Endocervical Adenocarcinoma: Symptoms, Diagnosis, and Treatment

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Endocervical Adenocarcinoma: Symptoms, Diagnosis, and Treatment

By Your Health Magazine Health Information Team

Unexpected bleeding after sex, a watery vaginal discharge, or pelvic discomfort can be easy to dismiss—especially when a recent cervical screening result was normal. These symptoms often have noncancerous causes, but they may also be warning signs of endocervical adenocarcinoma, a form of cervical cancer that begins in mucus-producing glandular cells inside the cervical canal.

Because this cancer can develop higher within the cervix, it may not always be visible during a routine pelvic examination. Understanding the symptoms, diagnostic process, and treatment options can help people know when follow-up is important.

What Is Endocervical Adenocarcinoma?

The cervix is the lower part of the uterus that opens into the vagina. Its outer surface contains flat squamous cells, while the endocervix—the canal leading toward the uterus—is lined with glandular cells that produce mucus. Endocervical adenocarcinoma develops when these glandular cells become cancerous and begin growing into surrounding tissue.

It is different from squamous cell carcinoma, the most common type of cervical cancer. It is also different from endometrial cancer, which begins in the lining of the uterus. A pathology examination is necessary to identify where a tumor began and what type of cells it contains.

Most endocervical adenocarcinomas are associated with a persistent infection involving a high-risk type of human papillomavirus, or HPV. However, certain less common forms are HPV-independent. Gastric-type adenocarcinoma is an important example and may behave differently from the more common HPV-associated form.

Possible Symptoms

Early endocervical adenocarcinoma may cause no noticeable symptoms. When symptoms do occur, they can resemble infections, hormonal changes, fibroids, or other gynecologic conditions. Possible warning signs include:

• Vaginal bleeding after sexual activity
• Bleeding between menstrual periods
• Periods that become heavier or last longer than usual
• Any vaginal bleeding after menopause
• Watery, blood-tinged, or unusually strong-smelling vaginal discharge
• Pelvic pain or pressure
• Pain during sexual activity

More advanced cervical cancer may cause persistent back or abdominal pain, leg swelling, fatigue, painful urination, blood in the urine, or changes in bowel movements. These problems do not automatically mean cancer is present, but they should not be ignored when they are new, unexplained, persistent, or worsening.

Risk Factors and Screening

Persistent high-risk HPV infection is the leading risk factor for HPV-associated cervical cancers. Smoking, a weakened immune system, inadequate screening, and a history of significant cervical cell abnormalities may also increase risk. HPV vaccination reduces the risk of cancers caused by the HPV types covered by the vaccine, but it does not eliminate the need for recommended cervical screening.

Screening may involve an HPV test, a Pap test, or both, depending on age, medical history, and current guidelines. A Pap test can identify abnormal glandular cells or adenocarcinoma in situ, a precancerous condition limited to the surface lining. Invasive endocervical adenocarcinoma has grown into deeper cervical tissue.

Screening is not the same as diagnostic testing. Because glandular abnormalities can occur within the cervical canal, symptoms still require evaluation even when previous screening was reassuring. Readers interested in cervical anatomy and sampling can learn more about the importance of endocervical components in women’s health.

How Is It Diagnosed?

An evaluation usually begins with a review of symptoms and medical history, followed by a pelvic examination. If screening results or symptoms raise concern, the clinician may recommend colposcopy. During this procedure, a magnifying instrument is used to examine the cervix closely.

A biopsy is required to confirm cancer. Depending on where the abnormal area is located, tissue may be collected through a cervical biopsy, endocervical curettage, loop electrosurgical excision procedure, or cone biopsy. A pathologist examines the tissue to determine whether cancer is present, whether it is invasive, and which subtype it represents. HPV-related testing and specialized laboratory stains may help classify difficult cases.

If invasive cancer is found, imaging such as MRI, CT, or PET-CT may be used to evaluate tumor size, nearby tissues, lymph nodes, and possible spread to distant organs. This process determines the cancer’s stage and helps guide treatment. Referral to a gynecologic oncologist—a physician specializing in cancers of the female reproductive system—is generally appropriate.

Treatment Options

Treatment depends primarily on the cancer’s stage, tumor size, lymph-node involvement, pathology findings, overall health, and the patient’s preferences. Fertility goals should be discussed before treatment begins whenever possible.

Surgery

Very small, early cancers may sometimes be treated with a cone biopsy that removes the abnormal area while preserving the uterus. Selected patients with early-stage disease may be candidates for radical trachelectomy, which removes the cervix and nearby tissue while leaving the uterus in place.

Other early cancers may require a hysterectomy, sometimes with removal of surrounding tissue and nearby lymph nodes. The precise procedure varies according to the tumor’s depth, size, location, and risk of spread. Additional radiation or chemotherapy may be recommended if surgical findings reveal higher-risk features.

Radiation and Chemotherapy

Larger tumors and cancers that have spread beyond the cervix are commonly treated with radiation therapy given at the same time as chemotherapy. Treatment may combine external-beam radiation with internal radiation, also called brachytherapy. Chemotherapy can improve how effectively radiation damages cancer cells.

Treatment for Advanced or Recurrent Cancer

For cancer that has spread to distant areas or returned after treatment, options may include chemotherapy, targeted therapy, immunotherapy, radiation, or a combination of approaches. Tumor testing may help the oncology team determine whether a particular systemic treatment is appropriate. Clinical trials may also provide access to treatments under investigation.

Side effects vary and may include fatigue, nausea, bowel or bladder changes, vaginal dryness, sexual discomfort, infertility, or early menopause. Supportive care, pelvic-floor therapy, sexual-health counseling, and fertility specialists may help address the practical and emotional effects of treatment. General information about cancer care and coping is available through MedlinePlus cancer resources.

When to Seek Care

Schedule an appointment with an obstetrician-gynecologist or primary care professional for unexplained bleeding after sex, bleeding between periods, persistent watery or bloody discharge, pelvic pain, or any bleeding after menopause. Seek prompt medical evaluation if bleeding is heavy, pain is severe, faintness develops, or symptoms rapidly worsen.

Do not wait for the next routine screening appointment when symptoms are present. Most of these symptoms are caused by conditions other than cancer, but an examination is the only reliable way to determine the cause. If endocervical adenocarcinoma is diagnosed, a gynecologic oncologist can explain the stage, treatment choices, expected side effects, and options related to fertility and quality of life.