Everything you need to know about adenocarcinoma (glandular cancer)

June 3, 2021

Cancer occurs when cells begin to grow uncontrollably. Cells of almost any organ can acquire this feature. In addition, as the tumor grows, they can be transported through the blood or lymph to other areas of the body, settle there and give rise to the growth of new lesions. Such foci are called secondary cancer, or metastases, and the initial tumor, respectively, is called primary cancer.

Metastases in any organs are classified depending on which organ the tumor initially originates from. For example, a secondary focus of lung cancer in the liver will still be called lung cancer, it will just receive the prefix “secondary”. Sometimes it is not possible to determine in which organ the tumor first appeared. However, the study reveals its metastases in other parts of the body. If their primary focus cannot be determined, then doctors talk about primary cancer of unknown origin, or hidden primary cancer.

Adenocarcinoma. Types and stages

Doctors classify glandular cancer according to several criteria. Experts distinguish three types of adenocarcinomas:

• Well differentiated adenocarcinoma . It disperses throughout the body very slowly and is highly treatable. In 3 out of 5 cases, this type of tumor occurs latently, so specialists detect it in the last stages.
• Moderately differentiated adenocarcinoma. The speed of development is average.
• Poorly differentiated adenocarcinoma. The most unsafe variety. It spreads quickly, is quite difficult to treat, and metastases appear early.

Oncologists identify types of adenocarcinoma by the organs in which the disease is found: pancreas, lungs, uterus, stomach, liver and others.

There are five stages of adenocarcinoma:

• Zero. Malignant cells do not go beyond the epithelium where they appeared.
• First. The neoplasm located in the organ reaches up to 2 cm in diameter.
• Second. The tumor is already up to 4 cm. Plus, it can spread metastases to the lymph nodes closest to the tumor.
• Third. The neoplasm occupies the entire thickness of the organ walls, then spreads to neighboring organs and gives rise to more metastases.
• Fourth. At this stage, a large number of metastases spread to distant human organs.

Types of Cancers

Tumors are usually classified according to their primary location. However, they can also be grouped by cell type, the way cancer cells look under a microscope. Knowing the cell type can give doctors clues about what tissue or organ a given tumor comes from.

Carcinomas

Carcinoma is cancer that originates from the cells lining the inner or outer surfaces of various organs in our body. Such cells are called epithelial. The most common types of carcinomas are:

1) Squamous cell carcinoma

The most striking example of flat cells are the cells found on the surface of the skin. In addition, they form part of the mucous membranes of many hollow organs. Squamous cell carcinoma can occur in the mouth, throat, esophagus, lungs, rectum, cervix, vagina, and some other organs.

2) Adenocarcinomas

These malignant neoplasms develop from glandular cells, that is, from those that are capable of producing any substances. Glandular cells are part of many organs of our body, including those that are not formally considered glands. For example, most stomach, intestinal, and colon cancers are adenocarcinomas, and approximately 4 out of 10 lung cancers are also adenocarcinomas.

Other types of malignant tumors

Cancers arise less frequently from other types of cells. Such tumors include:

• lymphomas - develop from cells of the immune system located in the lymph nodes and some other organs;
• melanomas - develop from skin cells that accumulate the pigment melanin and are responsible for the coloring of the skin;
• sarcomas - develop from connective tissue cells that are usually present in tendons, ligaments, muscles, fat, bones and cartilage;
• tumors of germ cells that can develop in the testes (testes) in men and ovaries in women.

So, with primary cancer of unknown origin, it is not always possible to determine the organ where the tumor originally arose. However, when examining the cells of a secondary lesion under a microscope, it is most often possible to classify them into one of five categories:

• adenocarcinoma (approximately 60% of all tumors of unknown origin);
• poorly differentiated carcinoma;
• squamous cell carcinoma;
• poorly differentiated malignant neoplasm;
• neuroendocrine carcinoma.

In the future, this information will help to more accurately identify the tumor and ultimately detect its primary focus.

What are the types of diagnosis for adenocarcinoma?

The patient needs to undergo a complete examination:

• Blood test to detect tumor markers. Determines the presence of substances that are characteristic of a particular type of glandular cancer.
• Blood testing in the laboratory (biochemical and general analysis). Helps identify disturbances in the functioning of internal organs.
• X-ray. With its help, specialists can detect metastases.
• Analysis of urine. Detects inflammation processes.
• Biopsy. Collecting tumor tissue for laboratory research.
• Ultrasound. With its help, doctors study the tissues of the infected organ and the lymph nodes closest to it. Then the tumor is identified and its size is determined.
• Scintigraphy. Doctors use this imaging technique, which involves injecting radioactive isotopes into the body and then producing a two-dimensional image. This helps to find inflammatory processes.

Identification example

Hidden primary cancer is uncommon. Moreover, during further examinations the primary lesion may be discovered. If this happens, the tumor is no longer considered a primary cancer of unknown origin. It is given a name in accordance with the organ of origin and, based on new data, the treatment regimen for cancer is modified.

In practice this happens as follows:

1. For example, a person is found to have an enlarged lymph node in the neck.
2. A biopsy reveals that there is a malignant tumor in the lymph node.
3. However, upon cytohistological examination, it turns out that the cells of this tumor are not similar to cancer cells of the lymphatic system.
4. The patient is tentatively diagnosed with a primary cancer of unknown origin.
5. The tumor cells found are similar to cancer cells of the oral cavity, soft tissues of the throat or larynx.
6. The patient is prescribed a series of in-depth examinations.
7. During these examinations, a small asymptomatic tumor lesion is found in the larynx.
8. The patient's diagnosis is changed to laryngeal cancer and treatment appropriate for this type of oncopathology is prescribed.

However, in some cases, even the most thorough examination does not detect the primary focus. Moreover, it is not always possible to find it even during a pathological examination.

What are the treatment options for adenocarcinoma?

After a complete examination, doctors choose the appropriate treatment method for adenocarcinoma in a particular case.

• Open surgery to remove the tumor. The specialist makes an incision (up to twenty cm) and removes the tumor.

+ The method is one of the cheapest

“It leaves a pretty big scar.”

• Laparoscopic removal. The operation is performed using a pair of small incisions (up to two cm). The affected tissues are removed with forceps. The process is controlled by a device with a camera.

+ Scars are almost invisible. Rehabilitation is one and a half times faster than with open surgery.

— The cost of this method is more than open surgery.

• Endoscopic removal. Specialists remove tumors in the initial stages using an endoscope. When removing, a tube with a camera and forceps are used. They are introduced into the body through natural openings.

+ No scars.

— Large tumors cannot be removed.

• Radiation therapy (radiotherapy). Malignant cells are destroyed by radiation. With preoperative radiation, the main thing is to reduce the tumor. During postoperative treatment, the main thing is to remove the cancer cells that remain. Instead of surgery, radiation therapy is prescribed for small tumors.

• Tumor removal using the CyberKnife robotic system. Radiosurgery is performed. This means that the adenocarcinoma is removed without making any incisions in the body. The impact accuracy is 99.6%.

• Radioiodine therapy. Used for several types of thyroid adenocarcinoma. This destroys the remaining malignant cells. The therapy involves the patient taking a radioiodine capsule orally.

• Focused ultrasound ablation. The main effect occurs through ultrasound. Prescribed in the early stages of glandular cancer of the prostate, kidney, breast, liver and bladder.

• Chemotherapy for adenocarcinoma. Cancer cells are destroyed by chemicals.

Why do you need to look for the primary focus?

The main reason for searching for the initial tumor is to choose the right treatment tactics. Secondary metastatic foci consist of the same cells as the initial tumor, even if they develop in completely different organs. This means that for their treatment, the same drugs will be effective as for the treatment of primary cancer, and not those used in the treatment of oncopathologies of the organ where metastasis has developed.

This is especially important in some forms of cancer that respond well to certain chemotherapy or hormonal drugs. For example, many breast tumors are characterized by such features. They can be effectively treated with hormonal drugs. This means that the same drugs are suitable for treating their metastases in the bones, brain, and liver.

Unfortunately, it is still almost impossible to predict the development of a malignant disease. Therefore, the most effective way to fight tumors is to detect cancer at the 1st stage of development. In this case, more than 90% of all malignant neoplasms can be successfully treated. A tumor can be detected in the initial stages of its occurrence only through periodic screenings. Such screening programs also operate in the medical field. At the initial consultation, an oncologist will assess your risk of developing cancer and draw up an individual plan for undergoing preventive examinations for early diagnosis of cancer.

The material was prepared in agreement with Anadolu doctor, therapist and medical oncologist Şeref Komurcu.

Treatment for stage 2 rectal cancer

The goal of therapy is to remove the malignant tumor - only by surgery. Today, there are a variety of surgical techniques; for stage 2 rectal cancer, resection or extirpation can be performed - when choosing a technique, the localization of the tumor is taken into account.

• If the tumor is located at a distance of 4-5 cm from the anal sphincter, abdominal-perineal extirpation can be performed with a colostomy in the left iliac zone.
• If the distance between the tumor and the sphincter is 7-9 cm, resection of the section of the intestine with the tumor is indicated, while the sigmoid colon is connected to the rectum and the process of defecation is not disturbed. Sometimes a temporary stoma is formed in a higher-lying section of the intestine to divert intestinal contents from the formed anastomosis during healing, which closes after a few months.
• If the tumor is located 8 cm above the anus, a low anterior resection can be performed; the anastomosis is formed using staplers through access from the abdominal wall, while the sphincter is preserved.
• Anterior resection is performed for a highly located tumor (more than 10 cm from the anus) from the side of the peritoneal cavity, while it is possible to save the lower part of the intestine, thus, the function of accumulating intestinal contents is preserved, there is no need to form a reservoir, and it is also possible to do without the formation of a temporary stoma.

The operation consists of three stages: the tumor is removed along with part of the afferent and efferent colon, and at the same time, regional lymph nodes are excised - lymphadenectomy. The final stage is the formation of a stoma or colorectal anastomosis. In some situations, chemotherapy may be prescribed after surgery.

For a free written consultation, in order to determine the indications for surgery, as well as choose the correct surgical treatment tactics, you can send me a complete description of the colonoscopy, histology data, and, if possible, MSCT data of the abdominal cavity with contrast, indicate your age and main complaints by email. Then I will be able to give a more accurate answer to your situation.

Classification of ovarian cancer

The most common type of disease is epithelial ovarian cancer. It occurs in 9 out of 10 cases, forming from cells located on the surface of the organ. Malignant cells quickly spread throughout the peritoneum. Metastasis is also possible to the navel, bladder or intestines, lymphatic vessels of the pelvic and inguinal nodes. Lesions may appear in the liver, spleen, lymph nodes in the neck and under the collarbones. In some patients, the primary tumor is observed in the mammary gland, intestines, and uterus (Krukenberg tumor).

There are several types of epithelial pathology:

Serous ovarian adenocarcinoma

. This is the most aggressive type of cancer, most often affecting both ovaries. The tumor has a multilocular, cystic structure. Malignant cells produce serous fluid.

Endometrioid adenocarcinoma of the ovary

. The formation resembles endometrial carcinoma. The tumor has a cystic structure and a stalk. It develops slowly, the growth pattern is non-aggressive. Has a favorable prognosis.

Clear cell adenocarcinoma of the ovary

. A rare type of carcinoma. The tumor consists of glycogen-containing transparent cells and cells shaped like nails. The neoplasm has a high ability to metastasize.

Brenner's tumor

– a benign, fibroepithelial tumor with possible degeneration into a malignant formation.

Mucinous adenocarcinoma of the ovary

. A multi-chamber tumor-like neoplasm filled with mucin, a mucus-like liquid produced by the epithelial cells of the cystoma.

Mixed ovarian tumors

consist of malignant formations of different histological types.

Unclassified ovarian tumors

The clinical picture of the course of the disease, according to the international classification, is usually divided into stages (T - primary tumor, M - distant metastases):

First stage (T1, I)

characterized by the development of a neoplasm in one or both ovaries

Second stage (T2, II)

characterized by tumor spread to the uterus, tubes, or adjacent pelvic organs

Third stage (T3, III)

characterized by metastasis to the peritoneum

Fourth stage (M1)

differs from the previous ones in the presence of a tumor in distant organs

Risk factors

You are at risk for colorectal cancer if you are over 40-50 years old or if you have been diagnosed with any of the following:

• precancerous subtype of polyp
  (adenoma);
• benign polyp with a diameter of more than 1 cm;
• several polyps;
• polyp in the lower gastrointestinal tract;
• polyp that is 5 years or more old;
• dysplasia of the intestinal lining at the site of polyp removal;
• polyposis syndrome (familial adenomatous polyposis, Lynch syndrome, etc.);
• IBD ( ulcerative colitis
  or
  Crohn's disease
  );
• chronic colitis;
• papillomas and condylomas in the rectum;
• diabetes mellitus, insulin resistance, high BMI;
• weakened immunity (HIV infection, suppressive therapy);
• previous cancer that required radiation therapy to the abdominal organs;
• pathogenic mutations in genes associated with hereditary forms of colorectal cancer.

The likelihood of developing colorectal cancer is greatly influenced by quality of life. Sedentary work, low physical activity, bad habits (smoking, alcohol), poor diet low in fiber and high in animal fats, lack of sun exposure and vitamin D deficiency provoke colorectal cancer.

. It is not surprising that among residents of cloudy and rainy St. Petersburg, colorectal cancer has taken 1st place among cancer diseases.

According to the St. Petersburg Health Committee for 2021, 13.7% of all identified cases of cancer in St. Petersburg residents, regardless of gender, are colorectal cancer.

Causes and symptoms

There are no reasons that can lead to the development of cancer with 100% accuracy. Predisposing factors include miscarriages and abortions, mastopathy, obesity, and chronic gynecological diseases.

Glandular breast cancer often develops in women suffering from hormonal disorders. A long-term imbalance of female and male sex hormones in the body leads to the development of a pathological process. Long-term use of oral contraceptives and hormonal medications is also dangerous. Therefore, you cannot select birth control pills on your own; this should be done by a doctor.

At stage 1, the disease may not produce specific symptoms. They appear as the tumor grows. What you should be wary of:

• emerging breast asymmetry;
• nipple discharge;
• pain and swelling;
• enlarged lymph nodes;
• redness and roughness of the skin.

These signs are a reason to urgently visit a mammologist.

Symptoms of ovarian cancer

At the initial stage of the disease, the patient does not experience any discomfort for a long time. They appear at the moment when the malignant neoplasm reaches a significant size, and the processes of its spread to other organs begin. The progression of ovarian cancer most often occurs very quickly.

Primary manifestations of the disease can cause periodic abdominal pain, a feeling of tightness and heaviness. As ovarian cancer develops, there is an increase in weakness and fatigue, loss of appetite, a slight increase in body temperature, and dysfunction of the gastrointestinal tract. Acute, sudden pain appears associated with rupture of the ovarian capsule and subsequent inflammation around it. The patient may be concerned about an increase in the size of the abdomen due to fluid accumulating in its cavity (ascites), shortness of breath, manifestations of cardiovascular failure, swelling of the extremities, impaired urination, changes in the nature of menstruation (scanty discharge).

Colorectal cancer screening

Colorectal cancer screening

is a preventive observation of patients at risk.
Screening activities include visiting a proctologist
and collecting stool samples for testing for
occult blood
and
the tumor marker pyruvate kinase
. It's simple and cheap.

According to statistics, a banal digital rectal examination can detect the presence of a tumor and its characteristics in 70% of cases, because the rectum is just the last 15 cm of the digestive system. In women, digital rectal examination is supplemented with vaginal examination.

Fecal occult blood test

Fecal occult blood test (Gregersen test)

It is recommended to take it annually for all people over the age of 40; if the result is positive, an unscheduled colonoscopy will be required.

Fecal pyruvate kinase test

Pyruvate kinase

– an enzyme that is produced by tumor cells and is used for the early diagnosis of precancerous diseases and colon cancer.

You can take all types of tests or arrange for them to be collected at home by contacting a medical office. We collect biological material in St. Petersburg and the Leningrad region: +7 (812) 323-07-49

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