Cervical adenocarcinoma

The cervix is covered on its outer part by flat squamous cells and lined inside the canal by tall mucus-producing glandular cells. Squamous cell carcinoma is the more familiar cancer. Adenocarcinoma develops from the glandular cells, which sit deeper in the canal, so changes can be out of view during a speculum examination.

Cancer Research UK reports that grades run from 1 to 3, with grade 1 cells most like normal tissue and grade 3 highly abnormal, and that the grade helps predict behaviour. There are subtypes of adenocarcinoma, some HPV-associated and some not, and pathologists record these in the report because they can influence treatment.

The precursor of adenocarcinoma is called adenocarcinoma in situ, or glandular abnormality. Cervical screening looks for high-risk HPV and then examines cells if it is found. Cells from the deeper canal may not always be sampled as well as surface cells, so glandular problems can be missed more readily than squamous ones.

This does not make screening pointless; it remains the main route to detecting HPV and pre-cancer early. It does mean that bleeding between periods, after sex or after the menopause, or unusual discharge, should be reported to a GP even when a recent screen was normal. Referral for colposcopy is arranged if screening is abnormal, and further procedures are tailored to glandular findings.

Early disease can cause no symptoms. When present they include bleeding after sex, bleeding between periods or after the menopause, heavier periods, a watery or blood-stained discharge, and pain in the pelvis or during sex. These have many benign explanations, but an urgent suspected cancer referral is appropriate if the GP is concerned.

Advanced disease may cause back or leg pain, leg swelling, bladder or bowel symptoms and tiredness, and warrants prompt review.

Colposcopy allows the cervix to be viewed under magnification and biopsied. A LLETZ or cone biopsy may be used to remove tissue for analysis and, for the earliest cancers, as treatment. Macmillan states that LLETZ is typically used for earliest-stage disease (stage 1A1) and may be the only treatment needed.

MRI of the pelvis assesses tumour size and local spread, and CT or PET-CT looks at lymph nodes and distant spread. Staging combines examination, imaging and pathology, and the multidisciplinary team agrees the plan.

Macmillan says surgery is the main treatment for stage 1 cervical cancer and for small stage 2A tumours. Options include simple or radical hysterectomy with lymph node assessment and, for selected people who want to preserve fertility, radical trachelectomy. Post-menopausal patients typically have tubes and ovaries removed too.

The NHS describes chemoradiotherapy as the primary treatment for large or spread cancers, with external beam radiotherapy and brachytherapy (internal radiation). Chemotherapy alone treats advanced or metastatic disease. Where cancer returns in the pelvis, extensive surgery such as pelvic exenteration may be considered in specialist centres.

Outlook depends mostly on stage at diagnosis, tumour size and nodal status. Smaller cancers found early are often curable, while larger tumours or spread to nodes call for combined treatment and closer follow-up. Your team can talk through what the findings mean for you.

HPV vaccination, taken up at school, prevents infection with the high-risk types behind most cervical cancers and adenocarcinomas, and continuing to attend cervical screening matters even after vaccination. Follow-up includes regular check-ups and imaging as advised. Late effects of treatment, such as early menopause after radiotherapy, are covered in our living after treatment guide.