Sarcoma of the uterus
Sarcoma of the uterus, a very rare kind of cancer in women, is a disease
in which cancer cells start growing in the muscles or other supporting
tissues of the uterus. The uterus is the hollow, pear-shaped organ where a
baby grows. Sarcoma of the uterus is different from cancer of the
endometrium, a disease in which cancer cells start growing in the lining of
the uterus.
Women who have received therapy with high-dose x-rays (external-beam
radiation therapy) to their pelvis are at a higher risk to develop sarcoma
of the uterus. These x-rays are sometimes given to women to stop bleeding
from the uterus.
A doctor should be seen if there is bleeding after menopause (the time
when a woman no longer has menstrual periods) or bleeding that is not part
of menstrual periods.
Sarcoma of the uterus usually begins after menopause.
If there are signs of cancer, a doctor will do certain tests to check for
cancer, usually beginning with an internal (pelvic) examination. During the
examination, the doctor will feel for any lumps or changes in the shapes of
the pelvic organs. The doctor may then do a Pap test, using a piece of
cotton, a small wooden stick, or brush to gently scrape the outside of the
cervix (the opening of the uterus) and the vagina to pick up cells. Because
sarcoma of the uterus begins inside, this cancer will not usually show up on
the Pap test. The doctor may also do a dilation and curettage (D & C) by
stretching the cervix and inserting a small, spoon-shaped instrument into
the uterus to remove pieces of the lining of the uterus. This tissue is then
checked under a microscope for cancer cells.
The prognosis (chance of recovery) and choice of treatment depend on the
stage of the sarcoma (whether it is just in the uterus or has spread to
other places), how fast the tumour cells are growing, and the patient’s
general state of health.
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Stages of sarcoma of the uterus
Once sarcoma of the uterus has been found, more tests will be done to find
out if the cancer has spread from the uterus to other parts of the body
(staging). A doctor needs to know the stage of the disease to plan treatment.
The following stages are used for sarcoma of the uterus:
Stage I
Cancer is found only in the main part of the uterus (it is not found in the
cervix).
Stage II
Cancer cells have spread to the cervix.
Stage III
Cancer cells have spread outside the uterus but have not spread outside the
pelvis.
Stage IV
Cancer cells have spread beyond the pelvis, to other body parts, or into the
lining of the bladder (the sac that holds urine) or rectum.
Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has
been treated.
How sarcoma of the uterus is treated
There are treatments for all patients with sarcoma of the uterus. Four kinds
of treatment are used:
- Surgery (taking out the cancer in an operation).
- Radiation therapy (using high-dose x-rays or other high-energy
rays to kill cancer cells and shrink tumors).
- Chemotherapy (using drugs to kill cancer cells).
- Hormone therapy (using female hormones to kill cancer cells).
Surgery is the most common treatment of sarcoma of the uterus. A doctor may
take out the cancer in an operation to remove the uterus, fallopian tubes and
the ovaries, along with some lymph nodes in the pelvis and around the aorta (the
main vessel in which blood passes away from the heart). The operation is called
a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and
lymphadenectomy. (The lymph nodes are small bean-shaped structures that are
found throughout the body. They produce and store infection-fighting cells, but
may contain cancer cells.)
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells
and shrink tumours. Radiation therapy for sarcoma of the uterus usually comes
from a machine outside the body (external radiation). Radiation may be used
alone or in addition to surgery.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by
pill, or it may be put into the body by a needle in a vein or a muscle.
Chemotherapy is called a systemic treatment because the drugs enter the
bloodstream, travel through the body, and can kill cancer cells outside the
uterus.
Hormone therapy uses female hormones, usually taken by pill, to kill cancer
cells.
Treatment by stage
Treatment of sarcoma of the uterus depends on the stage and cell type of the
disease, and the patient’s age and overall condition.
Standard treatment may be considered because of its effectiveness in patients
in past studies, or participation in a clinical trial may be considered. Not all
patients are cured with standard therapy and some standard treatments may have
more side effects than are desired. For these reasons, clinical trials are
designed to find better ways to treat cancer patients and are based on the most
up-to-date information.
Stage I Uterine Sarcoma
Treatment may be one of the following:
- Surgery to remove the uterus, fallopian tubes and the ovaries,
and some of the lymph nodes in the pelvis and abdomen (total abdominal
hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection)
- Total abdominal hysterectomy, bilateral salpingo-oophorectomy,
and lymph node dissection, followed by radiation therapy to the pelvis.
- Surgery followed by chemotherapy.
- Surgery followed by radiation therapy.
Stage II Uterine Sarcoma
Treatment may be one of the following:
- Surgery to remove the uterus, fallopian tubes and the ovaries,
and some of the lymph nodes in the pelvis and abdomen (total abdominal
hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection)
- Total abdominal hysterectomy, bilateral salpingo-oophorectomy,
and lymph node dissection, followed by radiation therapy to the pelvis.
- Surgery followed by chemotherapy.
- Surgery followed by radiation therapy.
Stage III Uterine Sarcoma
Treatment may be one of the following:
- Surgery to remove the uterus, fallopian tubes and the ovaries,
and some of the lymph nodes in the pelvis and abdomen (total abdominal
hysterectomy bilateral salpingo-oophorectomy, and lymph node dissection).
Doctors will also try to remove as much of the cancer that has spread to
nearby tissues as possible.
- Total abdominal hysterectomy, bilateral salpingo-oophorectomy,
and lymph node dissection, followed by radiation therapy to the pelvis.
- Surgery followed by chemotherapy.
Stage IV Uterine Sarcoma
Treatment will usually be a clinical trial using chemotherapy.
Recurrent Uterine Sarcoma
If the cancer has come back (recurred), treatment may be one of the
following:
- Clinical trials of chemotherapy or hormone therapy.
- External radiation therapy to relieve symptoms such as pain,
nausea, or abnormal bowel functions.
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