Uterine Adenocarcinoma (Adenocarcinoma Uterine Cancer) – symptoms, stages and treatment

Medically reviewed: 15, February 2024

Read Time:8 Minute
Medically reviewed 07 Jan 2024

Uterine Adenocarcinoma

Uterine adenocarcinoma is a malignant neoplasm arising from the glandular cells of the endometrium (mucous membrane). Most often, the tumor affects the body of the uterus, and only in every fourth case is it localized in the cervix area. The risk of morbidity increases with age, which is associated with hormonal changes in the female body during menopause. The main symptom of uterine adenocarcinoma (AM) is bleeding from the genital tract, which appears regardless of the menstrual cycle.

The exact reasons for the appearance of cancer cells in endometrial tissues have not been established. There is reason to associate oncology with hormonal changes, in particular, relative or absolute hyperestrogenism (predominance of estrogens over progesterone).

The group of factors most significant in the development of uterine adenocarcinoma includes:

  • age-related changes during menopause;
  • menstrual irregularities for 10 or more consecutive years;
  • numerous curettages of the uterine cavity (including abortions);
  • chronic anovulation;
  • early arrival of the first menstruation and late menopause (after 52 years);
  • long-term use of drugs with estrogens and oral contraceptives (more than 10 years);
  • no history of childbirth or pregnancy;
  • gynecological diseases – endometriosis, fibroids and uterine polyposis, polycystic ovaries, etc.

Adenocarcinoma often develops against the background of diabetes mellitus, obesity, hypertension, and thyroid diseases. Hereditary predisposition to AM is associated with mutations in the MLH1, MSH2, MSH6, and PMS2 genes.

Important!

Uterine adenocarcinoma is the second most common cancer in women after breast cancer.

Pathogenesis and stages of Uterine Adenocarcinoma

Carcinogenesis of uterine tumors is caused by disturbances in the regulation of the natural cell cycle and the appearance of atypical nodes prone to uncontrolled growth. Gradually, groups of abnormal cells form a tumor that affects only the mucous layer of the uterus, then spreads to the muscular and serous layers. Cancer cells are able to travel through the lymphatic and bloodstream to distant organs, forming metastases.

Stages of uterine adenocarcinoma:

  • I – the tumor develops only within the endometrium and grows into the myometrium to no more than half its thickness;
  • II – malignant formation affects the stroma, but does not extend beyond the body of the uterus;
  • III – adenocarcinoma spreads to neighboring organs (fallopian tubes, ovaries, vagina, rectum, bladder);
  • IV – multiple metastases are detected both in areas adjacent to the tumor and in distant organs.

AM most often metastasizes to the peritoneum, lungs, bones, and lymph nodes. Determining the stage of a tumor is important when making a prognosis and choosing treatment tactics.

Classification of the endometrial cancer

There are several classifications of adenocarcinoma of the uterine body, developed based on different criteria. Taking into account histological characteristics (tissue structure), 3 types of malignant neoplasms are distinguished: epithelial, mesenchymal, mixed (includes epithelial and mesenchymal cells).

Based on the degree of cell differentiation, cancer can be divided into the following types:

  • highly differentiated – most cells have a normal structure, the tumor focus develops slowly;
  • moderately differentiated – consists of cells of heterogeneous structure with an enhanced division process;
  • poorly differentiated cancer – cells have pronounced polymorphism with rapid aggressive growth.

Important!

Every second case of uterine adenocarcinoma occurs in poorly differentiated tumors. Therefore, timely early diagnosis plays a key role in successful treatment.

The type of neoplasm is determined during a histological examination of a sample taken (a piece of affected tissue). Based on the histology data, the doctor makes a final diagnosis and selects pathogenetic treatment.

Symptoms of uterine adenocarcinoma

In the initial stages, oncology is asymptomatic and is discovered accidentally during preventive medical examinations. The most striking sign of uterine adenocarcinoma in menopausal women is considered to be uterine bleeding. Patients of reproductive age complain of certain changes in the nature of menstruation:

  • excessively prolonged and heavy bleeding;
  • spotting between cycles;
  • discharge from the vagina in the form of “meat slop”.

The occurrence of bleeding is caused by damage to the endometrium and myometrium, which by their nature are densely permeated with vessels. Women with AM also report painful sexual intercourse and bleeding that occurs after intimacy.

Other symptoms:

  • liquid watery leucorrhoea that appears after physical exertion;
  • purulent discharge from the genital tract;
  • itching in the external genital area;
  • aching pain in the lower abdomen, radiating to the lower back and lower limbs;
  • cramping pain above the pubis.

In the later stages of the disease, severe weakness, weight loss, loss of appetite, and a slight increase in body temperature are observed – these are characteristic signs of intoxication by tumor metabolic products.

Important!

Bloody discharge from the genital tract is the most common and striking sign of uterine adenocarcinoma. If a symptom appears, you should immediately contact a gynecologist to determine the cause of the bleeding.

Complications of uterine adenocarcinoma

When the malignant process of adenocarcinoma spreads and is left untreated, the tumor produces multiple metastases. New lesions form in both neighboring and distant organs, which affects the functioning of the body as a whole and worsens the prognosis for remission.

With active cancer metastasis, the characteristic symptoms of uterine adenocarcinoma are accompanied by signs of damage to other organs and systems:

when a neoplasm compresses the bladder and rectum, increased frequency (or delay) of urination,

frequent bowel movements or constipation are observed;

with metastases to the lungs, cough and chest pain appear;

when bone tissue is damaged, patients complain of pain in the bones and joints;

metastases in the liver are manifested by pain in the right hypochondrium.

One of the complications of AM is rectovaginal and vesicovaginal fistulas (fistulas connecting internal hollow organs). Their formation is accompanied by the appearance of feces or urine from the vagina. In the later stages, some patients develop ascites, which can be suspected by the increasing volume of the abdomen.

Diagnostic methods of uterine adenocarcinoma

When collecting anamnesis, the doctor finds out the characteristics of menstrual function, metabolic disorders, cases of cancer in close relatives, and the duration of the reproductive period. During a bimanual examination on a gynecological chair, a specialist is able to determine the location of the tumor, the extent of the malignant process, and also take a smear for cytology.

Advanced diagnostics of adenocarcinoma includes the following techniques:

  • Aspiration biopsy is the removal of material from the uterine cavity for further laboratory examination of the sample. Helps identify abnormal cells, determine the degree of differentiation and type of cancer.
  • Hysteroscopy with curettage – allows you to examine the inner lining of the uterus and at the same time obtain a biopsy specimen for histology.
  • Ultrasound of the pelvis – during the examination, attention is paid to the thickness of the endometrium, pathological changes in the structure of tissues, and the presence of space-occupying formations.
  • MRI with contrast – allows you to study in detail the condition of the reproductive system and plan treatment.

If distant metastases are suspected, the woman is referred to computed tomography with contrast, cystoscopy, colonoscopy, urography, chest x-ray, and skeletal scintigraphy. An idea of the hormonal background, the functioning of the kidneys, liver, and pancreas is given by biochemical and clinical tests of blood and urine.

Important!

The main diagnostic complex is sometimes supplemented with a blood test for the CA-125 tumor marker. An increase in its concentration serves as an indirect sign of the spread of a cancerous tumor.

Principles of adenocarcinoma in uterus treatment

The main treatment method for diagnosed AM is surgical, which involves complete removal of the uterus along with the cervix, appendages and affected lymph nodes. During the intervention, an inspection of the abdominal cavity is performed to detect metastases, a biopsy of pathological areas and all suspicious foci.

To increase the effectiveness of treatment, surgery for uterine adenocarcinoma is supplemented with:

  • Chemotherapy – new generation cytostatic drugs are used that destroy atypical cells in the main focus and metastases. As a rule, chemotherapy is prescribed after surgery, which minimizes the likelihood of relapse.
  • Radiation therapy – a series of sessions of intracavitary or external irradiation inhibits the development of the node and reduces its size. Radiotherapy is used both before intervention as part of adjuvant therapy and after removal of the uterus to consolidate the results.
  • Taking hormonal drugs – medications support the functioning of the endocrine system, influencing the progesterone and estrogen receptors of the tumor.

Treatment tactics for uterine adenocarcinoma are developed individually for each patient. The prevalence of abnormal cells, histological type and aggressiveness of the tumor are taken into account.

Prognosis for the endometrial adenocarcinoma

The most dangerous forms of cancer of the uterus are clear cell and serous carcinomas, as well as poorly differentiated cancer. These types of tumors are characterized by high aggressiveness, rapid growth and metastasis.

The prognosis for adenocarcinoma of the uterus and cervix is determined by a number of other factors:

  • stage of development and size of the tumor;
  • woman’s age;
  • depth of cancer cell invasion into the myometrium;
  • tumor spread to the cervical canal, regional lymph nodes and ovaries;
  • the presence of metastases, their number and location.

The most favorable prognosis will be for stage 1 AM – the five-year survival rate in this case reaches 98%

Endometrial cancer prevention

Gynecologists strongly recommend not to neglect regular medical examinations and not to ignore symptoms indicating problems with women’s health.

It is necessary to promptly treat diseases that can provoke the appearance of cancer – polycystic ovary syndrome, obesity, diabetes, infertility, hormonal disorders.

It is prohibited to take oral contraceptives and other drugs that affect the functions of the endocrine system without a doctor’s prescription.

Questions and answers about uterine endometrial cancer (adenocarcinoma)

  • How quickly does uterine adenocarcinoma develop?

From the appearance of the first atypical cells to the formation of a mature tumor, it can take from 3 to 5 years. The duration of the process largely depends on the histotype and aggressiveness of the oncology.

  • How does cancer differ from adenocarcinoma?

Adenocarcinoma of the uterus is a type of cancer, the name of which indicates the origin of the tumor from the glandular cells of the mucous membrane.

  • Is it possible to do without surgery for AM?

At the first stage of the oncological process, when the tumor is small in size and has not grown into the thickness of the myometrium, the issue of conservative treatment can be considered. For stage IV cancer, surgery is abandoned in favor of chemotherapy and radiotherapy to increase a woman’s life expectancy.

  • Can the disease return after treatment?

The likelihood of new lesions (relapses) is difficult to predict and predict. Therefore, even after achieving remission, patients need to undergo regular screening tests to promptly detect atypical nodes.

  • Why is obesity considered a predisposing factor for AM?

Adipose tissue takes part in the production of estrogens, the excess of which leads to the degeneration of healthy cells into malignant ones.

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