Adenocarcinoma

What is Adenocarcinoma?

Adenocarcinoma is a type of cancer that starts in the cells that line our body’s glands or structures similar to glands. It can develop in various areas of the body, including common areas like the breast, lung, prostate, and parts of the digestive system such as the colon, rectum, pancreas, stomach, and esophagus. It’s important to note that about 70% of cancers of unknown origin are also made up of adenocarcinomas.

What Causes Adenocarcinoma?

Various environmental and lifestyle factors contribute to the development of different types of cancers. One of the main culprits is tobacco smoking, which plays a significant role in many cancer types.

In the case of lung cancer, specifically a form called adenocarcinoma, smoking is a substantial risk. Over 90% of cases are related to smoking. Other hazards include exposure to radiation, environmental toxins like arsenic and nickel, lung scarring and diseases, and genetic factors.

Breast cancer is the most common cancer diagnosed worldwide and in the U.S. The main risks for developing breast cancer include being female, an excess of estrogen which can result from various factors, and alcohol use. Certain genetic mutations and family history can also increase the risk of this type of cancer.

For prostate cancer, age is the leading risk factor. It’s rare to find a clinical diagnosis of prostate cancer in patients under 40. Other risk factors include cigarette smoking, family history of the disease, and specific genetic mutations.

In terms of colorectal – or colon and rectal – cancer, environmental and genetic factors both play a part. Certain inherited syndromes and a family history can increase the risk, as can personal health habits such as red and processed meat consumption, tobacco use, and alcohol consumption.

Pancreatic cancer’s risk factors include smoking, high blood sugar levels, obesity, a Western diet, and alcohol use, along with long-term aspirin use. Hereditary factors can also contribute to the risk. Some studies have found associations between certain blood types and gastrointestinal cancers, including pancreatic cancer. Also, cystic fibrosis patients who have undergone a lung transplant have a higher chance of developing pancreatic cancer. The risk rises significantly with the amount of cigarette smoking.

In gastric adenocarcinoma, H. pylori – a type of stomach bacteria – is a critical risk factor. In esophageal adenocarcinoma, gastroesophageal reflux disease (GERD) and alcohol consumption are significant risks.

Risk Factors and Frequency for Adenocarcinoma

Lung cancer is the leading cause of cancer related death in men and second for women worldwide, with 40% being adenocarcinoma. The incidence of lung cancer varies between countries, largely due to differences in smoking rates. Tobacco control efforts aim to reduce this incidence in the future.

Adenocarcinoma is also common in the breast. It is the most prevalent form of cancer in women and second most common world wide. The incidence of breast cancer is higher in western countries compared to Asian and African nations. Thanks to screening measures and adjuvant therapy, the rate of death from breast cancer is decreasing.

Prostate adenocarcinoma is the second most common cancer in men worldwide and the third leading cause of death in the US. However, the mortality rate is decreasing, which is mainly due to more screening and improved treatments.

• Colorectal cancers are the third most common cancer in men and second in women.
• The incidence and mortality of colorectal cancers is slowly declining in the US.
• This form of cancer is more common in Australia, New Zealand, Europe, and North America, and less common in Africa and Southcentral Asia.
• People from lower socioeconomic groups tend to have a higher incidence of colorectal cancer.

• Pancreatic cancer is the fourth leading cause of cancer related death in both men and women, with over 85% being adenocarcinoma.
• This cancer becomes more common with age and is rare in people younger than 45. Its highest occurrence is in men aged 65 to 69 and women aged 75 to 79.
• Pancreatic cancer is most common in western countries and among high-income groups in North America, as well as Western and Central Europe. It is least common in South Asia and Central and Eastern Sub-Saharan Africa.
• In the United States, incidence appears to be higher in men, and predominantly seen in African Americans.

Signs and Symptoms of Adenocarcinoma

Adenocarcinoma is a type of cancer that can affect different organs in the body, including the breast, lung, prostate, colon and rectum, and pancreas. Because adenocarcinoma can occur in various areas, the symptoms a patient experiences will depend on which organ is affected by the tumor and if the cancer has spread to other organs. In some cases, patients might not have any symptoms, or they might experience non-specific symptoms like unintentional weight loss. Family history may also aid in diagnosing adenocarcinoma as some instances of the cancer are inherited. The most commonly impacted organs are bones, lungs, liver, and lymph nodes. Here are some usual symptoms based on the organ affected by adenocarcinoma:

• Breast Adenocarcinoma: Sudden onset of pain, nipple discharge or inversion, new persistent skin changes, and palpable breast mass.
• Lung Adenocarcinoma: Chronic dry cough, difficulty breathing, coughing up blood, weight loss, and extrapulmonary features like clubbing, periostitis of long bones, and arthritis.
• Prostate Adenocarcinoma: Difficulty urinating, weak urine stream, incomplete emptying of the bladder, blood in the urine, and chronic back pain. An enlarged prostate may also be observed during physical examination
• Colon and Rectum Adenocarcinoma: Unintentional weight loss, fatigue, generalized weakness, blood in the stool, abdominal pain, and bowel obstruction.
• Pancreatic Adenocarcinoma: Chronic pain in the upper abdomen, nausea, vomiting, jaundice, weight loss, anorexia, asthenia, steatorrhea, hepatosplenomegaly, and thrombophlebitis.

Testing for Adenocarcinoma

To determine if one has adenocarcinoma (a type of cancer), doctors perform a thorough examination and history check. They may also arrange for laboratory tests such as complete blood counts, metabolic panel, and urine analysis.

Depending on the suspected location of the cancer and whether it has spread, imaging tests may be ordered. A computed tomography (CT) scan of the chest, abdomen, and pelvis, or possibly a magnetic resonance imaging (MRI), might be used to find the main site of the cancer. In certain circumstances, gender-specific exams are conducted. For example, men might get a prostate exam and a test for a protein called PSA, particularly if there are suspicions of prostate cancer. Women might have a thorough examination for breast and pelvis regions, including a pap smear and mammogram, if there’s a suspicion of breast cancer.

In some cases, doctors might use a test called a Positron emission tomography (PET) scan which can identify the primary site of the cancer in about 40% of cases and can also help to determine how widespread the cancer is. However, a PET scan isn’t always superior to a CT scan.

For those who might have a cancer in the gastrointestinal tract, doctors might suggest procedures like a colonoscopy, upper endoscopy with endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography(ERCP). All these data points can help detect the primary tumor site. A biopsy of the suspected area will be microscopically examined and further tested to confirm adenocarcinoma.

Remember, while certain biomarkers (like CEA, CA 19-9, CA 125, etc.) aren’t reliable for diagnosis, they are useful to track how well a treatment is working or to gauge the disease’s activity on diagnosis. CA 15-3 and CA 27.29 are often used to track disease status in patients with metastatic breast cancer undergoing treatment.

Treatment Options for Adenocarcinoma

Adenocarcinomas are a type of cancer that can occur anywhere in the body. The way we deal with and treat adenocarcinoma depends on where the cancer starts (the primary site), and how advanced the cancer is (the stage of cancer). Before starting any treatment, it’s significantly important to understand where in the body the adenocarcinoma is located and what type it is.

An important aspect of addressing this condition is what we call “interprofessional care.” This means an array of professional experts such as pathologists, radiologists, surgical oncologists, radiation oncologists, and medical oncologists, along with other health specialists, become part of the treatment journey.

If the cancer is caught early, surgery can be a good option as it desires to fully remove the cancer offering the best chance for long-term survival. The chosen treatment method, however, can vary based on various factors such as where the cancer is, what type it is, how advanced it is, as well as the patient’s health status.

Treatments with the aim of curing the patient can involve surgery, chemotherapy (either before or after surgery), radiation therapy, or a blend of radiation and chemotherapy. In some cases of breast and prostate cancer, hormonal therapy may also be recommended. Once the treatment is completed, proper follow-ups are crucial. These can include regular blood tests, occasional scanning, and long term care for symptoms and survivorship.

Patients with incurable adenocarcinoma might be offered palliative treatments that aim to prolong their life and improve their quality of life. These can include chemotherapy, immunotherapy, targeted therapies, and what we call “palliative” radiation and surgery (aimed at controlling symptoms and not curing cancer).

What else can Adenocarcinoma be?

When a doctor is trying to diagnose adenocarcinoma, they must consider different possibilities based on where the cancer might be found.

• In the lung, it could be a pair of harmless lung tumours, a lung infection, small cell lung cancer, cancer spread from another location, or tuberculosis.
• In the breast, it could be a harmless lump known as fibroadenoma, a breast abscess, traumatic fat damage, breast lymphoma, or again, cancer spread from elsewhere.
• In the prostate, the doctor might consider conditions like prostatitis, a prostatic abscess, benign prostatic hyperplasia (a fancy term for an enlarged prostate), prostate sarcoma, or metastasis.
• Finally, in the colon and rectum, potential culprits could be inflammatory bowel diseases like Crohn’s or ulcerative colitis, diverticulosis (tiny pouches in your colon), intestinal lymphoma, metastasis, or carcinoid (a type of slow-growing cancer).

A thorough evaluation is necessary to diagnose accurately and opt for the best treatment options.

What to expect with Adenocarcinoma

The chances of surviving adenocarcinoma, a type of cancer, depend on the particular type and how far it has spread when diagnosed. The most crucial factor affecting a patient’s prospects is the tumor’s stage, which is determined by its size (T), whether it has spread to nearby lymph nodes (N), and whether it has spread to distant parts of the body (M). Other things that influence survival rates include the patient’s overall health, where the cancer has spread, how much cancer is in the body, and whether the patient can tolerate the treatment.

Another major factor is where in the body the adenocarcinoma originated. Data from a large-scale population-based study (SEER) shows significant differences in survival rates based on the cancer’s location:

• In lung adenocarcinoma, the 5-year survival rate is 59% if the cancer is localized, 31.7% if it is regional, and 5.8% if it has spread to distant parts.
• In breast adenocarcinoma, the 5-year survival rate is 98.9% for localized cancer, 85.7% for regional cancer, and 28.1% for cancers that have spread to distant parts.
• In prostate adenocarcinoma, the 5-year survival rate is 100% for both localized and regional cancer, and 30.2% for cancers that have spread to distant parts.
• In colorectal adenocarcinoma, the 5-year survival rate is 90.2% for localized cancer, 71.8% for regional cancer, and 14.3% for cancers that have spread to distant parts.

Possible Complications When Diagnosed with Adenocarcinoma

The complications of adenocarcinoma, a type of cancer, vary based on the location of the cancer, how far it’s spread, and how it’s being treated. There are different complications that could arise from the tumor itself, the surgery to remove it, chemotherapy, immunotherapy, and radiation therapy.

Complications related to the tumor might include:

• Pain
• General weakness
• Weight loss
• Death

Surgery to remove the tumor can cause complications like:

• Infections after surgery
• Perforation, or a hole in an organ
• Bleeding
• Problems with anesthesia

Chemotherapy complications may include:

• Pancytopenia, a decrease in blood cells
• Life-threatening complications due to weakened immune system
• Kidney and liver dysfunction
• Neuropathy, or nerve damage
• Anaphylaxis, a severe allergic reaction

Immunotherapy can lead to complications such as:

• Colitis, inflammation of the colon
• Skin rash
• Thyroiditis, inflammation of the thyroid
• Pneumonitis, inflammation of the lungs
• Psoriasis, a skin condition
• Pericarditis, inflammation of the tissue around the heart

Radiation therapy might lead to complications like:

• Inflammation of nearby organs
• Skin rash
• Neuropathies, or nerve damage
• Mucositis, inflammation of the mucus membranes
• Progression of coronary artery disease

Preventing Adenocarcinoma

When it comes to managing any kind of disease, it’s crucial to educate the patient. In the case of a cancer type called adenocarcinoma, it’s especially important for the patient to know how to identify concerning symptoms. It helps if doctors have a strong relationship with their patients, which can make it easier for patients to openly share their worries.

Patients should be taught about several key topics:

• What adenocarcinoma is
• Why it’s important to determine the stage of the adenocarcinoma
• What tests and procedures are out there to diagnose adenocarcinoma
• The risks and benefits of different treatment options, as well as their potential side effects
• Why getting care from different kinds of healthcare professionals (which is called “interdisciplinary care”) is valuable in managing adenocarcinoma, plus the role of regular health checks