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

• Adenosarcoma of Corpus Uteri
• Müllerian Adenosarcoma of Uterus
• Uterine Adenosarcoma

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

• Adenosarcoma of Uterine Corpus is a low-grade cancer commonly affecting middle-aged and older women following menopause. It is classified as a mixed epithelial and mesenchymal tumor of the uterine corpus
• 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 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 Corpus remains unknown
• Uterine 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 Corpus 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 Corpus 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 Corpus? (Age and Sex Distribution)

• Adenosarcoma of Uterine Corpus may affect females of a wide age range, but is commonly observed in women older than 48-50 years (postmenopausal status)
• The tumor is also observed in adolescent girls in the 10-19 year age category. Some reports indicate that 1 in 3 tumors are observed in premenopausal women
• There is no geographical, racial, or ethnic preference noticed

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

The following risk factors are noted for Adenosarcoma of Uterine Corpus:

• Prior history of radiation therapy to the pelvic region
• Estrogen therapy for a long time duration
• Tamoxifen therapy for breast cancer
• History of polyps in the uterus

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 Corpus? (Etiology)

• The exact cause of Adenosarcoma of Uterine Corpus development is unknown
• 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 Corpus?

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

• The tumor arises in the body of the uterus (or uterine corpus); some rare cases are observed on the walls of the uterus, or in the connective tissue layers
• Small-sized tumors are generally painless, although larger tumors may cause pelvic and abdominal pain
• Average tumor size is about 6.5 cm
• Adenosarcomas are well-defined, firm tumors that appear like polyps or appear as a mass
• Females may experience abnormal vaginal bleeding and abnormal 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 Corpus Diagnosed?

The diagnosis of Adenosarcoma of Uterine Corpus 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. This exam is helpful in detecting submucosal leiomyomas
• Hysterosalpingography: It is usually performed in individuals with infertility. In this procedure, the structure of the uterus and fallopian tubes are studied by using a dye and X-ray images
• Needle biopsy of tumor: A needle biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a needle biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
• Open biopsy of tumor: A tissue biopsy is performed and sent to a laboratory for a pathological examination, who 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
• Differential diagnosis, to eliminate other tumor types is considered, before arriving at a definitive diagnosis

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 Corpus?

The possible complications of Adenosarcoma of Uterine Corpus include:

• Stress and anxiety due to fear of cancer of the uterus
• Development of Uterine Adenosarcoma with Sarcomatous Overgrowth:
  • If 25% of the adenosarcoma has sarcomatous features (which is high-grade malignancy), then it is called Uterine Adenosarcoma with Sarcomatous Overgrowth
  • If the smooth muscle walls (myometrium) are involved, then sarcomatous overgrowth may be seen. Invasion of the blood vessels and deep myometrium is observed in many cases
  • Such tumors are larger in size, may show hemorrhage and tissue death. These are higher grade malignant tumors
  • About 10% of Uterine Adenosarcomas exhibit this behavior
  • 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 uterus affecting adjoining reproductive organs
• Local recurrences are present in 1 in 3 cases, especially in the vagina. Some tumors recur early, while some recur after a long duration of time
• Recurrence is more often observed, if the tumor involves deep myometrial tissues (uterine mid-layer wall)
• There may be complications due to the tumor in pregnant women

How is Adenosarcoma of Uterine Corpus Treated?

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

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

Stage I uterine cancer: The cancer is found in the uterus only. Stage I is divided into stages IA and IB, based on how far the cancer has spread.

• Stage IA: The cancer is in the endometrium only or less than halfway through the myometrium (muscle layer of the uterus).
• Stage IB: The cancer has spread halfway or more into the myometrium.

Stage II uterine cancer: The cancer has spread into connective tissue of the cervix, but has not spread outside the uterus.

Stage III uterine cancer: The cancer has spread beyond the uterus and cervix, but has not spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB, and IIIC, based on how far the cancer has spread within the pelvis.

• Stage IIIA: The cancer has spread to the outer layer of the uterus and/or to the fallopian tubes, ovaries, and ligaments of the uterus.
• Stage IIIB: The cancer has spread to the vagina and/or to the parametrium (connective tissue and fat around the uterus).
• Stage IIIC: The cancer has spread to lymph nodes in the pelvis and/or around the aorta (largest artery in the body, which carries blood away from the heart).

Stage IV uterine cancer: The cancer has spread beyond the pelvis. Stage IV is divided into stages IVA and IVB, based on how far the cancer has spread.

• Stage IVA: The cancer has spread to the bladder and/or bowel wall.
• Stage IVB: The cancer has spread to other parts of the body beyond the pelvis, including the abdomen and/or lymph nodes in the groin.

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

In general, Uterine 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.

The treatment of Adenosarcoma of Uterine Corpus may depend upon a consideration of the following set of factors:

• Size of the tumor
• Severity of the signs and symptoms
• Location of the adenosarcoma
• Whether sarcomatous overgrowth is observed
• Age of the individual
• Whether the women is pregnant

The following treatment methods may be employed:

• Surgical treatment options:
  • Myomectomy: Removal of the tumor
  • Hysterectomy: The removal of a part of the uterus or the entire uterus
  • Radical hysterectomy: It involves the removal of the uterus and tissues surrounding it. This procedure is typically more suited for tumors that have spread beyond the uterus
  • Hysterectomy (abdominal) with salpingo-oophorectomy: It is a surgical procedure involving the removal of the uterus, and of the fallopian tube and ovary (salpingo-oophorectomy)
  • Myolysis: In this procedure, a needle is inserted into the tumor. After the insertion, the tumor is destroyed either by using an electric current, or by a freezing technique
  • Tumor embolization is a possible treatment option. Here the blood supply to the tumor is blocked resulting in its death
  • Radiofrequency ablation: In this technique, the tumors are destroyed using radio waves
• Radiation therapy and chemotherapy are employed depending upon each specific case
• 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 Corpus be Prevented?

Currently, it is not possible to prevent Adenosarcoma of Uterine Corpus. 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 Corpus? (Outcomes/Resolutions)

• Adenosarcoma of Uterine Corpus 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 Uterine Adenosarcoma)
• 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. The 5 year survival rate for stage I cancer is about 80%; for stage III, it is 50%
• Individuals with Uterine Adenosarcoma with Sarcomatous Overgrowth generally have a poor prognosis, since it is an aggressive and high-grade malignancy

Additional and Relevant Useful Information for Adenosarcoma of Uterine Corpus:

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.