph nodes. At the same time, a direct relationship was established between the frequency of metastasis of a cancer tumor to the pelvic lymph nodes and the depth of its invasion into the muscular membrane of the uterus. It becomes obvious that in patients with cancer of the body of the uterus, it is advisable to perform extended extirpation of the organ.
The fallopian tubes and ovaries must be removed from all patients with cancer of the uterine body, because every eighth to tenth of them have metastases to these organs.
The most favorable results are obtained by extended extirpation of the uterus with appendages. However, an operation of this volume is not indicated for all patients. Since cancer of the uterine body more often affects elderly women, often suffering from severe extragenital pathology (hypertension, diabetes mellitus, obesity), the risk of extended extirpation of the uterus seems to be very significant even in modern conditions.
The All-Union Cancer Research Center of the USSR Academy of Medical Sciences adopted the following tactics for managing patients with cancer of the uterine body, depending on the patient's condition, size, localization, depth of invasion and degree of tumor differentiation.
If only the mucous membrane of the uterine body is affected by the tumor, only the removal of the uterus with appendages should be performed, with the exception of cases of total lesion of the endometrium. Simple extirpation of the uterus with appendages can also be limited when the muscle wall is invaded by a tumor located in the upper part of the uterus to a depth of not more 1 cm, combined treatment is carried out: in the postoperative period, distance gamma therapy is indicated at a dose of 40-46 Gy.
In patients with cancer of the body of the uterus with a simultaneous tumor lesion of the ovaries, which sometimes has a different histological structure, in addition to removing the uterus with appendages, it is necessary to resect the greater omentum. In the postoperative period, antitumor chemotherapy should be included in the complex of therapeutic measures.
When deciding on the advisability of prescribing gestagens to patients with cancer of the uterine body, the detection of progesterone receptors in tumor cells is essential. If present, progesterone should be used in the preoperative and postoperative periods.
The high degree of differentiation of the glandular tumor of the cancer of the uterine body is a favorable prognostic sign, which should be taken into account when determining the scale of surgery.
The abdominal way of removing the uterus has a number of advantages over the vaginal one. They consist in the possibility of a more thorough examination of the abdominal cavity and, accordingly, the implementation of a radical operation, easier adherence to the principles of ablasticity due to favorable working conditions, as well as the availability of a wide examination of the pelvic organs.
Indications for vaginal extirpation of the uterus are pronounced obesity of a woman, prolapse and prolapse of the uterus.
Before starting the operation, the vagina is treated with a furacilin solution in the dressing room, then it is drained and lubricated with alcohol and an alcohol solution of iodine. A sterile gauze swab is inserted into the vagina, which is removed during surgery.
After opening the abdominal cavity with a lower midline or transverse suprapubic incision, the subcutaneous fat is fenced off by attaching a towel with the help of long clamps to the edges of the cut parietal peritoneum.
The wound is dilated with the Fora mirror and side mirrors. The bowel loops are pulled up with a damp soft cloth. After that, the abdominal organs are revised.
Then, long, strong clamps are applied to the wide and round ligaments on each side. Kocher clamps are applied to the round and funicular ligaments, first on the right, and then on the left, the ligaments are cut with scissors, catgut ligatures are applied to their stumps.
The leaves of the broad ligaments are pushed apart with the fingers to ensure the possibility of revision of the parametric tissue and lymph nodes along the blood vessels of the small pelvis. The vesicouterine fold is cut. The bladder is separated from the cervix with branches of closed scissors and pushed downward.
When performing the operation of simple extirpation of the uterus, two Kocher clamps are applied to the uterine arteries, the vessels are cut, the clamps are replaced with strong catgut or silk ligatures. Then the cardinal ligaments of the uterus are crossed together with the vaginal branches of the uterine artery, which are located along the cervix.
The Kocher or Mikulich forceps are applied to the peritoneum between the sacro-uterine ligaments. The peritoneum is dissected with scissors and exfoliated up to the sacro-uterine ligaments. Kocher or Mikulich clamps are applied to the latter. After crossing the ligaments, they are replaced with catgut ligatures, the ends of which are cut off.
After crossing all the ligaments, the uterus is lifted up. The tampon is removed from the vagina by pulling on the Kocher clamp applied to its free end. The anterior wall of the vagina is dissected in the transverse direction. Its walls are wiped with iodine tincture. A gauze swab is inserted into the lumen from the side of the abdominal cavity to prevent the contents of the vagina from entering the abdominal cavity.
The vagina is dissected around its entire circumference. Kocher clamps are applied to the walls of his stump in order to stop bleeding and fix the walls for suturing them. Separate catgut sutures are placed on the upper edge of the vaginal tube. Thus, the vagina is not sutured tightly. With the help of sutures, the edge of the vesicouterine fold is fixed to the anterior wall of the vagina, and the peritoneum of the rectovaginal cavity is fixed to the posterior wall. Peritonization of the pelvic wound is carried out due to the leaves of the broad ligaments, as well as stitching the anterior and posterior leaves of the peritoneum above the vaginal stump.
For cancer of the uterus, a modified method of extended extirpation of the uterus with appendages can be applied. Its meaning lies in the fact that, in addition to extirpating the uterus with appendages and removing a small vaginal cuff, the parameters of the fiber with the iliac lymph nodes contained in it are removed. In contrast to extended extirpation of the uterus with appendages in cervical cancer, this modification of the operation does not isolate the orifices of the ureters and does not remove paracolpium fiber.
The reason for such an operation is a very rare germination of periapical adipose tissue by cancer of the body of the uterus. When using a modified extended extirpation of the uterus, the trauma of the surgical intervention is reduced, the number of complications during the operation is reduced, and the course of the postoperative period is facilitated.
Combined method of treatment. The combined method includes surgery and radiation therapy, which can be performed in a different sequence: surgery followed by radiation, or first radiation and then removal of the affected uterus.
In clinical practice, the first option of combined treatment is used more often; the uterus is surgically removed, and then the patient is exposed to radiation.
The goal of postoperative irradiation is to target the remaining tumor elements in the vagina, small pelvis and abdominal cavity to prevent recurrence of the disease. It can be performed in the form of external gamma therapy, intracavitary irradiation, or a combination of both.
Remote irradiation is carried out by using gamma-therapeutic devices such as "Luch-1", "Rokus" or sources of megavoltage radiation.
The radiation dose to the area of ​​the vaginal stump reaches 40 Gy. Treatment can be carried out in various ways, using bipolar radiation from the anterior iliac and posterior sacro-gluteal fields.
Treatment can be carried out daily, irradiating the entire pelvis by using two parallel fields - two anterior and two posterior, with 2 Gy per focus on each side, or all four fields at the same focal doses. You can also apply the option of daily irradiation of the opposite fields of only one half of the pelvis: left anterior and left posterior or right anterior and right posterior; a focal dose of 2 Gy. The size of the irradiation fields varies depending on
power from the constitutional characteristics of patients. Most often they have a size of 14X16-16x18 cm.
Remote gamma therapy can be performed in a rotational mode using biaxial or axial, four-axis or tangential irradiation.
Intracavitary gamma therapy is prescribed for both therapeutic and prophylactic purposes. It is carried out using colpostates having a length of 8 cm and a diameter of 2-4 mm. The total absorbed dose at a depth of 0.5 cm from the surface of the vaginal mucosa is 20-25 Gy.
Preoperative radiation therapy is carried out by the method of intracavitary introduction of spherical sources, using special intraductors. The uterine cavity, cervical canal and vaginal vaults are exposed to radiation. The total gamma equivalent of the 60Co sources used is 50-80 meq of radium. The duration of the session is 1-2 days; 1-2 sessions per course.
When carrying out intracavitary gamma therapy with spherical sources, the total absorbed dose in the area of ​​point A and myometrium is 60 Gy.
Before the operation, intracavitary gamma therapy can be carried out by the method of manual sequential introduction of applicators and radiation sources and by the method of introducing high specific activity sources on tubular gamma therapy devices. When using the “AGAT-V” hose apparatus, irradiation is carried out during two sessions in a single focal dose of 10 Gy, total - 20 Gy. The duration of the sessions is 50-60 minutes.
Combined radiation treatment. The operation is performed 2-3 weeks after the end of the irradiation. Radiation therapy for patients with cancer of the uterine body is recommended to be used as an independent method of treatment in case of contraindications to surgery and the impossibility of radical removal of the tumor due to its significant spread to the surrounding tissues (parametric tissue, ligamentous apparatus of the uterus).
The principle that must be adhered to in radiation treatment of patients with cancer of the body of the uterus is the effect on the tumor of the uterus and regional lymph nodes located in the small pelvis.
Treatment begins with external gamma therapy in a static or rotational mode. Irradiation in a static mode is carried out from two or four fields. For radiation therapy, two opposite fields 15 cm wide and 14-15 cm high can be used; a single dose of 2 Gy. In the case of four-pole irradiation, the exposure is carried out in the same single dose with a field size of 6X7-15X18 cm.
When a dose of 10 Gy is reached, additional intracavitary gamma therapy is started. It consists in tight filling of the uterus with spherical sources.
Before starting treatment, a hysterocervicograph should be performed, in which you can get an idea of ​​the volume and shape of the uterine cavity, the location and shape of the cancerous tumor and the state of the cervical canal. This information is necessary to ensure the most appropriate location of radioactive sources in the uterine cavity and cervical canal. A linear radioactive source is introduced into the neck channel. Intracavitary therapy sessions are carried out once a week, lasting 1-2 days; for a course of 4-5 sessions.
On days free from intracavitary gamma therapy, remote irradiation of the parametric parts of the small pelvis is performed. The total gamma equivalent of intracavity sources with one application reaches 50-70 meq of radium. With each application, the patient receives 20-25 Gy. The total dose at point A with intracavitary irradiation is 65-80 Gy. The total absorbed doses during remote gamma therapy in the lateral parts of the pelvis are 35-40 Gy. The total dose for combined radiation therapy at point A is 80-90 Gy, at point B 60-65 Gy.
Hormone therapy. A new method of treating patients with cancer of the body of the uterus is the use of gestagens as one of the components of complex therapy. As an independent method of treatment, hormone therapy can be used for tumor metastases in the lungs and pelvic bones.
According to A. Varga and E. Henricksen (1965), the use of progestins in primary patients with cancer of the body of the uterus in combination with radiation or surgical treatment leads to a decrease in the number of relapses. Noteworthy is the report of J. Bonte (1972) on the enhancement of the therapeutic effect of radiation therapy on a tumor with iodine by the influence of progestins.

Rice. 41. Cancer of the body of the uterus. Under the influence of hormonal treatment, mucus is secreted by tumor cells.
In recent years, oxyprogesterone-capronate, a synthetic analogue of the corpus luteum hormone progesterone, has become widespread in the Soviet Union and abroad. As an ester of oxyprogesterone, it is persistent in the body and slow to act. Once injected intramuscularly, oxyprogesterone capronate acts on the body for 1 - 2 weeks.
Under the influence of hydroxyprogesterone capronate, the mitotic activity of uterine cancer cells decreases, their morphological and functional differentiation increases, and atrophic and degenerative changes occur in them (Fig. 41). Complete death of tumor cells may even occur.
According to Ya. V. Bokhman, under the influence of hydroxyprogesterone-capronate, cancer cells can undergo various changes. In 56.6% of patients, an increase in the structural and functional differentiation of the tumor was noted, in 34.7% of the effect, no effect was observed, and in 8.7% of patients, complete regression of the cancer occurred.
The sensitivity of the tumor to the effect of progesterone drugs depends on the degree of differentiation of the cancer of the uterine body [Bokhman Ya. V., 1979]. The most sensitive to gestagens are highly differentiated forms of glandular cancer.
A favorable result of the use of the hormone is found in patients, and the complete disappearance of the tumor occurs in 25.6%. The drug is also effective in the treatment of patients with severe endocrine exchange disorders.
To decide whether hormonal treatment is appropriate, it is important to know whether tumor cells have the corresponding receptors, which can be determined by radioimmunoassay.
Oxyprogesterone capronate is administered intramuscularly at 1 g 3 times a week (up to 8 ml of 1.2.5% oil solution) or daily at 500 mg for 1 1/2-2 months, and then gradually reduce the dose to 500 mg per week.
The duration of drug administration is determined individually. In the presence of unfavorable prognostic signs in the form of deep invasion of the myometrium, metastases in the pelvic and para-aortic lymph nodes, it is recommended to treat oxyprogesterone with capronate for at least 3 years, i.e., during the period of the most frequent clinical manifestations of relapse and metastases.
In patients with cancer of the body of the uterus, for whom radiation therapy and surgery are contraindicated, hormonal treatment is carried out throughout life after the diagnosis is made. The life of patients can be extended for many years.
Oxyprogesterone capronate is contraindicated in the general serious condition of patients, in particular with severe cardiovascular insufficiency, in which the absorption of the oily solution of the drug is impaired. Intolerance to the drug in the form of the onset of suffocation after its administration should also be considered as a contraindication to its appointment.

Chemotherapy.

Although many patients with cancer of the uterine body are successfully treated with surgical treatment and radiation, some of them need to be prescribed chemotherapy when the tumor progresses.
In clinical practice, cyclophosphamide, 5-fluorouracil, adriamycin, vincristine and other drugs are used, which are used either as a single agent or in various combinations. As research by N. Bruckner and G. Deppe (1977), F. Muggia et al. (1977), with the complex use of cytotoxic drugs, the effect is higher than when they are used alone.
In the Soviet Union, chemotherapy for patients with cancer of the uterine body is carried out with cyclophosphamide, ThioTEP, and 5-fluorouracil.
A.K. Pankov et al. (1980) reported favorable results of the endolymphatic use of these drugs. The authors injected 1600-2000 mg of cyclophosphamide or 100-150 mg of ThioTEP + 10,000 mg of 5-fluorouracil into the lymphatic vessels alternately in each lower limb with an interval of 7-10 days.

1. Kaupilla et al. (1980) used a combination of adriamycin, cyclophosphamide, 5-fluorouracil and vincristine to treat 20 patients with stage III-IV uterine cancer. A three-day cycle of cytotoxic treatment began with the introduction of 1.5 mg of vincristine, after 4 hours, adriamycin was injected intravenously at a dose of 40 mg / m2. On the 2nd and 3rd day of treatment, 5-fluorouracil at a dose of 500 mg / m2 was injected intravenously for 2 hours. The courses of treatment were repeated after 3 weeks. All patients underwent at least 4 courses.

A clear effect of the treatment was revealed in 5 patients (25%), a partial effect was also found in 5, changes in the tumor did not occur in 3, the progression of the process was ascertained in 7 patients (35%). One patient died of heart failure after eight months of remission.
The beneficial effect of the use of drugs was observed in half of the patients, both with progressive primary cancer and with a relapse of the disease.
Studies have shown the need to use combinations of cytotoxic drugs for the treatment of patients with cancer of the uterine body, in whom another method of treatment can no longer be applied.