What are the signs and symptoms of cervical adenocarcinoma in adult women?

Signs and Symptoms of Cervical Adenocarcinoma

Cervical adenocarcinoma most commonly presents with abnormal vaginal bleeding (post-coital, intermenstrual, or post-menopausal), though early-stage disease is frequently asymptomatic and detected only through screening. 1

Primary Clinical Presentations

Bleeding Patterns

• Abnormal vaginal bleeding is the hallmark symptom, manifesting as post-coital bleeding, intermenstrual bleeding, or post-menopausal bleeding 2, 1
• Intermittent spotting occurs particularly in early-stage disease 1
• Post-coital bleeding represents one of the most common symptomatic presentations requiring investigation 2, 1

Vaginal Discharge

• Vaginal discharge is a prominent symptom specifically associated with adenocarcinoma histology, distinguishing it somewhat from squamous cell carcinoma 1
• A watery vaginal discharge may occur in earliest stages 2

Pain and Discomfort

• Pelvic pain indicates locally advanced disease with parametrial or pelvic sidewall involvement 2, 1
• Dyspareunia (painful intercourse) occurs as disease progresses 2, 1

Critical Diagnostic Considerations

Asymptomatic Presentation

• Many early cervical adenocarcinomas are completely asymptomatic, which is precisely why screening programs exist 2, 1, 3
• Early symptoms are often not recognized by patients even when present 2, 1
• Preinvasive lesions and early invasive adenocarcinoma are typically detectable only through Pap smears and HPV DNA testing 3

Screening Limitations Specific to Adenocarcinoma

• Cervical cytologic screening methods are less effective for adenocarcinoma because adenocarcinoma in situ affects areas of the cervix that are harder to sample (the endocervical canal) 2
• 93% of women with adenocarcinoma had a normal Pap smear within 3 years before diagnosis, and 60% within 1 year 4
• Only 23% of adenocarcinomas are detected by screening; the remaining 77% present due to symptoms 4
• Adenocarcinoma predominates among cancers detected following Pap-negative, HPV-positive screening 5

Tumor Appearance and Growth Patterns

Gross Examination Features

• Gross appearance is variable and can be deceptive 2
• Papillary tumors are more commonly adenocarcinomas 2
• Exophytic tumors (growing out of the surface) may cause bleeding symptoms earlier 3
• Endophytic tumors with stromal infiltration have minimal surface growth and delayed symptom onset 2, 3
• Some early cancers are not appreciable on examination, and even deeply invasive tumors may appear deceptive 2

Important Clinical Pitfalls

Recognition Challenges

• Early symptoms are frequently not recognized by patients, emphasizing the critical importance of maintaining screening programs 2, 1
• The probability of cervical cancer in women with post-coital bleeding varies dramatically by age (1 in 44,000 for ages 20-24 versus 1 in 2,400 for ages 45-54) 1
• If examination is difficult or there is uncertainty about vaginal/parametrial involvement, examination under anesthesia with a radiation oncologist should be performed 2

Histologic Diversity

• Cervical adenocarcinomas are a heterogeneous group with variable etiologies, not all related to HPV infection 6, 7
• Adenosquamous carcinomas may be diagnosed later or be histologically more aggressive than pure adenocarcinomas, with higher tumor grade and vascular invasion 8