Adenocarcinoma of the uterus
Adenocarcinoma of the uterus is a malignant tumor of the endometrium. Occurs from glandular tissue, often affects the bottom of the uterus. It can be asymptomatic for a long time. In postmenopausal women, bleeding is possible, in young patients, unusually heavy menstruation. When adenocarcinoma of the uterus spreads, back pain, abdominal enlargement, vaginal discharge, and nonspecific cancer symptoms (weakness, loss of weight and appetite) appear. The diagnosis is established on the basis of examination data, laboratory and instrumental studies. Treatment – surgery, chemotherapy, radiation therapy, hormone therapy.
Adenocarcinoma of the uterus (endometrial cancer) is a malignant tumor originating from the glandular cells of the endometrium. It is a more common type of cancer of the uterus compared to leiomyosarcoma (a tumor originating from muscle tissue), diagnosed in 70% of cases of uterine cancer. It ranks second among malignant neoplasms in women after breast cancer. It is more often diagnosed at the age of 40-65 years. Currently, there is an increase in the incidence of uterine adenocarcinoma and a tendency towards rejuvenation of this type of cancer. 40% of patients are women of reproductive age.
Over a quarter of a century, the incidence in the group of women 40-49 years old has increased by 30%, in the group of women 50-59 years old – by 45%. At the same time, the incidence among women under the age of 29 has increased by 50% in the last 10 years alone. Adenocarcinoma of the uterus responds well to treatment in the early stages; with the progression of the process, the prognosis worsens. All of the above determines the importance of regular diagnostic examinations and the need for oncological alertness of gynecologists in relation to this disease. Treatment of adenocarcinoma of the uterus is carried out by specialists in the field of gynecology and oncology.
Causes of adenocarcinoma of the uterus
Adenocarcinoma of the uterus is a hormone-dependent tumor. The state of the glandular tissue of the endometrium changes cyclically under the influence of sex steroid hormones. An increase in the amount of estrogen provokes increased proliferation of endometrial cells and increases the likelihood of tumor development. Among the risk factors for the development of adenocarcinoma of the uterus associated with changes in hormonal levels, experts indicate the early onset of menstruation, late onset of menopause, polycystic ovary syndrome, hormone-producing ovarian tumors, obesity (adipose tissue synthesizes estrogens) and long-term use of large doses of estrogen-containing drugs.
The likelihood of developing adenocarcinoma of the uterus increases in the presence of certain diseases, in particular, with hypertension and diabetes mellitus. It should be noted that hormonal and metabolic disorders are a frequent, but not a necessary factor that precedes the development of uterine adenocarcinoma. In 30% of patients, the above disorders are absent. Among other risk factors, oncologists call the lack of sex life, pregnancy and childbirth, as well as the presence of breast cancer and endometrial cancer in close relatives. A malignant tumor often develops against the background of adenomatosis and polyposis of the uterus.
Classification of adenocarcinoma of the uterus
Taking into account the level of cell differentiation, three types of endometrial cancer are distinguished:
- Highly differentiated uterine adenocarcinoma – the majority of cells retain their normal structure. A small number of cells with a disturbed structure (with elongated nuclei, elongated or enlarged) are revealed.
- Moderately differentiated uterine adenocarcinoma – cellular polymorphism is more pronounced, increased cell division is observed.
- Poorly differentiated adenocarcinoma of the uterus – there is a pronounced cellular polymorphism, multiple signs of pathological changes in the structure of cells are revealed.
Taking into account the direction of tumor growth, three types of uterine adenocarcinoma are distinguished: with predominantly exophytic growth (the tumor grows into the uterine cavity), with predominantly endophytic growth (the tumor grows into the underlying tissues) and mixed. Malignant neoplasms with exophytic growth are more often detected.
Taking into account the prevalence of the process, four stages of uterine adenocarcinoma are distinguished:
Stage I – the tumor is localized in the body of the uterus, the surrounding tissues are not involved.
Stage II – the tumor spreads to the cervix.
Stage III – adenocarcinoma of the uterus spreads to the surrounding tissue, metastases in the vagina and regional lymph nodes can be detected.
Stage IV – adenocarcinoma of the uterus extends beyond the small pelvis, grows into the rectum or bladder, distant metastases can be detected.
Symptoms of adenocarcinoma of the uterus
The disease can be asymptomatic for a long time. In postmenopausal women, uterine bleeding is a warning sign. Women of reproductive age may have too heavy and too long periods. Bleeding is not a pathognomonic sign of adenocarcinoma of the uterus, since this symptom can appear in a number of other gynecological diseases (for example, with adenomyosis and uterine myoma), but the presence of this symptom should cause oncological alertness and serve as a reason for in-depth examination. This is especially true for the appearance of uterine bleeding during the period of established menopause.
Young women with uterine adenocarcinoma often see a gynecologist for ovarian dysfunction, infertility, irregular menstruation, and vaginal discharge. Elderly patients may complain of serous discharge of varying consistency. With the development of adenocarcinoma of the uterus, the leucorrhoea becomes abundant, watery. The presence of foul-smelling discharge is a prognostically unfavorable sign, indicating a significant spread and disintegration of uterine adenocarcinoma.
Pain usually appears with the spread of the tumor process, localized in the lumbar region and lower abdomen, can be constant or paroxysmal. Some patients go to the doctor only at the stage of germination and metastasis. Possible complaints in the late stages of adenocarcinoma of the uterus include weakness, lack of appetite, weight loss, hyperthermia and edema of the lower extremities. With the germination of the intestinal wall and bladder, defecation and urination disorders are observed. In some women, an increase in the size of the abdomen is revealed. In the later stages, ascites is possible.
Diagnosis of adenocarcinoma of the uterus
The diagnosis is made on the basis of gynecological examination data, the results of instrumental and laboratory tests. The simplest method for laboratory diagnosis of uterine adenocarcinoma is aspiration biopsy, which can be performed repeatedly on an outpatient basis. The disadvantage of this technique is low information content in the initial stages of uterine adenocarcinoma. Even with repeated studies, the probability of detecting the initial stage of cancer by analysis of the aspiration contents is only about 50%.
During the screening examination and when suspicious symptoms appear, an ultrasound of the pelvic organs is prescribed. This method of instrumental diagnostics makes it possible to identify volumetric processes and pathological changes in the structure of the endometrium. The leading place in the diagnosis of adenocarcinoma of the uterus is hysteroscopy. During the procedure, the gynecologist not only examines the inner surface of the uterus, but also performs targeted biopsy of the altered areas, RFE of the uterine cavity and cervical canal.
A promising diagnostic method for uterine adenocarcinoma is fluorescent diagnostics – endoscopic examination of the uterine cavity after the introduction of photosensitizers into the body, which selectively accumulate in altered tissues. The technique allows visualizing volumetric formations up to 1 mm in diameter. After hysteroscopy and fluorescence diagnostics, a histological examination of the biopsy specimen is performed. CT and MRI are used to assess the prevalence of uterine adenocarcinoma, to identify affected lymph nodes and distant metastases.
Treatment of adenocarcinoma of the uterus
The best five-year survival rates for uterine adenocarcinoma are observed after complex therapy, including surgery, radiation and drug therapy. Treatment tactics, intensity and time of use of each component of complex therapy are determined individually by oncogynecologists. Indications for surgery are stages I and II of adenocarcinoma of the uterus. The expediency of surgical intervention at stage III is determined taking into account the number of unfavorable prognostic factors.
In endometrial cancer, hysterectomy, panhysterectomy, or extended removal of the uterus with adnexectomy, removal of regional lymph nodes and pelvic tissue can be performed). Radiation therapy for uterine adenocarcinoma is used at the stage of preoperative preparation and in the postoperative period. Remote irradiation and uterine brachytherapy (irradiation with a cylinder inserted into the uterus or vagina) are used.
Chemotherapy and hormone therapy for uterine adenocarcinoma are auxiliary methods aimed at reducing the risk of recurrence and correcting hormonal levels. In the process of chemotherapy, cytostatics are used. In the course of hormone therapy, drugs are prescribed that affect progesterone and estrogen receptors located in the area of a malignant neoplasm. For grade IV adenocarcinoma of the uterus, surgery is not indicated; treatment is carried out using chemotherapy and radiotherapy.
Forecast and prevention of uterine adenocarcinoma
The prognosis is determined by the stage of endometrial cancer, the age and general health of the patient. Five-year survival rate for stage I and II of uterine adenocarcinoma is 98-70%, for stage III – 60-10%, for stage IV – about 5%. In 75% of cases, relapses occur in the first three years after the end of therapy. In almost half of cases, tumors are located in the vagina, in 30% – in regional lymph nodes, in 28% – in distant organs.
Preventive measures for the prevention and timely detection of adenocarcinoma of the uterus include regular examinations of a gynecologist, periodic ultrasound of the pelvic organs, timely treatment of precancerous diseases of the uterus, correction of endocrine disorders, a balanced diet and physical activity to maintain a normal weight, weight loss measures for obesity, adequate therapy of diabetes mellitus and hypertension.