Adenosarcoma of Uterine Cervix

Adenosarcoma of Uterine Cervix

Article
Sexual Health
Women's Health
+3
Contributed byMaulik P. Purohit MD MPHApr 25, 2018

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

  • Adenosarcoma of Cervix
  • Cervical Adenosarcoma

What is Adenosarcoma of Uterine Cervix? (Definition/Background Information)

  • Adenosarcoma of Uterine Cervix is a rare, low-grade cancer commonly affecting middle-aged women following menopause. It is a biphasic tumor (i.e., having 2 phases) with components of Müllerian glands (which are benign or atypical) and stroma (that is low-grade malignancy)
  • In adenosarcoma, the adeno- part is the epithelial component which is benign. The sarcoma component of adenosarcoma consists of low-grade malignancy of the stromal cells that surrounds the benign glands
  • The general risk factors for tumor development include past treatment for breast cancer, radiation treatment to the pelvis, and a history of uterine polyps. Nevertheless, the cause of Adenosarcoma of Uterine Cervix remains unknown
  • Cervical Adenosarcomas are generally painless and asymptomatic during the early stages. Symptomatic women are commonly known to have vaginal bleeding and sensation of mass in the pelvic region. Large tumors sizes can cause signs and symptoms due to compression of adjoining organ structures
  • The treatment of choice for Adenosarcoma of Uterine Cervix is a surgical removal of the entire tumor. However, other treatment modalities, such as radiation and chemotherapy, may also be necessary
  • The prognosis of Adenosarcoma of Uterine Cervix depends upon a variety of factors that include the stage of the tumor, the age of the individual, and severity of the signs and symptoms

Who gets Adenosarcoma of Uterine Cervix? (Age and Sex Distribution)

  • Adenosarcoma of Uterine Cervix may affect females of a wide age range, but is commonly observed in middle-aged women
  • Typically, study reports indicate that women with Cervical Adenosarcomas are younger than women with uterine adenosarcomas
  • There is no geographical, racial, or ethnic preference noticed
  • The tumor is rare and only 2% of adenosarcomas involving the female genital tract is seen in the uterine cervix

What are the Risk Factors for Adenosarcoma of Uterine Cervix? (Predisposing Factors)

The following risk factors may be noted for Adenosarcoma of Uterine Cervix:

  • Endometriosis: An abnormal and painful condition in which endometrial tissue grows outside the uterus
  • Some women may have a previous history of polyps that may be recurrent
  • Prior history of radiation therapy to the pelvic region
  • Estrogen therapy for a long time duration
  • Tamoxifen therapy for breast cancer

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones 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 Adenosarcoma of Uterine Cervix? (Etiology)

  • The exact cause of Adenosarcoma of Uterine Cervix development is unknown; although it is believed that some tumors may originate from endometriosis
  • Unlike other cervical cancers, Cervical Adenosarcomas are non-HPV related (HPV - human papilloma virus)
  • Research is being performed to understand the causative factors of this low-grade malignant tumor

What are the Signs and Symptoms of Adenosarcoma of Uterine Cervix?

The signs and symptoms of Adenosarcoma of Uterine Cervix may include the following:

  • Small-sized tumors are generally painless, although larger tumors may cause pelvic and abdominal pain (and discomfort)
  • The tumors may involve both the uterus and cervix, while some are multi-focal
  • Adenosarcomas are well-defined, firm tumors that appear like polyps, nodules, or appear as a mass
  • Females may experience abnormal vaginal bleeding and discharge from the vagina
  • Large tumors may compress adjoining organs and structures. This may lead to increased urination frequency
  • Individuals may have a sensation of a mass prolapsing into the vagina; the tumor may block the uterine cavity
  • Infrequently, one may observe associated weight loss, weakness, and lethargy
  • Some women may not experience any symptoms, during the initial stages of tumor growth

How is Adenosarcoma of Uterine Cervix Diagnosed?

The diagnosis of Adenosarcoma of Uterine Cervix may involve the following tests and procedures:

  • Complete physical examination with thorough evaluation of medical history
  • Ultrasound scan of the pelvis: It is a noninvasive procedure that uses high frequency sound waves to produce real-time images
  • Abdominal and pelvic CT scan: It is a noninvasive procedure that provides more details of soft tissues, blood vessels, and internal organs
  • Pelvic MRI scan: It is a noninvasive medical test that uses a powerful magnetic field to produce images of soft tissues, bones, organs, and all other internal structures of the abdomen and pelvis
  • Blood tests that include:
    • Complete blood count (CBC) to detect the cause of anemia
    • Determination of estrogen/progesterone levels in blood
  • Hysteroscopy: This procedure involves placing a probe through the cervix to examine the cavity of the uterus
  • Colposcopy:
    • The cervix is examined with an instrument, called a colposcope. This helps the physician get a magnified view of the cervix
    • In order for this procedure to be performed, the individual has to lie on a table, as for a pelvic exam. An instrument, called the speculum, is placed in the vagina to keep the opening apart, in order to help the physician visualize the cervix. The colposcope is then used to get a magnified view of the inside

Tissue biopsy of the mass:

  • A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
  • Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
  • Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis

Note:

  • In a majority of cases, Cervical Adenosarcoma may be detected incidentally during exam for other conditions, since it does not mostly cause any significant signs and symptoms
  • Generally, the cancer is difficult to diagnose, and sometimes misdiagnosed as a benign adenofibroma
  • Some tumors show features of a high-grade sarcoma (up to 25% of the tumor)

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 the possible Complications of Adenosarcoma of Uterine Cervix?

The possible complications of Adenosarcoma of Uterine Cervix include:

  • Stress and anxiety due to fear of cancer of the uterus
  • Development of Cervical Adenosarcoma with Sarcomatous Overgrowth:
    • If 25% of the adenosarcoma has sarcomatous features (which is high-grade malignancy), then it is called Cervical Adenosarcoma with Sarcomatous Overgrowth
    • Such tumors are larger in size, may show hemorrhage and tissue death. These are higher grade malignant tumors
    • Such tumors are generally known to metastasize and often have poor prognosis
  • Polypoid tumors may undergo mechanical injury, such as torsion or twisting, which can result in excruciating pain
  • The polyps may cause cervical prolapse
  • Some tumors may grow to large sizes, and even grow out of the cervix affecting adjoining reproductive organs
  • Local recurrences may be noted, especially in the vagina. Some tumors recur early, while some recur after a long duration of time
  • In case of a misdiagnosis as a benign tumor, it can lead to an incomplete removal or inadequate resulting in tumor recurrence

How is Adenosarcoma of Uterine Cervix Treated?

Once a diagnosis of cervical cancer has been made, the extent to which the tumor has spread is assessed. This is called staging.

  • The FIGO (International Federation of Gynecology and Obstetrics) and the AJCC (American Joint Committee on Cancer) TNM staging systems - are two similar, commonly used staging systems
  • A tumor that remains confined only to the superficial layers of the cervix is said to be carcinoma in situ (Stage 0 according to AJCC system)
  • Depending on how far the tumor has spread beyond the cervix, stages I through IV are defined
  • Stage I cancer is confined wholly to the cervix (the cancer has spread to involve even the deeper layers of the cervix unlike stage 0)
  • Stage IV cancer involves the nearby organs, such as the bladder, rectum, or even other distant organs

Following is the staging protocol for cervical cancer, according to the American Joint Committee on Cancer (AJCC), updated July 2016:

Stage 0 cervical cancer (carcinoma in situ):

  • In this stage, abnormal cells are found in the innermost lining of the cervix
  • These abnormal cells may become cancer and spread into nearby normal tissue

Stage I cervical cancer: The cancer is found only in the cervix. Stage I is divided into stages IA and IB, based on the amount of cancer that is found.

  • Stage IA: A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix
    • In stage IA1, the cancer is not more than 3 mm deep and not more than 7 mm wide
    • In stage IA2, the cancer is more than 3 mm, but not more than 5 mm deep; it is not more than 7 mm wide
  • Stage IB: It is divided into stages IB1 and IB2, based on the size of the tumor
    • In stage IB1, the cancer can only be seen with a microscope and is more than 5 mm deep and more than 7 mm wide; or the cancer can be seen without a microscope and is not more than 4 cm
    • In stage IB2, the cancer can be seen without a microscope and is more than 4 cm

Stage II cervical cancer: The cancer has spread beyond the uterus, but not onto the pelvic wall (the tissues that line the part of the body between the hips), or to the lower third of the vagina. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread.

  • Stage IIA: The cancer has spread beyond the cervix to the upper two-thirds of the vagina, but not to tissues around the uterus
  • Stage IIA is divided into stages IIA1 and IIA2, based on the size of the tumor
    • In stage IIA1, the tumor can be seen without a microscope and is not more than 4 cm in size
    • In stage IIA2, the tumor can be seen without a microscope and is more than 4 cm in size
  • Stage IIB: The cancer has spread beyond the cervix to the tissues around the uterus, but not onto the pelvic wall

Stage III cervical cancer: The cancer has spread to the lower third of the vagina, and/or onto the pelvic wall, and/or has caused kidney problems. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.

  • Stage IIIA: The cancer has spread to the lower third of the vagina, but not onto the pelvic wall
  • Stage IIIB: The cancer has spread to the pelvic wall; and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the urinary bladder). This blockage can cause the kidney to enlarge or stop working

Stage IV cervical cancer: In stage IV, the cancer has spread beyond the pelvis, or can be seen in the lining of the bladder and/or rectum, or has spread to other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer has spread.

  • Stage IVA: The cancer has spread to the nearby organs, such as the urinary bladder or rectum
  • Stage IVB: The cancer has spread to other parts of the body, such as to the lymph nodes, lung, liver, intestine, or bone

(Source: Stages of Cervical Cancer, July 2016, provided by the National Cancer Institute at the National Institutes of Health; U.S. Department of Health and Human Services)

The treatment modality is chosen, depending on the type and stage of the tumor, age of the individual, and the need to preserve the ability to bear children. Sometimes, more than one type of treatment modalities may be necessary.

In general, Cervical Adenosarcoma is an aggressive cancer and the treatment can be challenging. A multidisciplinary approach with a team of healthcare specialists and experts from various medical fields may be necessary to treat the cancer at a healthcare institution that has the experience and expertise in dealing with such high-grade cancers.

Treatment options for Adenosarcoma of Uterine Cervix may include:

Surgery:

  • Stage 0 tumors, confined to the superficial layers of cervix can be treated with cryosurgery (the cells are killed using extreme cold temperatures) or by using laser therapy
  • Conization procedure, besides helping with the biopsy, can also help in treating very early-stage cervical cancers in women, who want to preserve their childbearing ability
  • Radical trachelectomy: The surgeon removes the cervix, upper part of the vagina, and nearby lymph nodes, while preserving the ability to have children
  • Hysterectomy: In this procedure, the uterus and cervix are removed. This is done by making an incision on the abdomen (termed abdominal hysterectomy), or through the vagina (termed vaginal hysterectomy), or by using a laparoscope (termed laparoscopic hysterectomy). Surgery is performed under general or epidural anesthesia, though the ability to have children is lost. Complications, such as bleeding, infection, or damage to the urinary tract, or the intestinal system may occur in rare cases
  • Radical hysterectomy: The uterus, cervix, the upper part of the vagina and tissues, next to the uterus are removed. Additionally, some pelvic lymph nodes may also be surgically taken out. The surgery is performed under anesthesia and may be carried out, via an incision made on the abdomen or by using laparoscopy. With this invasive procedure, the ability to have children is lost. Rarely, complications such as bleeding, infection, or damage to the urinary tract or the intestinal system, may occur. Removal of lymph nodes may lead to swelling of legs (lymphedema)
  • Pelvic exenteration: The uterus, tissues surrounding the uterus, cervix, pelvic lymph nodes, and the upper part of the vagina, are removed. In addition, depending on the tumor spread, the remainder of the vagina, the bladder, rectum, and a part of the colon, may also be removed. Recovery from this surgery, takes a long period

Chemotherapy:

  • Medications are used to kill the tumor cells, which may be given as oral pills or injected into veins
  • A combination of chemotherapy medications may be used
  • Chemotherapy may be used in addition to radiation and/or surgery, to treat cancers that have spread or recurred. When chemotherapy and radiation therapy are used together, it is called concurrent chemoradiation
  • Side effects of chemotherapy may include nausea, vomiting, hair loss, loss of appetite, diarrhea, fatigue, increased risk of infection, mouth sores, and easy bruising, depending on the drugs used

Radiation therapy:

  • This procedure uses high-energy beams to kill the cancer cells
  • These beams may be delivered from outside the body (external beam radiation therapy) or the radioactive material maybe placed inside the vagina or the uterus (internal radiation therapy or brachytherapy)
  • Possible side effects may include:
    • Fatigue, nausea, vomiting, and diarrhea
    • Bladder irritation, leading to inflammation (cystitis)
    • Ovaries may be affected resulting in menstrual changes, or premature menopause
    • The vulva and vagina may be affected, causing soreness, or even scar tissue formation

Clinical trials on adjuvant chemotherapy and combinational chemotherapy, as secondary treatment to hysterectomy, may be helpful.

  • Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals
  • Follow-up care with regular screening and check-ups are important

How can Adenosarcoma of Uterine Cervix be Prevented?

Currently, it is not possible to prevent Adenosarcoma of Uterine Cervix. However, controlling certain factors may help lower one’s risk for the condition.

  • Healthy diet and exercise, as well as avoidance of unnecessary exposure to chemicals, may help decrease its risk
  • Avoiding smoking
  • Using appropriate protective gear while working with X-rays and other radioactive source
  • In order to avoid a relapse, or be prepared for a recurrence, the entire diagnosis, treatment process, drugs administered, etc. should be well-documented and follow-up measures initiated

Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory. Often several years of active vigilance are crucial and necessary.

What is the Prognosis of Adenosarcoma of Uterine Cervix? (Outcomes/Resolutions)

  • Adenosarcoma of Uterine Cervix is a low-grade malignancy. The prognosis of the tumor depends upon a set of several factors, which include:
    • Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
    • Overall health of the individual: Individuals with overall excellent health have better prognosis compared with those with poor health
    • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
    • The size of the tumor: Individuals with small-sized tumors fare better than those with large-sized tumors
    • Individuals with bulky disease have a poorer prognosis
    • Involvement of vital organs may complicate the condition
    • The surgical respectability of the tumor (meaning, if the tumor can be removed completely) - it is a treatment option
    • Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have worse prognosis compared to tumors that do not recur
    • Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond to treatment
    • Progression of the condition makes the outcome worse (progressive Cervical Adenosarcoma)
  • The prognosis of Cervical Adenosarcoma depends upon the involvement of the cervical wall and the growth and invasion of the sarcoma. Tumor recurrence due to wrong diagnosis and/or inadequate treatment can result in poorer outcomes. Hence, a correct diagnosis of the tumor is crucial
  • In many cases, there is a delay in diagnosis due to the uncommon nature of the tumor, and hence, the prognosis is generally poor for advanced or late stages of the cancer. However, if the tumor is diagnosed while it is still confined within the uterus, the prognosis is better

Additional and Relevant Useful Information for Adenosarcoma of Uterine Cervix:

Removal of the uterus will cause the regular menstrual bleeding to stop. This also means that a woman may not have children after uterus removal; though, sexual intercourse is still possible.

Was this article helpful

On the Article

Maulik P. Purohit MD MPH picture
Approved by

Maulik P. Purohit MD MPH

Assistant Medical Director, Medical Editorial Board, DoveMed Team

0 Comments

Please log in to post a comment.

Related Articles

Test Your Knowledge

Asked by users

Related Centers

Loading

Related Specialties

Loading card

Related Physicians

Related Procedures

Related Resources

Join DoveHubs

and connect with fellow professionals

Related Directories

Who we are

At DoveMed, our utmost priority is your well-being. We are an online medical resource dedicated to providing you with accurate and up-to-date information on a wide range of medical topics. But we're more than just an information hub - we genuinely care about your health journey. That's why we offer a variety of products tailored for both healthcare consumers and professionals, because we believe in empowering everyone involved in the care process.
Our mission is to create a user-friendly healthcare technology portal that helps you make better decisions about your overall health and well-being. We understand that navigating the complexities of healthcare can be overwhelming, so we strive to be a reliable and compassionate companion on your path to wellness.
As an impartial and trusted online resource, we connect healthcare seekers, physicians, and hospitals in a marketplace that promotes a higher quality, easy-to-use healthcare experience. You can trust that our content is unbiased and impartial, as it is trusted by physicians, researchers, and university professors around the globe. Importantly, we are not influenced or owned by any pharmaceutical, medical, or media companies. At DoveMed, we are a group of passionate individuals who deeply care about improving health and wellness for people everywhere. Your well-being is at the heart of everything we do.

© 2023 DoveMed. All rights reserved. It is not the intention of DoveMed to provide specific medical advice. DoveMed urges its users to consult a qualified healthcare professional for diagnosis and answers to their personal medical questions. Always call 911 (or your local emergency number) if you have a medical emergency!