Adenocarcinoma of the Uterine Cervix

Background: Adenocarcinoma of the uterine cervix is an increasingly common cervical neoplasm that has received little attention in the primary care literature. The purpose of this paper is to describe an illustrative case that provides an excellent opportunity to review the symptoms, diagnostic pitfalls, treatment options, and prognosis of this important disease. Methods: Case report is described, along with results of a literature review using MEDLINE and pertinent references from retrieved articles. Results: The relative incidence of cervical adenocarcinoma has risen from 5 to 10 percent of all cervical neoplasms in the 1950s to 10 to 20 percent in recent series. Some studies have also reported an increasing absolute incidence linked to widespread oral contraceptive use. The diethylstilbestrol-associated clear-cell variant accounts for only 2 to 3 percent of cases. About 10 percent of patients have only a nonbloody vaginal discharge. Cervical adenocarcinoma might be more easily missed on a Papanicolaou smear than squamous cell dysplasia and cancer, and it has no characteristic colposcopic appearance. The prognosis is excellent with early detection. Conclusions: Family physicians should maintain a high index of suspicion for cervical adenocarcinoma when symptoms suggest this disease regardless of Papanicolaou smear results.