Uterine Sarcoma: Symptoms & Treatment
Overview
Uterine sarcoma is a rare type of uterine cancer which starts in the muscle and supporting tissues of the uterus (womb). Another type of uterine cancer is endometrial cancer which is more common than uterine sarcomas.
Uterine sarcoma is a rare disease which means it affects less than 0.2 million people in America. According to a study, the incidence of unexpected gynecologic malignant neoplasm was 2.7%, including uterine sarcoma was 0.2%.
Types
Most uterine sarcomas can be divided into three types, based on the type of cell they start in.
Uterine leiomyosarcoma (LMS)
This type of sarcomas arises from the muscular wall of the uterus and can grow and spread fast. This is the most common type currently.
Endometrial stromal sarcoma (ESS)
ESS is a rare type which arises from the supporting connective tissue of the endometrium.
Low-grade ESS grows slowly and has a better outlook than others. High-grade ESS is often found when it is growing quickly and/or has spread. High-grade ESS is very hard to treat.
Undifferentiated sarcoma
This type of sarcomas may arise from endometrium or myometrium. Undifferentiated sarcoma usually grows and spread very fast and have a poor outlook.
Causes & Risk Factors
The exact cause of uterine sarcoma is unknown currently, while some factors may be related to uterine sarcoma, including:
- Pelvic radiation therapy
- Race: African-American women have a higher risk of getting the condition than white or Asian women
- RB gene changes
Symptoms
Some symptoms of uterine sarcomas may include:
- Abnormal discharges
- Feeling a mass
- Vaginal bleeding after menopause
- Bleeding between periods
- Pelvic pain
Diagnosis
Many uterine sarcomas are diagnosed during or after the surgery, which are often thought to be benign fibroid tumors. Generally, doctors will ask your medical history, family history ,and symptoms, they will give you a pelvic exam. If doctor suspects cancer, you may need some more tests:
- Sampling and testing endometrial tissue
- Endometrial biopsy
- Hysteroscopy
- Dilation and curettage (D&C)
- Testing endometrial tissue
If your doctor suspects your cancer has spread, you may need the following tests:
- Cystoscopy and proctoscopy
- Transvaginal ultrasound
- CT scans or CT-guided needle biopsy
- MRI
- Positron emission tomography scan (PET)
- Chest x-ray
Stages of Uterine Sarcoma
Treatment
Your treatment for uterine sarcoma usually depends on your health condition, the type and stage of your cancer. There are five choices of treatment: surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy.
Generally, most women with uterine sarcomas have surgery to remove sarcomas. Radiation, chemotherapy, and hormone therapy are usually used to lower the risk of recurrence after the surgery. These three treatment options can also be used for patients who cannot have surgery.
Surgery
Surgery is the main treatment for uterine sarcomas. The goal of surgery is to remove all of the cancer cells, which usually means removing the whole uterus (hysterectomy). In some cases, the fallopian tubes, ovaries, and part of the vagina may also need to be removed. Specific surgeries may include:
- Hysterectomy: the type of hysterectomy usually depends on the range that cancer has spread
- Bilateral salpingo-oophorectomy
- Lymph node surgery
Other options may be used to cancer that has spread to other areas of the body:
- Omentectomy
- Peritoneal biopsies
- Pelvic washings
- Tumor debulking
Radiation Therapy
Radiation therapy uses high-energy radiation (such as x-rays) to kill cancer cells.
- Brachytherapy (also called internal radiation therapy)
- External beam radiation therapy
Sometimes both brachytherapy and external beam radiation therapy are used, depending on the condition of cancer.
Chemotherapy
Chemotherapy gives cancer-fighting drugs into a vein or muscle, or take drugs orally so that the drugs can enter the blood and run in the whole body. It can treat cancer that has spread beyond the uterus and can be used combined with surgery.
Drugs can be used in chemotherapy may include:
- Dacarbazine
- Docetaxel
- Doxorubicin
- Liposomal doxorubicin
- Epirubicin
- Gemcitabine
- Ifosfamide
- Paclitaxel
- Temozolomide
- Trabectedin
- Vinorelbine
Hormone Therapy
This therapy can treat cancer that has spread beyond the uterus. Hormone therapy uses hormones or hormone-blocking drugs to stop cancer cells from growing. It is mainly used to treat ESS and rarely used to treat other types of uterine sarcomas. Drugs can be used in hormone therapy may include:
- Progestins
- Gonadotropin-releasing hormone (GNRH) agonists
- Aromatase inhibitors
Targeted Therapy
Targeted therapy uses drugs that target cancer cells. This makes most healthy cell left and has fewer side effects than chemotherapy. Targeted therapy can be used for many kinds of cancer, but it is still a very new area in uterine sarcomas treatment. At present, only a few drugs are used in this therapy, including:
- Panzopinab: it can be used to treat leiomyosarcoma that has spread or come back after treatment.
- Olaratumab: it can be used with the chemo drug doxorubicin to treat uterine sarcomas which are not responding to other treatments.
Please consult your doctors for your symptoms and treatment.
Keywords: uterine sarcoma; uterine cancer.
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