Adenocarcinoma: Yes Cervical Cancer Can Still Happen in Young Women

Background:

Woldwide efforts to reduce cervical cancer have been successful with the development and implementation of the cervical cancer/HPV vaccine. Success has been noted in the reduction throughout the United States (U.S.) with the reduction in squamous cell cervical cancers, those that account for appoximately 75%-80% of all cervical cancers. Adenocarnocinoma however has risen, and has risen notable in young reproductive age women.

Case: M. L. is a 24. year-old-female who telephoned her obstetrican complaining of break through bleeding on her oral contraceptive pill. While many healthcare providers typically reassure their patients, this provider brought the patient in for an exam. On exam, the physican, discovered a small mass protruding from the internal os of her cervix. Surprised by this finding, the physican took a small biopsy. Noting that the patient had always had all normal cervical cytology screenings. The healthcare provider was suspicious as it did not appear to be a cervical polyp. Pathology returned adenocarcioma. The patient was immediately referred to the gynecologic onology practice. Upon arrival, a full pelvic exam was performed, patient was sent for a chest, abdoment and pelvic ct scan. and scheduled for a radical hysterectomy. Ct scan demonstrated that there was a sizable tumor around her cervix and measureable nodes along the illiac chain. She underwent surgery, recovered and began a traditional course or chemotherapy for cervical cancer- Paclitaxel and Carboplatin. every 21 days for 6 courses. Premedication was given with each course and patient was sent home with antemetic therapy. The patient did well completed chemotherapy and was sent for complete pelvic radiation as she had residual lymph nodes. 2 weeks into the radiation she telephoned the office with severe abdominal pain. The nurse practitioner triaged the patient, examined the patient, patient was admitted for dehydration and a ct scan. CT scan demontrated severe lymph node invasion with pelvic seeding. Radiation was stopped and the patient was placed on palliation second line chemotherapy of Topotecan for comfort care. Hospice was consulted.

Conclusion: Adenocarcinoma is a particularly challening cancer to treat. If not caught early in the disease process can spead sporatically in the abdominal and pelvic cavity. This type of cervical cancer presents great challenges to the healthcare team. Typical treatment options for microinvasive disease are large conization procedures with conservative follow-up or hysterectomy. Invasive adenocarcioma as presented above has high rates of morbidity and mortality for women with difficulty disease courses.

Keywords: Adenocarcinoma