Uterine adenocarcinoma: what is it and how to treat it?

Malignant neoplasms of the organs of the female reproductive system are found in gynecological practice more and more often. Uterine adenocarcinoma has the property of forming in the cervix, on the uterine endometrium, as well as in the tissues of the ovaries and on the walls of the vagina. The tumor is formed from mutant cells of the glandular epithelium.

What is uterine adenocarcinoma

Uterine adenocarcinoma is formed from mucus-producing cells on the walls of the uterine endometrium. The tumor process in the uterus develops in one of two types:

  •                 endophytic;
  •                 exophytic.

With the endophytic type, the tumor deepens into the cervix, approaching the uterine body. The exophytic type is characterized by the growth of the tumor towards the vagina. Both types of uterine adenocarcinomas are malignant, deeply affecting the mucous and muscle tissues of the uterine walls.

Gradually, the lesion area spreads to neighboring sections of cellular structures. Thus, the cervix and body of the uterus, the fallopian tubes, ovaries, lymph nodes and the tissues surrounding the uterus are connected to the oncological process.

Stages, forms and types of uterine adenocarcinoma

Four stages of development of uterine adenocarcinoma are distinguished:

  •                 Initial. The tumor is localized in the uterus on the endometrium.
  •                 The second one. The tumor grows into the cervical canal.
  •                 The third. The tumor captures adjacent tissues. The process of metastasis to the lymphatic system begins.
  •                 The fourth (terminal). The tumor process extends beyond the pelvic organs. Metastases occur in distant organs and tissues.

There are uterine adenocarcinomas and the forms of cell differentiation of the oncological process:

  •                 Highly differentiated. Mutant cells adapt to the healthy cell structure of the uterine endometrium. Such cancer is called “superficial.” A tumor that does not extend beyond the uterine myometrium has a low percentage probability of metastasis – about 1-3%.
  •                 Moderately differentiated. It is characterized by a wide variety of mutating cell structures. A larger number of cells begins to connect to the oncological process, creating a high severity of localization. The infection spreads through the bloodstream and lymph flow to the pelvic organs. The risk of metastasis is observed in 8-10% of cases. In patients of reproductive age, metastasis may not be observed for a long time.
  •                 Low grade. The tumor is characterized by a high degree of malignancy, growing rapidly, capturing new areas of neighboring tissues. The prognosis of adenocarcinoma of this form is unfavorable due to lymph node metastasis.

The following types of uterine adenocarcinoma are classified:

  •                 Endometriosis. The most common oncopathology. The probability of development in women of different age groups is 70-75%. The tumor grows into the myometrial layer, and if measures are taken in time, the prognosis can be very positive.
  •                 Squamous cell. It develops on squamous structures of the uterine walls. Such a tumor is rarely diagnosed. Most often manifests itself as a component of cervical cancer.
  •                 Papillary. At risk for women are carriers of the papilloma virus. The tumor is formed from clusters of outgrowths of papillomas. In the total mass, the tumor is similar to a head of cauliflower.
  •                 Light cell. The tumor affects glandulocytes and glandular structures. Identified in the early stages of development, clear cell adenocarcinoma can be treated without subsequent metastasis.
  •                 Mixed. A tumor of this type combines several cellular neoplasms. It can develop slowly or rapidly, it is difficult to diagnose. The “behavior” of mixed adenocarcinoma in the body is impossible to predict.
  •                 Mucious. A tumor contains a large amount of mucin in its atypical cells and is a nodular mass with fuzzy borders. Radiation therapy in these situations is powerless. Mucous adenocarcinoma creates a high risk of metastasis to regional lymph nodes.
  •                 Serous. It develops from serous endometrial interepithelial cancer to the lower segment and cervix. This type of uterine adenocarcinoma is considered the most aggressive. Serous adenocarcinoma is not associated with an overabundance of estrogen. Tumor cells are rounded with a large nucleus. In some cells, there may be several nuclei. The most prone to the development of serous adenocarcinoma are women who have survived labor.

Causes of Uterine Adenocarcinoma

Uterine adenocarcinoma refers to tumors that develop against a background of hormonal imbalance. The glandular cells of the intrauterine epithelium undergo a degeneration process and begin to abnormally divide against the background of a variable concentration of steroid sex hormones.

With an increase in estrogen levels in the blood, cells of the uterine endometrium grow rapidly, increasing the likelihood of developing a tumor. Of the most common factors that provoke the formation of uterine adenocarcinoma, the following can be distinguished:

  •                 Anovulation. Violation of the release of a mature egg in the middle of the menstrual cycle.
  •                 Infertility. A whole complex of organic disorders of reproductive function in the body.
  •                 Early menarche and late menopause. Too early menstruation that occurs in girls before the age of twelve. Also late onset of menopause. Thus, the increased duration of the menstrual cycle prolongs the effect of estrogen on the uterine endometrium, which contributes to the formation of neoplasms.
  •                 Menstrual irregularities. The absence or intentional suppression of ovulation, in which the concentration of progesterone in the blood decreases sharply and the concentration of estrogen increases. At risk are women who have devoted themselves to great sport.
  •                 Obesity. It is scientifically confirmed that the fat layer contributes to the production of additional estrogens. As a result, this triggers the growth mechanism of the uterine endometrium.
  •                 Lack of labor. Women who escaped childbirth are at risk of developing malignant tumor processes in the uterus.
  •                 Hormone therapy. The duration of administration and high dosages of hormonal drugs affect the level of development of tumor processes.
  •                 Diabetes. Endocrine disorders qualitatively affect the functions of the organs of the female reproductive system.
  •                 Tumor processes in the ovaries or polycystic. Even benign neoplasms in the ovaries can be the “start” of uterine adenocarcinoma.
  •                 Hereditary predisposition. The tendency to cancer of the organs of the female reproductive system in women in several generations is able to be inherited.
  •                 Prolonged exposure to hazardous toxins. Women, whose main employment is associated with harmful production, constitute a significant risk group for the development of cancer of the reproductive organs.
  •                 Bad habits. Smoking and drinking alcohol is extremely dangerous for women at any age. Toxins and breakdown products of tobacco and alcohol products are often the root cause of the development of uterine tumors.
  •                 Imbalance in the diet. The constant consumption of too fatty fried meat, smoked meats, fast foods, sugary carbonated drinks negatively affects the functions of the female reproductive system.

Symptoms of uterine adenocarcinoma

Uterine adenocarcinoma is most often localized on the uterine floor and does not manifest itself for a long period. Certain symptoms may not appear even in the thermal stage.

In patients who have not reached menopause, against the background of the progression of the tumor, too much bleeding occurs that is not related to the menstrual cycle. With menopause, uncharacteristic bleeding, often of a dark brown color, can be observed.

In most cases, uterine adenocarcinoma begins to manifest itself in the second stage of the tumor process, in which pathology grows into the cervix. Bloody spotting should alert the woman, especially when they acquire a watery appearance with subsequent heavy bleeding.

In young girls, uterine adenocarcinoma is manifested by too long and heavy periods, as well as sudden uterine bleeding in the middle of the cycle. Women entering the menopause phase can pay attention to the resumption of menstruation after a long natural period of their complete absence.

In addition to bleeding and noticeable menstrual irregularities, it is necessary to pay attention to the following symptoms of uterine adenocarcinoma:

  •                 drawing pains in the lower part of the lumbar and abdominal cavity;
  •                 uncharacteristic abdominal enlargement;
  •                 copious discharge of serous color with an unpleasant odor;
  •                 discomfort and cutting pain after intercourse;
  •                 frequent increases in basal temperature;
  •                 sleep disturbances;
  •                 increased anxiety;
  •                 decreased vital activity;
  •                 pain inside the perineum;
  •                 cramps when urinating;
  •                 frequent false urge to urinate;
  •                 chronic constipation.

It should be borne in mind that the pathology begins to develop long before the appearance of the listed symptoms. Highly differentiated uterine adenocarcinomas can generally not express themselves at all until the very terminal stage. Gynecologists at routine examinations reveal progressive tumor processes in the nucleation stage against the background of precancerous conditions of the endometrium.

Methods for the diagnosis of uterine adenocarcinoma

Uterine adenocarcinoma can be detected using instrumental and laboratory studies. It includes:

  •                 gynecological examination;
  •                 uterine biopsy;
  •                 hysteroscopy;
  •                 ultrasound examination of the retroperitoneal cavity, abdominal cavity and pelvic organs;
  •                 general blood analysis;
  •                 blood chemistry;
  •                 magnetic resonance imaging of the pelvic organs;
  •                 computed tomography of the retroperitoneal cavity.

In cases where the pathology develops asymptomatically, a smear (Pap test) from the cervix for the presence or absence of mutant cells in the cervical canal and vaginal environment will reveal the true picture of the occurring pathologies in the organs of the female reproductive system.

The most accessible for the detection of cancer pathologies is considered a biopsy, but due to the low information content, at the first stages of the incipient malignant process, doctors are in no hurry to make a final diagnosis based on its results.

When suspicious neoplasms are detected during screening, a complete ultrasound examination of the pelvic organs is prescribed.

The most modern progressive methods for detecting malignant tumors in the uterus include hysteroscopy. Using a device equipped with a special probe, a visual examination is carried out in the uterine cavity, and an endometrial fragment is also taken for subsequent histology. In advanced conditions, the doctor may resort to curettage of the uterine walls for further detailed studies of biological material.

Treatment and prognosis of uterine adenocarcinoma

Modern oncologists are inclined to the consensus that the greatest therapeutic effect provides the complete removal of the uterine cavity and appendages. The next stage of treatment is radiotherapy and chemotherapy. It should be noted that the expected result can be achieved at the first or second stage of tumor development. At the third stage, an anamnesis is collected and a compromise decision is made depending on the general condition of the woman’s body. In any case, after surgical resolution of the pathology, due attention is given to postoperative rehabilitation, which takes 1-2 months. It is important to observe several simple rules during this period:

  •                 adjust the diet;
  •                 spend free time in the fresh air;
  •                 exclude direct contact with toxic substances;
  •                 avoid stressful situations;
  •                 limit sex life;
  •                 observe the rules of intimate hygiene;
  •                 increase the body’s immune functions.

The first few days after surgery, patients complain of:

  •                 certain discomfort in the pelvic area;
  •                 fatigue;
  •                 gagging;
  •                 digestive disorders;
  •                 false urge to urinate;
  •                 temporary disability.

Radiation therapy for uterine adenocarcinoma is performed before and after surgical resolution of the pathology. The procedure itself can be carried out remotely or internally. Modern devices allow the radiating cylinder to be inserted into the uterine cavity, the rays of which act directly on the affected areas of the organ. Thus, the process of decay of tumor cells begins. At the first stage of the neoplasm, there is a chance to get rid of the focus completely only through radiation exposure. When a tumor is found to be inoperable, chemical and radiation therapy become the primary therapeutic measures.

Since uterine adenocarcinoma is classified as hormone-dependent tumors, hormonal drugs aimed at reducing the concentration of estrogen in the blood are prescribed to eliminate it.

A positive prognosis for uterine adenocarcinoma can be counted only in those cases when the pathology was diagnosed and eliminated in the early stages of its development. Highly differentiated adenocarcinomas that underwent timely removal and failed to trigger the metastasis mechanism have a favorable prognosis. Usually, a year after a successful surgical intervention, a woman returns to her former life. In such patients, the chances of a full recovery are 80-90%.

After the operation of uterine adenocarcinoma of the second degree of malignancy, the woman loses the opportunity to conceive and bear the embryo. Rehabilitation in such cases takes a longer period, after which the chances of a full recovery range from 60-70%.

In the third stage of the oncological process in the uterine cavity, the prognosis is usually unfavorable. Moreover, it will not be possible to avoid metastases in this course of the disease. Often during surgery, a decision is made to remove the site or the entire surface of the vagina. The chances of recovery in patients in this case are no more than 40-50%.

At the fourth stage of uterine adenocarcinoma, doctors fight to save a woman’s life by any means. The final parameters are influenced by the size of the tumor and the extent of metastasis.

Cancer prevention of the female reproductive system

In fact, there are no specific preventive measures for uterine adenocarcinoma, however, with the observance of simple recommendations, many women manage to maintain their health. It is about the following:

  •                 Regular examinations by a gynecologist. For women of reproductive age and on the eve of menopause, gynecological examinations must be performed twice a year.
  •                 Periodic ultrasound examination of the pelvic organs. Ultrasound gives an extensive informational picture of the general condition of the organs of the female reproductive system, identifying pathologies that occur “on a hidden” type.
  •                 Timely detection and treatment of endocrine diseases, which is directly related to the reproductive functions of women.
  •                 Elimination of pseudopathological diseases of the cervix and uterine body. This refers to cervical erosion, polyps and papillomas in the uterine body.
  •                 Balanced diet. You should abandon foods that are high in carcinogens and all kinds of chemical additives, fast foods, salted, fried, smoked. Introduce plant foods rich in trace elements and antioxidants into the diet. It is also worth controlling your weight. It is obesity that puts women at risk for cancer.
  •                 Overcoming bad habits. Alcoholic beverages and tobacco products are not adversely affected by women’s health.
  •                 Physical activity, which will help to adjust weight, improve blood circulation and trophic organs of the pelvic organs, and will also generally strengthen the protective functions of the body.

Girls who have cases of breast cancer, ovary, cervical cancer among blood relatives should be extremely attentive to themselves – a hereditary predisposition is not ruled out. Often neglected infectious diseases of the pelvic organs become the “trigger” mechanism for the development of oncological pathologies in the female reproductive system.

event_note April 6, 2020

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