围绝经期妇女常见病变,别怕!有这些症状建议咨询医生

2022-05-05 曜影医疗 网络

在2022年母亲节到来之际,我们希望大家能尽早认识这一围绝经期妇女的常见疾病:子宫内膜癌。

​#向肿瘤说拜拜#:“癌症防治 早早行动”!大多数人谈癌色变,选择逃避,非常不利于癌症的早期发现和治疗。为此,曜影医疗准备了#向肿瘤说拜拜#系列科普,帮助大家正确认识癌症、积极防控癌症。在2022年母亲节到来之际,我们希望大家能尽早认识这一围绝经期妇女的常见疾病:子宫内膜癌。


✦子宫内膜癌✦


子宫内膜癌(EC)是子宫内膜的一种病变,是我国围绝经期妇女常见的疾病;60-70岁是发病高峰年龄,但也存在2%-5%的病例发生于40岁之前。

 

为什么会发生子宫内膜癌?

在了解子宫内膜癌发病过程之前,我们先来了解一下子宫的结构。

子宫是一个形状似梨形的,位于膀胱和直肠之间,在女性怀孕时容纳胎儿的器官;具有一个薄的内衬层和一个厚的外层,薄薄的内层称为子宫内膜,厚的部分为子宫肌层。绝经前,子宫内膜会增厚为怀孕做准备,如果没怀孕则内膜脱落来月经。绝经以后不再有月经,因此子宫内膜就不再增生和脱落了。

而妇女罹患子宫内膜癌,是因子宫中的正常细胞转变为异常细胞,并出现生长失控的情况。

 

关注要点:危险因素&高危人群

子宫内膜癌的危险因素,主要是指存在过多内源性或外源性雌激素,而没有足够孕激素拮抗的临床情况。

主要高危人群包括:长期无排卵,肥胖合并高血压糖尿病,以及月经初潮早和绝经晚等症状的女性。

 

如何发现:常见症状&诊断方式

子宫内膜癌最常见的症状是异常的阴道出血

  • 育龄期妇女异常出血的定义为:月经期之间出血或月经过多。
  • 对于绝经后的妇女,任何阴道出血都被认为是不正常的。对于没有接受更年期激素治疗的妇女,即使只是一滴血,也是不正常的;而接受更年期激素治疗的妇女,在治疗的头几个月经常会有一些阴道出血(如果正在接受激素治疗,存在绝经后出血的情况,仍应及时告知你的医生)。

子宫内膜癌可以通过以下常见的检查方式来诊断:

  • 子宫内膜活检
  • 宫腔镜检查+诊断性刮宫

这些检查都是获取子宫内膜组织做进一步病理学分析。

 

分期:子宫内膜癌能有多严重

如被诊断为子宫内膜癌,接下去就要确定它的分期。分期是用来描述癌症扩散的程度,子宫内膜癌的分期依据如下:

  • 癌细胞侵入子宫肌壁的深度
  • 是否有癌症扩散到其他器官的迹象(可通过体格检查、腹部和骨盆磁共振成像、胸部x光或其他成像检查来确定)

子宫内膜癌的分期,从I期(即癌症尚未侵入子宫内膜外)到IV期(即癌症已经扩散到远处的器官,如肝脏)不等。

 

子宫内膜癌能被治愈吗?

手术通常是为了确定癌症侵入子宫肌壁的深度。同时,子宫内膜癌可通过切除子宫、卵巢和输卵管来治愈。

手术种类包括:

  • 有时,可通过腹腔镜进行(通过腹部的小皮肤切口,使用带有微型摄像机的工具引导手术医生)。
  • 有些情况下,手术需要在腹部做一个更大的皮肤切口,即需开腹手术。

腹腔镜手术和开腹手术的选择取决于患者的具体情况、意愿以及医生建议等。

不能手术者:放疗也是一种治疗方式。

 

如果患上子宫内膜癌,还能怀孕吗?

尽管子宫内膜癌在绝经后的女性中更为常见,但它也会影响年轻女性。当被诊断出患有子宫内膜癌,并且想在未来要个孩子,医生会告诉你治疗癌症的最佳方案以及未来怀孕的可能选择。

 

如何预防子宫内膜癌?

定期妇科体检,以及异常阴道流血随时就诊。

正确饮食和适量运动,与子宫内膜癌风险降低相关;并且将体重控制在理想水平,可以改善免疫功能、内源性性激素和代谢激素水平。

研究发现,使用雌激素-孕激素口服避孕药可将子宫内膜癌风险降低30%-40%,停药后此风险降低可持续数年,这比单纯孕激素避孕药对子宫内膜癌的预防作用更具优势。

 

本文作者:曜影医疗妇科主任 孔玉屏医生

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    2022-05-07 海豹

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