Cervical Adenocarcinoma in the Shadows: The Impact of Missed Screening

Cervical adenocarcinoma is a rising concern in women's health, particularly due to its increasing incidence among younger women and its ability to evade early detection through conventional cytology-based screening. Unlike squamous cell carcinoma, adenocarcinoma often arises higher in the endocervical canal, making it more challenging to detect, especially in patients who default on cervical screening. We report the case of a 39-year-old British lady who presented with severe anemia secondary to heavy vaginal bleeding. She had never attended cervical screening despite living in a country with an established national screening program. Clinical examination revealed a friable cervical mass. Initial investigations revealed profound microcytic hypochromic anemia requiring urgent transfusion. Imaging with CT demonstrated a bulky, irregular cervix with suspicious pelvic lymphadenopathy, while MRI confirmed a large cervical mass (7.4 × 6.5 × 6.0 cm) with parametrial extension and para-aortic nodal disease, consistent with International Federation of Gynecology and Obstetrics (FIGO) Staging stage IIIC2 cervical carcinoma. Histopathology revealed Human Papillomavirus (HPV)-associated adenocarcinoma, Silva pattern C, with strong carcinoembryonic antigen (CEA) positivity and no lymphovascular invasion. Following multidisciplinary team review, the patient was referred for definitive chemoradiotherapy. This case illustrates how defaulted cervical screening can result in delayed diagnosis and advanced disease, even within high-resource healthcare systems. It highlights the diagnostic challenges specific to adenocarcinoma, the limitations of Pap smear in detecting glandular lesions, and the importance of HPV-based screening and public education to improve participation. Early recognition of abnormal bleeding and systematic evaluation with MRI and histopathology are crucial for timely diagnosis and management.