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

• Bartholin Gland Adenosquamous Carcinoma
• Bartholin Gland Cancer - Adenosquamous Carcinoma Type

What is Adenosquamous Carcinoma of Bartholin Gland? (Definition/Background Information)

• Adenosquamous Carcinoma of Bartholin Gland is a malignant tumor that typically affects middle-aged and elderly women. It is a rare subtype of squamous cell carcinoma
• Bartholin glands are glands that are present normally on either side of the vagina. Their function is to secrete a fluid into the vagina, in order to make the vaginal opening smooth and slippery
• The cause of Adenosquamous Carcinoma of Bartholin Gland and the factors that influence its development are unknown. However, general risk factors for the development of cervical and vulvar cancers include infection by human papilloma virus (HPV), certain hormonal medications, and smoking
• In many cases, Adenosquamous Carcinoma of Bartholin Gland is confused with Bartholin gland cyst, which is a benign condition. Hence, the condition is often ignored. This may result in delayed diagnosis and metastasis to the groin (inguinal) lymph nodes
• The treatment of choice is a surgical excision with clear margins followed by radiation therapy or chemotherapy, as decided by the healthcare provider. In majority of cases, the prognosis is good with appropriate treatment
• Nevertheless, the prognosis of Adenosquamous Carcinoma of Bartholin Gland depends upon many factors including the stage of the tumor and health status of the affected individual. There is also a possibility of metastasis, which may influence the course of the cancer

Who gets Adenosquamous Carcinoma of Bartholin Gland? (Age and Sex Distribution)

• Adenosquamous Carcinoma of Bartholin Gland generally affects women over the age of 40 years
• The condition is generally prevalent worldwide; all racial and ethnic groups are at risk
• Around 5% of all malignant tumors of the Bartholin glands are adenosquamous carcinomas

What are the Risk Factors for Adenosquamous Carcinoma of Bartholin Gland? (Predisposing Factors)

The risk factors for Adenosquamous Carcinoma of Bartholin Gland are generally unknown. However, the risk factors for cancers occurring in the cervical and vulvar region include:

• Infection with human papilloma virus (HPV)
• History of diethylstilbestrol (DES, a synthetic form of estrogen) use in mothers: Female children of women, who took this drug while pregnant, developed adenocarcinoma of vagina, more commonly than the rest of the population
• Lack of periodic/regular Pap smear tests
• Weakened immune system as a result of disease, such as AIDS, or due to immune-suppressing drugs
• Smoking
• Having the first child at a young age (before 17 years) and multiple pregnancies

Note: There are no specific risk factors established for Adenosquamous Carcinoma of Bartholin Gland.

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 Adenosquamous Carcinoma of Bartholin Gland? (Etiology)

• The cause of Adenosquamous Carcinoma of Bartholin Gland is generally unknown
• Genetic mutations have been suspected by researchers in some cases, but these have not been well-characterized

What are the Signs and Symptoms of Adenosquamous Carcinoma of Bartholin Gland?

The signs and symptoms of Adenosquamous Carcinoma of Bartholin Gland include:

• In majority of the cases, the condition is asymptomatic and does not present any signs or symptoms (during the initial period)
• The tumor may be single; though, it is not uncommon to find multiple tumors in an individual
• The skin lesions may appear as crusted ulcer, plaques, and nodules
• There may be pain, itching, and burning sensation
• It may ulcerate and bleed. Occasionally, after the ulcer heals, it may become ulcerated again
• In some cases, the carcinoma may appear more pigmented than surrounding skin
• Individuals with immunocompromised states have more aggressive tumors

Additionally, the tumor may cause the following signs and symptoms:

• Abnormal vaginal bleeding, vaginal discharge
• Pain during sex and bleeding after sexual intercourse
• Anemia (due to bleeding)
• Loss of weight, loss of appetite

How is Adenosquamous Carcinoma of Bartholin Gland Diagnosed?

A diagnosis of Adenosquamous Carcinoma of Bartholin Gland is made by:

• Complete physical examination with detailed medical history evaluation
• Examination by a dermatologist using a dermoscopy, a special device to examine the skin
• Radiological studies, such as ultrasound scan, CT and MRI scans, to determine the extent of tumor spread

Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment.

Tissue biopsy:

• 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

In case of metastatic tumors, the following diagnostic procedures can be used to procure the tissue sample:

• Fine needle aspiration (FNA) biopsy of the tumor
• Core biopsy or open biopsy 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 Adenosquamous Carcinoma of Bartholin Gland?

The possible complications due to Adenosquamous Carcinoma of Bartholin Gland could include:

• Discomfort, irritability of the affected region
• Painful or uncomfortable sexual intercourse
• The tumor can metastasize to the lymph nodes of the groin and other regions of the body
• Severe emotional and psychological stress
• There is a high frequency of recurrence of the carcinoma following treatment
• Complications that arise from cancer therapy (such as due to chemotherapy or radiation therapy)

How is Adenosquamous Carcinoma of Bartholin Gland Treated?

Early diagnosis and treatment of Adenosquamous Carcinoma of Bartholin Gland is important to avoid complications such as metastasis to other regions. The treatment measures may include:

• In most cases, a wide surgical excision and removal of the entire tumor is the preferred treatment option. This may be followed by radiation therapy and/or chemotherapy
• The surgical removal of the tumor depends on the size and stage of the Bartholin Gland Adenosquamous Carcinoma. The surgical procedures performed could include:
  • Hemivulvectomy, which is partial removal of vulva
  • Total vulvectomy, which is complete removal of vulva: Sometimes, local lymph nodes may also be removed using total vulvectomy, with bilateral inguinal and femoral lymphadenectomy
  • If the tumor size is large, then partial pelvic exenteration may be performed. During this procedure, all the cancer tissue and surrounding pelvic tissue is removed to decrease the bulk of the tumor. This is often followed by radiation therapy and chemotherapy
• If the tumor has metastasized (in rare cases), then a combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
• 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 and encouraged

How can Adenosquamous Carcinoma of Bartholin Gland be Prevented?

• There are no specific preventative risk factors for Adenosquamous Carcinoma of Bartholin Gland
• Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory, due to its high metastasizing potential and possibility of recurrence. Often several years of active vigilance is necessary

What is the Prognosis of Adenosquamous Carcinoma of Bartholin Gland? (Outcomes/Resolutions)

• In general, Adenosquamous Carcinoma of Bartholin Gland is a malignant tumor. If metastasis (such as to the local lymph nodes) is observed, then the prognosis is guarded or unpredictable
• Tumors in their early stage with complete excisional treatment typically have good prognosis
• In cases of metastasis, its prognosis depends upon a set of several factors that 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
  • The surgical respectability of the tumor (meaning, if the tumor can be removed completely) 
  • Overall health of the individual: Individuals with overall excellent health have better prognosis compared to those with poor health
  • Age of the individual: Older individuals generally have poorer prognosis than younger individuals
  • Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have a poorer 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 so well to treatment

Additional and Relevant Useful Information for Adenosquamous Carcinoma of Bartholin Gland:

• Vulvar cancer is the fourth most common malignancy of the female reproductive tract. Vulvar cancers are very uncommon. Only 0.1% to 5% of cancers occurring in the vulva are of Bartholin gland origin
• Bartholin glands were first described by a Dutch scientist named Caspar Bartholin in 1677
• 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/womb

The following article link will help you understand cervical cancer:

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