What are other Names for this Condition? (Also known as/Synonyms)

• AIS of Cervix
• Cervical Adenocarcinoma In Situ
• High-Grade Cervical Glandular Intraepithelial Neoplasia (HG-CGIN)

What is Adenocarcinoma In Situ of Cervix? (Definition/Background Information)

• Adenocarcinoma In Situ (AIS) of Cervix is a small-sized, localized, premalignant adenocarcinoma, observed in the uterine cervix, which is the lower portion of the womb. AIS of Cervix typically affects adult women
• It may be described as an epithelial lesion and carries a very high-risk for invasive carcinoma, if left untreated. The condition is also known as High-Grade Cervical Glandular Intraepithelial Neoplasia (HG-CGIN)
• The risk factors for Adenocarcinoma In Situ of Cervix include human papillomavirus (HPV) infection and having multiple sexual partners. This precancerous condition is predominantly noted against a background of HPV infection
• In most cases, women do not present any signs and symptoms of Adenocarcinoma In Situ of Cervix. The condition is usually diagnosed through a Pap smear or colposcopy
• Treatments vary widely from periodic observation to surgical removal of the abnormal tissue. The prognosis of Adenocarcinoma In Situ of Cervix is generally good with suitable treatment (i.e., surgical excision of the precancerous lesion). However, in some cases, the abnormal growth may advance to cancer

Who gets Adenocarcinoma In Situ of Cervix? (Age and Sex Distribution)

• Adenocarcinoma In Situ of Cervix is exclusively observed in adult women, more often in the 30-40 year age category (mean age about 37 years)
• AIS of Cervix occurs in women on an average 10-15 years before invasive adenocarcinoma (malignancy) of cervix is diagnosed
• The condition may occur in all races and ethnic groups and no specific predilection is observed 

What are the Risk Factors for Adenocarcinoma In Situ of Cervix? (Predisposing Factors)

The risk factors for Adenocarcinoma In Situ of Cervix may include:

• Contracting human papillomavirus (HPV) infection: HPV is a virus that is often transmitted through sexual contact. High-risk HPV association is seen in most cases (that include HPV 16 and HPV 18)
• Having multiple sexual partners
• Using birth control pills for extended periods of time
• Taking medication that suppresses the immune system (such as during a chemotherapy)
• Other factors causing a poor immune system including HIV infection and organ transplant
• Giving birth at a young age; being sexually active at a young age
• A diet lacking fruits and vegetables
• Smoking

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Adenocarcinoma In Situ of Cervix? (Etiology)

• The exact cause of Adenocarcinoma In Situ of Cervix is unknown; it is believed that there may be multiple causal factors involved
• It is considered a preinvasive lesion to invasive cervical adenocarcinoma

Research has shown that the human papilloma virus causes the development of Adenocarcinoma In Situ of Cervix that leads to cervical adenocarcinoma in the following manner:

• The first step is an individual acquiring human papilloma virus infection:
  • High-risk individuals for HPV infections are those with multiple sexual partners, or individuals having sex with high-risk or highly promiscuous men (the more the number of partners, the greater is the risk)
  • Adolescent and young adult women have higher risk
  • Most infections are self-limiting or easily treatable, thus the main risk from HPV infection is chronicity or persistence of infection
  • Chronic or recurrent infections are a very vital aspect of progression to premalignancy
• The next step is the persistence of HPV infection and formation of premalignant lesions (such as adenocarcinoma in situ). Several years (decades) of persistent HPV infection can result in the development of precursor to cancer
• The final step is the development of cervical cancer from the premalignant stage: The time period of development from premalignancy to malignancy is variable, but can be very slow and may take many more years to decades. Certain genes are known to be involved in the process; but, these are not well-characterized

What are the Signs and Symptoms of Adenocarcinoma In Situ of Cervix?

Most women with Adenocarcinoma In Situ of Cervix do not show any symptoms. In rare cases, the signs and symptoms of the condition may include:

• Vaginal discharge
• Genital warts due to HPV infection
• Abnormal bleeding

How is Adenocarcinoma In Situ of Cervix Diagnosed?

Adenocarcinoma In Situ of Cervix usually remains asymptomatic, and hence, it is generally diagnosed during an annual Pap smear exam through:

• A Pap smear: It involves the collection of a small sample of cells from the cervix that is tested for abnormalities
• A human papillomavirus test may be performed to detect if there is an abnormal growth that is caused by the virus
• A colposcopy, which is a magnified examination of the vagina, cervix, and vulva, may be done to determine the severity of the condition. Sometimes, Cervical AIS may be present inside the endocervical canal. Large premalignant lesions may point to the presence of high-grade squamous intraepithelial lesion (HSIL)
• A biopsy of the abnormal tissue sample may be taken to detect, if the growth has become cancerous. In some cases, the diagnosis may be very challenging to the pathologist

Note: 

• Cervical cytology shows abnormalities; often, Adenocarcinoma In Situ of Cervix is found along with HSIL
• A variant of AIS, known as stratified mucin-producing intraepithelial lesion (SMILE) may be noted. It is seen with HSIL in many cases

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are possible Complications of Adenocarcinoma In Situ of Cervix?

The potential and major complication of Adenocarcinoma In Situ of Cervix includes the transformation of the condition to malignancy (cervical adenocarcinoma), if the condition is not promptly diagnosed and adequately treated.

How is Adenocarcinoma In Situ of Cervix Treated?

• The treatment of Adenocarcinoma In Situ of Cervix includes undertaking an excisional surgery, which is followed by a close follow-up and regular monitoring
• If really necessary, a surgical removal of the uterus may be undertaken, if the woman has completed her family and does not wish to bear a child
• In case no surgery is performed to remove Cervical AIS; then, regular colposcopic studies, testing for HPV infection, and cell analysis studies are important considerations

The following removal techniques may be considered:

• Laser therapy: The abnormal cells are destroyed using lasers
• Loop electrosurgical excision procedure, which is used to remove abnormal tissue with a thin wire loop
• Cryocauterization can help destroy the abnormal cells by freezing them
• Cone biopsy, which is a surgical procedure performed to remove the abnormal segment of the cervix (in severe cases)

How can Adenocarcinoma In Situ of Cervix be Prevented?

Currently, there are no methods available to completely prevent Adenocarcinoma In Situ of Cervix development. However, in order to minimize the risk, women may consider the following factors: 

• Get Pap smears done regularly as recommended by the healthcare provider
• Practice safe sex
• Avoid sex with multiple partners 
• Avoid smoking
• Administration of HPV vaccine at an age recommended by the healthcare provider

What is the Prognosis of Adenocarcinoma In Situ of Cervix? (Outcomes/Resolutions)

• In most cases, Adenocarcinoma In Situ of Cervix has a good prognosis with adequate treatment
• Nevertheless, even if it resolves on its own or is treated effectively, it is important to have regular checkups to detect any early recurrences
• In case of a late diagnosis, then there is a high risk for adenocarcinoma of the cervix. In such cases, the prognosis depends on several factors including the stage of the malignancy and overall health status of the woman

Additional and Relevant Useful Information for Adenocarcinoma In Situ of Cervix:

• Cervical cancer, the second most common cancer in women worldwide, is a malignant (capable of invading nearby and distant tissues) tumor of the cervix, which is the lower part of the uterus

The following article link will help you understand cervical cancer:

http://www.dovemed.com/diseases-conditions/cervical-cancer/