Cervical adenocarcinoma is a type of cancer that develops in the cervix, the lower, narrow part of the uterus connecting to the vagina. Understanding this form of cervical cancer is important for early detection and effective management.
What is Cervical Adenocarcinoma?
Cervical adenocarcinoma originates from the glandular cells that line the endocervical canal, the inner part of the cervix. These cells are responsible for producing mucus. This differentiates it from squamous cell carcinoma, which arises from the thin, flat squamous cells covering the outer part of the cervix (ectocervix).
While squamous cell carcinoma accounts for the majority, approximately 80% to 90% of cervical cancers, adenocarcinoma represents a smaller but significant portion, about 10% to 20% of cases. Historically, the incidence of adenocarcinoma has been increasing, particularly in younger women, even as the overall incidence of cervical cancer has declined.
Primary Causes and Risk Factors
The primary cause of cervical adenocarcinoma is persistent infection with high-risk types of Human Papillomavirus (HPV). HPV types 16 and 18 are linked to adenocarcinoma, accounting for about 70% of all cervical cancer cases. HPV is a common sexually transmitted infection, often asymptomatic, which can be transmitted through skin-to-skin or any sexual contact.
Other factors can increase a person’s risk of developing cervical adenocarcinoma. Long-term use of oral contraceptives is associated with an increased risk. Having multiple full-term pregnancies also contributes to a higher risk. Additionally, a weakened immune system, such as from HIV infection or due to immunosuppressive medications, can make individuals more susceptible to developing cervical cancer.
Recognizing Symptoms and Importance of Early Screening
In its early stages, cervical adenocarcinoma often does not present with noticeable symptoms. When symptoms appear, they can include abnormal vaginal bleeding, such as bleeding after sexual intercourse, between menstrual periods, or after menopause. Other signs may involve unusual vaginal discharge, which can be watery, foul-smelling, or tinged with blood, and pelvic pain.
These symptoms are not exclusive to cervical adenocarcinoma and can be associated with other less serious conditions, making early screening important. Regular cervical cancer screening tests, including Pap tests (Papanicolaou test) and HPV tests, are important for detecting pre-cancerous changes or early-stage cancer. A Pap test examines cervical cells for abnormal changes, while an HPV test checks for the presence of high-risk HPV strains. Early detection through these screenings allows for timely intervention, improving treatment outcomes and preventing the progression to invasive cancer.
Diagnosis and Treatment Strategies
Following an abnormal screening result, diagnostic procedures are performed to confirm cervical adenocarcinoma. A colposcopy allows for a magnified view of the cervix, vagina, and vulva to identify abnormal areas. During this procedure, a biopsy is often taken. Other biopsy types include endocervical curettage (ECC), loop electrosurgical excision procedure (LEEP), or cone biopsy, which removes a cone-shaped piece of tissue for diagnosis or treatment.
After diagnosis, the cancer is staged to determine its extent, which involves assessing tumor size, depth of invasion, and spread to lymph nodes or distant organs. Imaging tests like MRI, CT, and PET scans are used in this staging process. The International Federation of Gynecology and Obstetrics (FIGO) staging system is used to classify the cancer’s progression, guiding treatment decisions.
Treatment for cervical adenocarcinoma is individualized based on the cancer stage, patient health, and desire for future fertility. Surgery is a common option, ranging from cold knife conization for early-stage disease to hysterectomy (removal of the uterus) or trachelectomy (removal of the cervix while preserving the uterus for fertility).
Radiation therapy, including external beam radiation therapy (EBRT) and brachytherapy (internal radiation), uses high-energy beams to target cancer cells. Chemotherapy, often combined with radiation, uses drugs to kill cancer cells or inhibit their growth. Additionally, targeted therapy employs drugs that block specific molecules involved in cancer cell growth, while immunotherapy stimulates the body’s immune system to fight cancer.
Prevention and Prognosis
Primary prevention of cervical adenocarcinoma centers on Human Papillomavirus (HPV) vaccination. The HPV vaccine is effective in preventing infections by high-risk HPV types, particularly HPV 16 and 18, which are responsible for a large percentage of cervical cancers. Vaccination is most effective when administered at younger ages, ideally between 9 and 14 years old, before potential exposure to the virus through sexual activity. The 9-valent HPV vaccine (Gardasil 9) protects against several high-risk HPV types.
Consistent and regular cervical cancer screening, including Pap tests and HPV tests, serves as a secondary prevention strategy. These screenings allow for the early detection of precancerous changes, enabling timely intervention before cancer develops. The prognosis for cervical adenocarcinoma depends on the stage at which it is diagnosed and the patient’s overall health. Localized cervical cancer, meaning it has not spread outside the cervix or uterus, has a higher 5-year relative survival rate compared to cases where the cancer has spread to distant organs. Ongoing follow-up care after treatment is important to monitor for any recurrence and manage long-term health.