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Adenocarcinoma is a malignant tumor originating from the glandular epithelium, commonly found in organs such as salivary glands and lungs, and belongs to a highly malignant type of cancer. Its pathological features are acinar, papillary, or solid growth patterns, often accompanied by mucus secretion, which needs to be identified by special staining. According to tissue morphology, it can be divided into three types: adenocarcinoma, mucinous carcinoma, and simple carcinoma. Adenocarcinoma often presents as invasive growth, easily invading blood vessels and lymphatic vessels, leading to hematogenous and lymphatic metastasis. Clinical symptoms include irritating coughing, bloody sputum, chest pain, and compression symptoms (such as diaphragmatic paralysis and pleural effusion). Distant metastasis is common in areas such as the brain, bones, and liver, causing corresponding organ dysfunction. Diagnosis requires a combination of tissue biopsy and immunohistochemical analysis to distinguish primary cancer from metastatic cancer.
Figure 1. Adenocarcinoma.
Adenocarcinoma is a type of lung cancer that is least associated with smoking and accounts for 40% of primary lung tumors. Often located in the peripheral part of the lungs, it also affects the pleura and forms related scar circles and pleural effusion. The theory that peripheral adenocarcinoma occurs in scar areas associated with tuberculosis, infarction, or other lesions has been around for a long time. The concept of scar cancer suggests that changes in the pre cancerous lesion epithelium in the scar area can cause cancer. However, some researchers suggest that scars are secondary to cancer. Adenocarcinoma is a malignant tumor of the glandular epithelium, which can have acini, papillae, bronchioles, alveoli, or solid growth patterns. It is often accompanied by mucus production, and detecting mucus requires special staining, especially in poorly differentiated tumors. The detection of mucus can sometimes distinguish between solid adenocarcinoma and large cell carcinoma with similar morphological manifestations.
The overall shape of the tumor is round or oval, with most cases having no capsule but incomplete. The texture is of moderate hardness, and the cut surface is gray white.
Microscopically, the tumor cells exhibit obvious atypia and diverse structures. Some are arranged in solid masses or small cord like structures, some have visible glandular cavity formation, and some are arranged in tubular or glandular like structures. It is generally believed that those with glandular like structures have a higher degree of differentiation and a lower degree of malignancy. The amount of connective tissue between small strands and clumps is uncertain, and many of them are similar to hard cancer. Soft cancer can be referred to as having less stroma and more cancer cells.
Biological characteristics: Adenocarcinoma has highly invasive and destructive growth characteristics. Adenocarcinoma is prone to invade the walls of blood vessels and lymphatic vessels, resulting in a higher incidence of hematogenous and lymphatic metastasis.
The timing of the onset of symptoms of adenocarcinoma mainly depends on the location of the tumor. Adenocarcinoma often presents with stubborn and irritating coughing, sputum with blood spots or a small amount of blood streaks, chest pain or tightness, and excessive phlegm. If the tumor is large, compression symptoms may occur, such as ipsilateral diaphragmatic paralysis (compression of the phrenic nerve), pleural dyspnea (invasion of the pleura), head and face swelling, venous distension (compression of the superior vena cava), limb numbness, facial sweating, edema, eyelid ptosis (compression of the brachial plexus nerve).
| Symptoms | Details |
| Distant metastasis manifestations | The most common metastatic sites of adenocarcinoma are the brain, bone, liver, and adrenal gland. Patients with brain metastases may experience intracranial hypertension and localization symptoms, mainly including headache, vomiting, blurred vision, dizziness, unilateral limb weakness, ataxia, etc. Patients with bone metastasis may experience local pain, fractures, and hypercalcemia. |
| Coughing | Over the age of 40, unexplained and stubborn irritating coughing is often an early precursor to adenocarcinoma, especially in the central type, which is caused by spasmodic contraction of the trachea due to the stimulation of cancer tumors. Therefore, the disclosure of precursor signals in central type lung cancer is much earlier than in peripheral type lung cancer. Chest pain and stabbing pain are also early signals, characterized by sharp stabbing pain, often appearing earlier in undifferentiated lung cancer. |
| Hemoptysis | It is an early signal of central lung cancer, due to the rich distribution of blood vessels in the tracheal mucosa, but with very few blood vessels. Peripheral lung cancer, due to its distance from the trachea, usually appears later with hemoptysis. Adenocarcinoma of the lung may present with unexplained low-grade fever, especially intermittent fever (reported to account for 70%), which should be taken seriously. Report symptoms of irritating coughing, changes in cough patterns of primary bronchitis, or persistent stubborn cough that persists for more than three weeks (ineffective treatment). |
Due to the invasive growth of adenocarcinoma, extensive and extensive resection should be performed. The lymph node metastasis rate of adenocarcinoma is relatively high, up to 36% to 47%. Radical or selective neck lymph node dissection should be performed simultaneously with the removal of the primary lesion. For the treatment of the facial nerve, regardless of whether facial nerve paralysis occurs or not, sacrificing the facial nerve is necessary to completely remove the tumor. Frozen tissue pathology sections should be used during surgery to check for residual tumor cells at the surgical edge. Adenocarcinoma is not sensitive to radiation and should not be treated with radiotherapy alone, but adjuvant therapy after surgery may also improve the efficacy. For those who are not suitable for surgery in the late stage, palliative radiotherapy has a certain control effect, but cannot achieve the goal of cure. Adjuvant chemotherapy can also be used after surgery.
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