Highly differentiated adenocarcinoma of the uterus and endometrium

A malignant tumor affecting the inner layers of the uterus is called adenocarcinoma of the uterine body, and if the pathological cell of the neoplasm does not differ significantly in its structure from the cells of the affected organ, such a one-time lesion is designated as highly differentiated adenocarcinoma of the uterus.

Doctors consider the most severe case of damage to be the spread of the tumor into the deep layers of tissue. Such a neoplasm may indicate itself too late, when it is no longer possible to help the woman, and this complicates the diagnosis itself.

When a highly differentiated adenocarcinoma of the uterus is diagnosed, an insignificant change in the pathological cell is observed. It is not much different from the normal one: only its size is increased, the nucleus is elongated.

The danger of this disease is manifested in its hormone dependence. Most often, this disease is detected in women aged 50-65 years during menopause. In this case, cancer cells are aggressive and begin to penetrate into nearby tissues and organs quite quickly. If the tumor and its metastases are differentiated only within the uterus itself (the first stage of the disease), surgical intervention is performed to remove the appendage together with the body of the uterus. In the case of damage to all layers of the uterus by metastases (the second stage of the disease), the nearby nodes of the lymphatic system are also subject to removal.

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Well differentiated endometrial adenocarcinoma

Cancerous lesions of the uterine body are not as numerous as, for example, malignant tumors of the cervix. This is explained by the fact that the endometrium (the internal mucous layer lining the uterine cavity and supplied with many blood vessels) is more often affected by pathology already at a significant age for a woman - the period of 45 - 65 years (the period of menopause).

During this period, the woman's hormonal background begins to change, her reproductive activity decreases: there is no longer a need to maintain the menstrual cycle, ensure the maturation of the egg, and so on. But failures in the production of hormones are also observed at a young age. Therefore, it is impossible to categorically say that highly differentiated adenocarcinoma of the endometrium (as, incidentally, not only highly differentiated) affects the mucous layer of the uterus only in "adult" women.

Highly differentiated endometrial adenocarcinoma is the most common type of malignant tumor of the uterine body, progressing on the basis of glandular epithelium. This pathology is characterized by weakly expressed polymorphism of cells.

The affected cell of the glandular epithelium, having gone through multiple stages of maturation, has come as close as possible to the “normal” cell, even partially taking over its physiological functions.

A high level of differentiation of cancerous neoplasms gives a good prognosis for recovery, unlike low-differentiated pathology. However, it is worth noting that histological and cytological studies of highly differentiated adenocarcinoma are comparable to the results of the analysis of another disease - atypical hyperplasia. Only a high-level specialist can conduct a correct diagnosis.

Well differentiated endometrioid adenocarcinoma

Cancerous neoplasms mutate from tubular glands of stratified or pseudo-stratified epithelium. Highly differentiated endometrioid adenocarcinoma often develops on the basis of endometrial hyperplasia; estrogen stimulation of the woman's body can also trigger degeneration.

Tumors of this type of pathology are usually small in size and are represented by cells that do not differ significantly from the norm. The cell is larger and has a larger ovoid nucleus in the center. This pathology reveals immunopositivity to proteins of intermediate filaments of connective tissues, as well as other tissues of mesodermal origin.

Risk factors include:

• Obesity.
• Prolonged or late menopause.
• Infertility.
• Diabetes mellitus.
• Long-term use of hormonal drugs based on estrogen.
• Taking tamoxifen, an estrogen antagonist (used to treat breast cancer).
• Uncontrolled use of oral contraceptives.

Treatment of well-differentiated adenocarcinoma of the uterus

The insidiousness of almost all malignant neoplasms is that when they begin to show their symptoms, as a rule, the late stage of the disease is already observed. This is the period when the tumor has metastasized into neighboring organs and is itself in the stage of decay, poisoning the entire body of the patient with toxins. But if, during a preventive examination by a gynecologist, a suspicion of this pathology arose, and the disease was diagnosed, oncologists establish the degree of damage to the body.

If the tumor is localized in the body of the uterus and has not affected nearby tissues, treatment of highly differentiated adenocarcinoma of the uterus consists of resection of the uterus itself and appendages. If the entire body of the uterus has already been affected, the surgeon has to remove the female organ and the nearby lymph nodes. Since there is a high probability of cancer cells entering the lymphatic system with their subsequent spread throughout the body.

In severe condition of the patient and impossibility of surgical intervention, treatment of highly differentiated adenocarcinoma of the uterus is carried out with active use of hormone therapy, radiation and radiotherapy. In case of repeated relapses, polychemotherapy has to be administered.

If obvious tumor processes are not observed, the patient undergoes adjuvant chemotherapy (mainly performed after surgery) to avoid "hidden" metastases. To enable organ-preserving surgery, which allows the operated organ to be completely preserved or at least surgical damage to be minimized, neoadjuvant chemotherapy is performed before surgery. It also makes it possible to assess the sensitivity of the neoplasm to chemotherapy drugs.

In chemotherapeutic treatment of highly differentiated adenocarcinoma of the uterus, the following drugs are used: cisplatin, doxorubicin, epirubicin, paclitaxel, carboplatin AUC5 and others. Usually, a treatment protocol is drawn up, represented by a complex of several mutually supporting drugs.

Epirubicin. The drug is administered slowly, over three to five minutes, into a vein. It is diluted with isotonic sodium chloride solution. In case of monotherapy, the dose is 60–90 mg per m2 (of the patient’s body surface). The dosage can be divided into two to three days. The dose is repeated after three weeks.

In case of dysfunction of the hematopoietic capacity of the system, advanced age of the patient or when used in combination with other types of therapy (for example, radiation), the dosage of the drug is taken at the rate of 60-75 mg/m2. In this case, the quantitative component of the course should not exceed 1000 mg/m2.

Paclitaxel. The dosage of the drug is strictly individual. The drug is administered intravenously in a three-hour or daily infusion. The amount of the drug is calculated from the indicators of 135 - 175 mg per 1 m2 of the patient's body area. The interval between injections is three weeks.

Hormonal therapy includes the use of medroxyprogesterone acetate, tamoxifen.

Medroxyprogesterone acetate. Tablets are prescribed orally. Daily intake is 200 - 600 mg. The expected effect occurs in eight to ten weeks.

The starting dose for intramuscular administration of the drug is 0.5 - 1 g per week. After stabilization of the condition, the dosage is reduced to 0.5 g per week.