Highly differentiated adenocarcinoma of the uterus and endometrium
Last reviewed: 23.04.2024
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A malignant tumor that affects the inner layers of the uterus is called the adenocarcinoma of the uterus body, while if the pathological cell of the neoplasm does not differ significantly in structure from the cells of the affected organ, such a single lesion is referred to as a highly differentiated uterine adenocarcinoma.
The most severe case of a lesion is considered to be spreading the tumor to the deeper layers of tissues. Such a neoplasm can identify itself too late, when it is already impossible to help a woman, complicates this and the diagnosis itself.
When ascertaining the highly differentiated adenocarcinoma of the uterus, an insignificant change in the pathological cell is observed. It does not differ much from normal: only its size is enlarged, the core is extended.
The danger of this disease manifests itself in her hormone dependence. Most often this disease is detected in women aged 50 - 65 years in the menopause. At the same time, cancer cells are aggressive and begin to penetrate fairly quickly into nearby tissues and organs. If the tumor and its metastases differentiate only within the uterus itself (the first stage of the disease), surgery is performed to remove the appendage along with the uterus. In the case of lesion by metastases of all layers of the uterus (the second stage of the disease), the nodes of the lymphatic system located nearby are also to be removed.
[Highly differentiated endometrial adenocarcinoma
Cancer damage to the uterus is not as numerous as, for example, malignant tumors of the cervix. This is because the endometrium (the inner mucous layer lining the uterine cavity and equipped with a variety of blood vessels) is more often affected by pathology already in a significant age for a woman - the period of 45 to 65 years (the period of menopause).
During this period, the hormonal background of the woman begins to be reconstructed, his childbearing activity decreases: there is no longer any need to support the menstrual cycle, to ensure the maturation of the egg and so on. But failures in the production of hormones are observed at a young age. Therefore, it is categorical to say that the highly differentiated adenocarcinoma of the endometrium (as, however, not only highly differentiated) affects the mucosal layer of the uterus only "adult" women can not.
Highly differentiated endometrial adenocarcinoma is the most common type of malignant tumor of the uterus body, progressing on the basis of glandular epithelium. This pathology is characterized by a weakly expressed polymorphism of cells.
The affected cell of glandular epithelium, having passed multiple stages of maturation, as much as possible approached to a cell of "norm", even partially taking upon itself its physiological functions.
A high level of differentiation of cancerous tumors gives a good prognosis for recovery, in contrast to a low-grade pathology. However, it should be noted that the histological and cytological studies of a highly differentiated adenocarcinoma are comparable with the results of an analysis of another disease - atypical hyperplasia. Only a high-level specialist is able to diagnose correctly.
Highly differentiated endometrioid adenocarcinoma
Cancerous tumors mutate from the tubular glands of stratified or pseudostratified epithelium. The highly differentiated endometrioid adenocarcinoma often develops on the basis of endometrial hyperplasia, and the estrogen stimulation of the female organism can be the impetus to the degeneration.
Tumors of this type of pathology usually have small dimensions and are represented by cells that do not differ significantly from the norm. The cell has a larger size and in the center there is a larger ovoid nucleus. This pathology reveals immunopositivity to proteins of intermediate filaments of connective tissues, as well as other tissues having a mesodermal origin.
The risk factor is:
- Obesity.
- Prolonged or late menopause.
- Infertility.
- Diabetes.
- Prolonged use of hormonal drugs, the basis of which is estrogen.
- The use of tamoxifen, an estrogen antagonist (used in the treatment of breast cancer).
- Uncontrolled intake of oral contraceptives.
Treatment of highly differentiated uterine adenocarcinoma
The insidiousness of almost all malignant neoplasms is that when they start 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 at the stage of decay, poisoning the whole organism of the patient with toxins. But if, with a preventive examination of the gynecologist, there was a suspicion of this pathology, and the disease was diagnosed, oncologists determine the degree of damage to the body.
If the tumor is localized in the body of the uterus, and has not affected nearby tissues, the treatment of a highly differentiated uterine adenocarcinoma is the resection of the uterus itself and the appendages. If the entire body of the uterus has already been affected, the surgeon must be removed together with the female organ and the nearby lymph nodes. Since the probability of cancer cells entering the lymphatic system is high, with further spreading throughout the body.
When the patient is seriously ill and impossible to perform a surgical procedure, the treatment of highly differentiated uterine adenocarcinoma is performed with active use of hormone therapy, radiotherapy and radiotherapy. In the case of repeated relapses, it is necessary to introduce polychemotherapy.
If no obvious tumor processes are observed, in order to avoid "hidden" metastases, the patient undergoes adjuvant chemotherapy (performed mainly after the operation). To enable the organ-saving operation, which allows the organ to be fully retained, or at least to minimize surgical damage, neoadjuvant chemotherapy is performed prior to surgery. It also makes it possible to evaluate the sensitivity of the neoplasm to chemotherapy drugs.
Chemotherapeutic treatment of highly differentiated uterine adenocarcinoma uses drugs: cisplatin, doxorubicin, epirubicin, paclitaxel, carboplatin AUC5 and others. Usually a treatment protocol is drawn up, represented by a set of several mutually supportive drugs.
Epirubicin. The drug is injected slowly, for three to five minutes, into a vein. It is diluted with isotonic sodium chloride solution. In the case of monotherapy, the dose is 60 - 90 mg per m2 (body surface of the patient). Dosage can be divided into two to three days. Reception is repeated after three weeks.
In the case of dysfunction of the system's hematopoiesis, elderly patient's age or when combined with other therapies (for example, radiation therapy), the dosage of the drug is taken at the rate of 60 -75 mg / m2. At the same time, the quantitative component of the course should not exceed 1000 mg / m2.
Paclitaxel. The dosage of the drug is highly individual. The drug is administered intravenously in a three-hour or daily infusion. The amount of the drug is calculated from the indices of 135 to 175 mg per 1 m2 of the body area of the patient. The interval between injections is three weeks.
Hormone therapy includes the use of medroxyprogesterone acetate, tamoxifen.
Medroxyprogesterone acetate. Tablets are administered orally. Daily intake is 200 - 600 mg. The expected effect comes 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.