What is Adenomyosarcoma and How is it Treated?
Adenomyosarcoma is a rare type of cancer that affects the uterus. It is also known as uterine adenosarcoma. It is composed of two types of cells: benign epithelial cells and malignant stromal cells. The epithelial cells are similar to the cells that line the uterus, while the stromal cells are the connective tissue cells that support the uterus. Adenomyosarcoma can grow into the muscle layer of the uterus, which is called adenomyoma, or into the blood vessels, which is called adenofibroma.
Adenomyosarcoma is a rare cancer, accounting for less than 5% of all uterine sarcomas. It usually affects women in their 50s and 60s, but it can also occur in younger or older women. The exact cause of adenomyosarcoma is unknown, but some risk factors may include previous radiation therapy to the pelvis, exposure to certain chemicals or hormones, or genetic mutations. The most common symptoms of adenomyosarcoma are abnormal vaginal bleeding, pelvic pain, or a palpable mass in the lower abdomen.
The diagnosis of adenomyosarcoma is based on a biopsy of the tumor tissue, which can be obtained by a dilation and curettage (D&C) procedure or a hysterectomy (removal of the uterus). The biopsy can show the characteristic features of adenomyosarcoma, such as the presence of both epithelial and stromal components, and the degree of malignancy of the stromal cells. The stromal cells can be classified as low-grade or high-grade, depending on how fast they grow and how abnormal they look. If the stromal cells occupy more than 25% of the tumor volume, it is called sarcomatous overgrowth, which indicates a more aggressive behavior and a worse prognosis.
The treatment of adenomyosarcoma depends on several factors, such as the stage of the disease, the grade of the stromal cells, the presence or absence of sarcomatous overgrowth, and the patient’s age and general health. The main treatment option is surgery, which aims to remove the entire tumor and any surrounding tissue that may be affected. This may include a hysterectomy, a salpingo-oophorectomy (removal of the fallopian tubes and ovaries), or a pelvic lymph node dissection (removal of the lymph nodes in the pelvis). Surgery can cure most cases of early-stage adenomyosarcoma without sarcomatous overgrowth.
However, some cases of adenomyosarcoma may require additional treatment after surgery, such as chemotherapy or radiation therapy. Chemotherapy is the use of drugs that kill cancer cells or stop them from growing. Radiation therapy is the use of high-energy rays that damage cancer cells or prevent them from dividing. These treatments can help reduce the risk of recurrence or metastasis (spread) of adenomyosarcoma, especially in cases with high-grade stromal cells or sarcomatous overgrowth. However, there is no clear evidence that these treatments improve survival rates for adenomyosarcoma patients.
The prognosis of adenomyosarcoma varies depending on several factors, such as the stage of the disease, the grade of the stromal cells, the presence or absence of sarcomatous overgrowth, and the response to treatment. In general, adenomyosarcoma has a better prognosis than other types of uterine sarcomas, but it still has a high risk of recurrence or metastasis. The 5-year overall survival rate for adenomyosarcoma patients ranges from 40% to 80%, depending on these factors.
Adenomyosarcoma is a rare and complex type of uterine cancer that requires specialized care and follow-up. If you have any symptoms or concerns related to adenomyosarcoma, you should consult your doctor as soon as possible.