Adenocarcinoma of the uterus

Adenocarcinoma of the uterus is one of the varieties of malignant tumors of the uterus. This cancer is characterized by the fact that it affects first of all the most superficial layer, the endometrium of the uterus.

Clinical manifestations of endometrial cancer take place in the form of bleeding, which, as the disease progresses, is supplemented by pain symptoms in the lower abdomen. There may be a tendency either to an increase, or to a decrease in the size of the uterus. The development of pathological processes in most cases directly covers the body of the uterus.

[1], [2], [3], [4], [5], [6]

Causes of the adenocarcinoma of the uterus

The exact causes of the development of uterine cancer (as well as many other forms of cancer) are unknown. According to some studies, the risk of developing uterine cancer is increasing:

Just as it is currently impossible to say with absolute certainty what actually causes cancer in its various forms, the causes of adenocarcinoma of the uterus can be reduced only to a list of factors that can provoke or contribute to the development of this malignant disease.

The age range in which there is the greatest likelihood of the formation of such a tumor covers the period in the life of a woman from 50 to 65 years of age.

As the results of some studies indicate, women are at particular risk in the risk group when they have a metabolic disorder and who are overweight, with obesity. In particular, with obesity of 2-3 degrees, with a significant excess of the body mass index.

There is a high probability of the appearance of uterine adenocarcinoma in women who never gave birth.

Increases the risk of such a disease later on the onset of menopause, if the female menopause occurred over the age of 52 years.

The causes of adenocarcinoma of the uterus also include the presence of a woman with polycystic ovary syndrome.

Increases the possibility of developing this malignant tumor and breast cancer, transferred by a woman, and besides this, if it is in direct relationship with those who had uterine cancer - from the mother or sister.

[7], [8], [9]

Symptoms of the adenocarcinoma of the uterus

The neoplasm has the appearance of a tumor node, the growth process of which occurs according to the exophytic type, with the possibility of subsequent distribution to the myometrium. But, as a rule, such a tendency is found in exceptional cases, mainly the tumor has a certain specific localization, does not expand the lesion zone on the endometrium on its entire surface, and does not penetrate into the myometrium and parameters.

Symptoms of adenocarcinoma of the uterus at the stage of its emergence appear as the following precancerous and background diseases of the damaging endometrium.

The endometrial polyp is characterized by the appearance on the inner shell of the uterus of a limited thickening, extending as a projection in the uterine cavity.

Another precursor of the malignant neoplasm starting in the uterus may be a significantly increased amount of endometrial glands, which is known as endometrial adenomatosis.

The precancerous state or the onset of the development of cancer is signaled by such phenomena as the presence of prolonged painful symptoms of a noisy type in the lumbar region; prolonged bleeding with a high degree of blood loss during the menstrual cycle in women of reproductive age; bleeding in the uterus, which can be provoked during the onset of menopause, such as the resumption of bleeding after a long time.

A simple and effective preventive measure can be regular visits to a gynecologist. The specialist is able to diagnose symptoms of adenocarcinoma of the uterus and appoint a timely appropriate treatment, preventing the transition of the disease to a more serious phase and the possible emergence of all kinds of complications.

[10], [11], [12]

Cervical adenocarcinoma

Cervical cancer is a malignant disease, which in most cases develops in the flat epithelial cells, of which the inner covering of the cervix is composed. With a much lesser degree of probability there may be adenocarcinoma of the cervix, which has a source of cells producing mucus.

Cancerous tumor, localized in the cervix, can be either exophytic or endophytic. In the first case, the direction of tumor growth is turned inside the vagina, while for the other, expansion of the zones of the affected areas is due to deepening into the canal, towards the body of the uterus.

It should be noted that there is also a third type - cervical cancer of the papillary type. With it, the tumor is formed by a combination of something resembling small papillae, similar in appearance to Brussels sprouts.

Cervical adenocarcinoma is diagnosed by the method, which consists in detecting the presence of cancer cells in smears taken in the cervix of the uterus, or, on the contrary, ascertaining their absence. This method of diagnosis is called a Pap test or a Pap test. Often cancers of the cervix can be asymptomatic, which makes it especially timely to make a diagnosis and start treatment.

[13], [14], [15], [16]

Adenocarcinoma of the body of the uterus

Adenocarcinoma of the uterus body is a malignant neoplasm that occurs from the tissues of the muscular or mucous membrane of the uterus.

Proceeding from the fact that the endometrium shows considerable sensitivity to the effects of sex hormones, in particular, estrogen, this oncology is a hormone-dependent cancer.

Approximately half of the cases of tumor localization is the area of the uterine fundus, there may be less lesions of the isthmus, or the whole uterine cavity may be enveloped.

As the disease progresses, pathological cells tend to expand the area of affected areas by spreading to neighboring cells. Those involved in the processes of metastatic disease can be the cervix, ovaries with uterine tubes, and tissues surrounded by the uterus, as well as lymph nodes and lymphatic transport to all other organs.

Adenocarcinoma of the uterus body is most often found in women before the onset of menopause. It is diagnosed by scraping from the cervical canal for subsequent histological examination. An unfavorable factor complicating the diagnosis is its occurrence in the deep layers of tissues.

[17], [18],

Stages

Distinguish the following stages of adenocarcinoma of the uterus:

1. In the first stage of this cancer, the tumor from the uterine mucosa extends to the uterine wall. The degree of probability with timely diagnosis and treatment start to stop further pathological progress and prevent the occurrence of complications is very high and is approximately 87%.
2. The second stage is characterized by the inclusion of the neck of the uterus in the area of the lesion of this oncology. In this case, the surrounding organs remain unaffected. The prognosis of successful treatment is favorable, and the chance of recovery is 76%.
3. At the third stage of adenocarcinoma of the uterus, the surrounding internal organs are affected, and lymph nodes are also involved in the affected area. The probability of recuperation at this stage compared to the previous ones is reduced to 63%.
4. The features of the fourth stage are that the cancer, in addition to spreading to nearby organs, is accompanied by the appearance of metastases. The possibility of recovery is indicated by a probability of 37%.

Depending on the stage, one or another, conservative or radical treatment methods, such as surgical intervention for the purpose of tumor removal, radiation therapy, etc., are appropriate.

[19], [20], [21]

Forms

Highly differentiated uterine adenocarcinoma

A highly differentiated uterine adenocarcinoma is one of the varieties of malignant tumors belonging to a group of cancers that can develop in the epithelium of glandular tissues. The criteria for the difference between these species are determined by the degree of their cellular differentiation.

In this case, there is a minimal degree of polymorphism. This means that the affected cells of a tissue differ from the healthy in the most insignificant way.

Of the obvious symptoms and manifestations that characterize the highly differentiated adenocarcinoma of the uterus, it can be noted only that, with its presence, the nuclei of cells that undergo pathological degeneration increase in size and become somewhat more elongated. Proceeding from this, the differentiated diagnostics and the statement of the exact corresponding diagnosis in this case presents certain difficulties.

With this form of uterine adenocarcinoma, its surface distribution in the myometrium occurs. The risk of significant complications and the appearance of lymphogenous metastases with its localization, which does not go beyond the mucous membrane in this area of the uterus, is minimal. The degree of probability is no more than 1%.

[22], [23], [24], [25]

Moderately differentiated uterine adenocarcinoma

Moderately differentiated uterine adenocarcinoma is characterized by a high level of polymorphism of cells that underwent changes caused by this cancer in the uterus, in its muscle tissue or mucous membrane.

The mechanism of action of this oncology of the uterus largely has a similarity with the development and course of adenocarcinoma of a highly differentiated species. A significant difference in this case is that a significantly larger number of cells with which active processes of mitosis and cell division occur are involved in pathological phenomena.

Thus, the moderately differentiated uterine adenocarcinoma is characterized by a higher degree of severity. It is more likely to lead to the development of all kinds of complications and the development of pathologies in the case of untimely diagnosis and initiation of treatment.

By spreading cancerous growth is mainly along with the current of lymph in the lymph nodes of the small pelvis. Metastasis of lymphatic origin with moderately differentiated uterine adenocarcinoma occurs in 9% of female patients.

In young women up to the age of 30, the presence of metastases in the vast majority of cases is not detected.

Low-grade uterine adenocarcinoma

Low-grade uterine adenocarcinoma is the third histopathological grade of the cancer of the uterus. An oncological neoplasm is a collection of cells formed in the form of bands or masses having an irregular shape. Manifestations of intracellular mucin are observed only in one case of two.

In some individual cases, oxyphilic, light, with a large amount of glycogen, or lipid-rich, foamy cell cytoplasm may occur.

One of the characteristic features that distinguish low-grade adenocarcinoma of the uterus are manifestations of pronounced cellular polymorphism. At this type of cancer of the uterus, there is an obvious malignancy, which is expressed in the formation of tissues that underwent pathological changes.

The prognosis in this case seems to be the least favorable. The probability of deep invasion in the myometrium is three-four times higher, and the appearance of metastases in regional lymph nodes is 16-18 times higher than the frequency with which they occur at those stages of this oncology of the uterus, which differ by a higher degree of differentiation.

Endometrioid adenocarcinoma of the uterus

Endometrioid adenocarcinoma of the uterus is one of the most common malignant tumors in the uterus. This type of oncology occurs in 75% of cancers in women.

In this type of adenocarcinoma occurs the formation of structures of a glandular nature, forming from one to several layers of tubular epitheliocytes, which is characterized by cellular atypia. Tumor parenchyma becomes the site of papillary and tubular structures, and in addition, the formation of squamous cell metaplasia is possible.

Endometrioid adenocarcinoma of the uterus can be triggered by estrogen stimulation, the prerequisites for its development can also serve as endometrial hyperplasia.

The following varieties are differentiated:

• An extremely aggressive form is a serous carcinoma, which is very similar to the serous carcinoma of the fallopian tubes and ovaries. As a rule, it occurs in 7-10% of cases and occurs in elderly women.
• Next, you should note a clear cell carcinoma. The prognosis, if present, is unfavorable, due to the fact that with it there is a tendency to the appearance of early implantation metastasis in the serous membranes of the peritoneal cavity.
• And finally, the most rare is secretory adenocarcinoma. The prognosis is positive in most cases.

[26], [27], [28], [29]

Diagnostics of the adenocarcinoma of the uterus

If a woman at that age, when menopause occurs, bleeding from the uterus has appeared, she should immediately visit a gynecologist so that as a result of the necessary studies accurately determine the cause. And, if necessary, conduct additional diagnostic measures to exclude, or, on the contrary, confirm the fact of the onset of development of oncology in the uterus.

Among the main methods used to diagnose adenocarcinoma of the uterus, it is necessary to note, first of all, a gynecological examination.

In the course of the examination, a specialist can detect a foreign neoplasm in the uterus when palpating. In this case, additional diagnostics are assigned using the following methods.

Due to ultrasonic examination (ultrasound) of the small pelvis, it can be ascertained that the inner layer of the uterus is characterized by an increased thickness. In addition, with already diagnosed and established cancer, ultrasound can detect metastases.

Scraping of the uterine cavity for diagnostic purposes is performed to obtain an endometrium so that it can later be examined under a microscope.

The modern method is hysteroscopic diagnosis and endometrial biopsy. The hysteroscope is an optical device that is inserted into the uterine cavity for internal examination and biopsies - the separation of a tissue fragment for subsequent examination under a microscope for detection of cancer in case of suspicion.

[30], [31]

Differential diagnosis

To date, adenocarcinoma of the uterus is classified by several types of cancer endometrial disease. Sometimes differential diagnosis to separate the endometrioid adenocarcinoma from atypical hyperplasia of the endometrial tissue is fraught with certain difficulties. The precise determination of the corresponding diagnosis is a scrupulous analysis of the stromal state. The presence of necrotic changes in her tissues, or a significant decrease in her presence, up to complete disappearance, in areas between the glandular formations, and also if specific foam cells are found, all this may indicate an endometrioid adenocarcinoma.

Treatment of the adenocarcinoma of the uterus

Treatment of uterine adenocarcinoma involves certain methods and methods of treatment, the expediency of which is determined in each case based on the stage of the disease process.

For the first stage, it is characteristic that with her treatment is mostly operational in nature and reduces to the removal of the uterus along with its appendages.

The second stage, in addition to removing the uterus and appendages, also has as a testimony the removal of lymph nodes in proximity to it. This is dictated by the reasons that they probably have the presence of metastases.

At a later stage, treatment occurs by applying one of the following methods.

Radiotherapy is a course of dosed irradiation of the corresponding parts of the uterus with special X-ray radiation. As a result, the cells of the pathological focus disintegrate up to the complete destruction of the tumor.

Chemotherapy is a method of targeted harmful effects of special drugs on the adenocarcinoma of the uterus. Treatment of adenocarcinoma of the uterus with the help of chemotherapy occurs with the use of drugs Doxorubicin, Carboplatinum, Cisplatinum and others.

Operation with adenocarcinoma of the uterus

Operation with adenocarcinoma of the uterus is a fairly common way of treating this oncology of the uterus.

Such surgical intervention, designed to remove the body of the uterus, is called a hysterectomy.

In some cases, along with the uterus, the tissues surrounding it may also be removed: the cervix with part of the vagina, both ovaries, fallopian tubes and regional lymph nodes.

The length of the recovery period after such an operation is determined by the individual characteristics and general health of each particular patient. Typically, an extract from the hospital can occur after a few days, and in order to fully restore the strength of the woman need from 4 to 8 weeks.

In the first few days after the operation, discomfort, pain, fatigue or general weakness may occur. Sometimes there are attacks of nausea, there are problems with the bladder and constipation. All these phenomena are of a temporary nature and after a very short period of time they come to naught.

Operation with adenocarcinoma of the uterus causes a significant change in the hormonal background due to a significant decrease in the level of female hormones. This can have consequences in the form of dryness in the vagina, hot flushes and increased night sweats.

Optimize the hormonal balance is helped by special drugs and drugs, which today there are many.

Prevention

It is not possible to completely avoid the onset and development of cancer of the uterus. However, there is prevention of uterine adenocarcinoma, which suggests certain measures and principles, following which it is possible to minimize the risk of uterine oncology.

One of the most important moments in this regard is maintaining the optimal body weight, and maintaining the mass index within those values that correspond to the norm.

To maintain the appropriate body weight, a woman needs to lead an active lifestyle, increase the content of fresh fruits and vegetables in her diet, and optimize the daily caloric intake.

Reducing the likelihood of oncological diseases is also facilitated by a decrease in the intensity of carcinogenic factors in the air, in the premises at work.

Prevention of adenocarcinoma of the uterus can have an effect and be effective only if a woman of 30 years and older undergoes regular preventive examinations at a gynecologist at least twice a year. Systematic visits to a female doctor are mandatory from the time when a girl begins to live sexually.

Such examinations make it possible, in the early stages, to detect diseases that precede the development of cancer.

[32], [33], [34], [35], [36], [37]

Forecast

Prognosis of uterine adenocarcinoma is most favorable if a cancerous tumor is detected and diagnosed at the first stage of the disease.

In this case, complete recovery is possible due to surgical intervention, which does not differ greatly in severity, followed by appropriate therapy.

In less than a year the woman will be able to fully return to normal life.

Treatment of adenocarcinoma of the uterus at its second stage is associated with more significant complications, since there is a larger operative field, and the postoperative period requires a long course of radiological and chemotherapy.

The degree of uterine involvement at this stage often requires its complete removal. This circumstance leads in the end to an absolute loss of fertility and provokes a severe hormonal imbalance.

The recovery course can take up to three years, and as a result, the healthy state of the organism that preceded the disease is still not fully achieved.

The prognosis of uterine adenocarcinoma in the third stage is aggravated by the fact that in cases of severe metastasis, in addition to removing the uterus proper, it is also necessary to remove part of the vagina, or the entire vagina as a whole. Even after three years of recovery, a full recovery is unattainable.

The fourth stage is characterized by the fact that the question of the actual struggle for the patient's life becomes urgent. There is a well-founded probability of a lethal outcome.

Restorative measures can have a certain positive effect, but in the future life will be associated with a number of aggravating factors.

Prognosis for cervical adenocarcinoma

An unfavorable prognosis for adenocarcinoma of the cervix is due to the following factors.

The tendency to a wide distribution of lesions throughout the body.

A high probability of a lethal outcome during 5 years from the onset of the disease in its 4th stage.

Metastasis of lymph nodes, peculiarities of their localization and large size. A direct correlation of the presence of metastases to the percentage of deaths due to this type of cancer in a 5-year time interval

The frequency of deaths increases depending on the size of the pathological neoplasm. So for tumors not exceeding 2 cm after 5 years of disease the overwhelming majority of patients survive. Tumor sizes from 2 to 4 cm reduce this probability to 60%. When the cancerous formation has a value of more than 4 cm, in almost half the cases (40%;) a fatal outcome occurs.

In cases of tumor infiltration of the parameter, the number of survivors after 5 years is 69%, in the absence of a survival forecast, it is 95%.

The prognosis for adenocarcinoma of the cervix is also negative for deep invasion.

In addition, the prognosis of successful radiological treatment is exacerbated by the presence of thrombocytopenia and anemia.

[38], [39], [40]