Uterine Sarcoma Treatment
General Information(Symptoms and Diagnosis)
Stages
Treatment
General Information About Uterine Sarcoma
Key Points
- Uterine sarcoma is a disease in which malignant (cancer)
cells form in the muscles of the uterus or other tissues that support
the uterus.
- Being exposed to x-rays can increase the risk of uterine
sarcoma.
- Signs of uterine sarcoma include abnormal bleeding.
- Tests that examine the uterus are used to detect (find) and
diagnose uterine sarcoma.
- Certain factors affect prognosis (chance of recovery) and
treatment options.
Uterine
sarcoma is a disease in which malignant (cancer) cells form in the
muscles of the uterus or other tissues that support the uterus.
The uterus is part of the female
reproductive system.
The uterus is the hollow, pear-shaped organ
in the pelvis,
where a fetus
grows. The cervix
is at the lower, narrow end of the uterus, and leads to the vagina.
Anatomy of the female
reproductive system. The organs in the female reproductive system
include the uterus, ovaries, fallopian tubes, cervix, and vagina. The
uterus has a muscular outer layer called the myometrium and an inner
lining called the endometrium.
Uterine sarcoma is a very
rare kind of cancer
that forms in the uterine muscles or in tissues
that support the uterus. (Information about other types of sarcomas can be found in the
PDQ summary on Adult
Soft Tissue Sarcoma Treatment.) Uterine sarcoma is different from
cancer of the endometrium,
a disease in which cancer cells
start growing inside the lining of the uterus. (See the PDQ summary on
Endometrial Cancer Treatment for information).
Being
exposed to x-rays can increase the risk of uterine sarcoma.
Anything that increases
your risk of getting a disease is called a risk
factor. Having a risk factor does not mean that you will
get cancer; not having risk factors doesn't mean that you will not get
cancer. Talk with your doctor if you think you may be at risk. Risk
factors for uterine sarcoma include the following:
- Past treatment with radiation
therapy to the pelvis.
- Treatment with tamoxifen
for breast cancer.
If you are taking this drug,
have a pelvic exam
every year and report any vaginal
bleeding (other than menstrual
bleeding) as soon as possible.
Signs
of uterine sarcoma include abnormal bleeding.
Abnormal bleeding from the
vagina and other signs
and symptoms may be
caused by uterine sarcoma or by other conditions.
Check with your doctor if you have any of the following:
- Bleeding that is not part of menstrual
periods.
- Bleeding after menopause.
- A mass
in the vagina.
- Pain or a feeling of fullness in the abdomen.
- Frequent urination.
Tests
that examine the uterus are used to detect (find) and diagnose uterine
sarcoma.
The following tests and
procedures may be used:
- Physical
exam and history
: An exam of the body to check general signs of
health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patient's health
habits and past illnesses and treatments will also be taken.
- Pelvic exam: An exam of the
vagina, cervix, uterus, fallopian
tubes, ovaries,
and rectum. A speculum is inserted into
the vagina and the doctor or nurse
looks at the vagina and cervix for signs of disease. A Pap test of the cervix is
usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers
of one hand into the vagina and places the other hand over the lower
abdomen to feel the size, shape, and position of the uterus and
ovaries. The doctor or nurse also inserts a lubricated, gloved finger
into the rectum to feel for lumps or abnormal areas.
Pelvic exam. A doctor
or nurse inserts one or two lubricated, gloved fingers of one hand into
the vagina and presses on the lower abdomen with the other hand. This
is done to feel the size, shape, and position of the uterus and
ovaries. The vagina, cervix, fallopian tubes, and rectum are also
checked.
- Pap test: A procedure to
collect cells from the surface of the cervix and vagina. A piece of
cotton, a brush, or a small wooden stick is used to gently scrape cells
from the cervix and vagina. The cells are viewed under a microscope to find out if
they are abnormal. This procedure is also called a Pap smear. Because
uterine sarcoma begins inside the uterus, this cancer may not show up
on the Pap test.
Pap test. A speculum is
inserted into the vagina to widen it. Then, a brush is inserted into
the vagina to collect cells from the cervix. The cells are checked
under a microscope for signs of disease.
- Transvaginal
ultrasound exam: A procedure used to
examine the vagina, uterus, fallopian tubes, and bladder. An ultrasound transducer
(probe) is inserted into the vagina and used to bounce high-energy
sound waves (ultrasound)
off internal tissues or organs and make echoes. The echoes form a
picture of body tissues called a sonogram.
The doctor can identify tumors
by looking at the sonogram.
Transvaginal
ultrasound. An ultrasound probe connected to a computer is inserted
into the vagina and is gently moved to show different organs. The probe
bounces sound waves off internal organs and tissues to make echoes that
form a sonogram (computer picture).
- Dilatation
and curettage : A procedure to remove
samples of tissue from the inner lining of the uterus. The cervix is dilated and a curette (spoon-shaped
instrument) is inserted into the uterus to remove tissue. The tissue
samples are checked under a microscope for signs of disease. This
procedure is also called a D&C.
Dilatation and
curettage (D and C). A speculum is inserted into the vagina to widen it
in order to look at the cervix (first panel). A dilator is used to
widen the cervix (middle panel). A curette is put through the cervix
into the uterus to scrape out abnormal tissue (last panel).
- Endometrial
biopsy : The removal of tissue from the
endometrium (inner lining of the uterus) by inserting a thin, flexible
tube through the cervix and into the uterus. The tube is used to gently
scrape a small amount of tissue from the endometrium and then remove
the tissue samples. A pathologist
views the tissue under a microscope to look for cancer cells.
Certain
factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment
options depend on the following:
- The stage
of the cancer.
- The type and size of the tumor.
- The patient's general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
Stages of Uterine Sarcoma
Key Points
- After uterine sarcoma has been diagnosed, tests are done
to find out if cancer cells have spread within the uterus or to other
parts of the body.
- Uterine sarcoma may be diagnosed, staged, and treated in
the same surgery.
- There are three ways that cancer spreads in the body.
- Cancer may spread from where it began to other parts of the
body.
- The following stages are used for uterine sarcoma:
- Stage I
- Stage II
- Stage III
- Stage IV
After uterine sarcoma has been diagnosed, tests are done to find out if
cancer cells have spread within the uterus or to other parts of the
body.
The process used to find
out if cancer has
spread within the uterus
or to other
parts of the body is called staging.
The information gathered from the
staging process determines the stage
of the disease. It is important to know
the stage in order to plan treatment. The following
procedures may be used in the staging process:
- Blood
chemistry studies : A procedure in which a
blood sample is
checked to measure the amounts of certain substances released into the
blood by organs and
tissues in the
body. An unusual (higher or lower than normal) amount of a substance
can be a sign of
disease.
- CA
125 assay
: A test that measures the level of CA 125 in the
blood. CA 125 is a substance released by cells
into the bloodstream. An increased CA 125 level is sometimes a sign of
cancer or other condition.
- Chest
x-ray : An x-ray
of the organs and bones inside the chest. An x-ray is a type of energy
beam that can go through the body and onto film, making a picture of
areas inside the body.
- Transvaginal
ultrasound exam: A procedure used to
examine the vagina,
uterus, fallopian tubes,
and bladder. An ultrasound transducer
(probe) is inserted into the vagina and used to bounce high-energy
sound waves (ultrasound)
off internal tissues or organs and make echoes. The echoes form a
picture of body tissues called a sonogram.
The doctor can identify tumors
by looking at the sonogram.
Transvaginal
ultrasound. An ultrasound probe connected to a computer is inserted
into the vagina and is gently moved to show different organs. The probe
bounces sound waves off internal organs and tissues to make echoes that
form a sonogram (computer picture).
- CT
scan (CAT scan): A procedure that makes a
series of detailed pictures of areas inside the body, such as the abdomen and pelvis, taken from different
angles. The pictures are made by a computer linked to an x-ray machine.
A dye may be injected into a vein or swallowed to help
the organs or tissues to show up more clearly. This procedure is also
called computed tomography, computerized tomography, or computerized
axial tomography.
- Cystoscopy
: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted
through the urethra into the bladder. A cystoscope is a thin, tube-like
instrument with a light and a lens
for viewing. It may also have a tool to remove tissue samples, which
are checked under a microscope
for signs of cancer.
Cystoscopy. A
cystoscope (a thin, tube-like instrument with a light and a lens for
viewing) is inserted through the urethra into the bladder. Fluid is
used to fill the bladder. The doctor looks at an image of the inner
wall of the bladder on a computer monitor.
Uterine
sarcoma may be diagnosed, staged, and treated in the same surgery.
Surgery is used to diagnose, stage, and treat uterine sarcoma. During this
surgery, the doctor removes as much of the cancer as possible. The
following procedures may be used to diagnose, stage, and treat uterine
sarcoma:
- Laparotomy:
A surgical
procedure in which an incision
(cut) is made in the wall of the abdomen to check the inside of the
abdomen for signs of disease. The size of the incision depends on the
reason the laparotomy is being done. Sometimes organs are removed or
tissue samples are taken and checked under a microscope for signs of
disease.
- Abdominal
and pelvic
washings: A procedure in which a saline
solution is placed into the abdominal and pelvic body cavities. After a short
time, the fluid is
removed and viewed under a microscope to check for cancer cells.
- Total abdominal
hysterectomy: A surgical procedure to remove the uterus
and cervix through
a large incision (cut) in the abdomen.
Hysterectomy. The
uterus is surgically removed with or without other organs or tissues.
In a total hysterectomy, the uterus and cervix are removed. In a total
hysterectomy with salpingo-oophorectomy, (a) the uterus plus one
(unilateral) ovary and fallopian tube are removed; or (b) the uterus
plus both (bilateral) ovaries and fallopian tubes are removed. In a
radical hysterectomy, the uterus, cervix, both ovaries, both fallopian
tubes, and nearby tissue are removed. These procedures are done using a
low transverse incision or a vertical incision.
- Bilateral
salpingo-oophorectomy: Surgery to remove both ovaries and both fallopian
tubes.
- Lymphadenectomy:
A surgical procedure in which lymph
nodes are removed and checked under a microscope for signs
of cancer. For a regional
lymphadenectomy, some of the lymph nodes in the tumor area
are removed. For a radical
lymphadenectomy, most or all of the lymph nodes in the
tumor area are removed. This procedure is also called lymph node
dissection.
Treatment in addition to
surgery may be given, as described in the Treatment Option Overview
section of this summary.
There
are three ways that cancer spreads in the body.
Cancer can spread
through tissue, the
lymph system, and
the blood:
- Tissue. The cancer spreads from where it began by growing
into nearby areas.
- Lymph system. The cancer spreads from where it began by
getting into the lymph system. The cancer travels through the lymph vessels to other parts
of the body.
- Blood. The cancer spreads from where it began by getting
into the blood. The cancer travels through the blood vessels to other parts
of the body.
Cancer
may spread from where it began to other parts of the body.
When cancer spreads
to another part of the body, it is called metastasis.
Cancer cells break
away from where they began (the primary
tumor) and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system,
travels through the lymph vessels, and forms a tumor (metastatic tumor) in another
part of the body.
- Blood. The cancer gets into the blood, travels through the
blood vessels, and forms a tumor (metastatic tumor) in another part of
the body.
The metastatic tumor is
the same type of cancer as the primary tumor. For example, if uterine
sarcoma spreads to the lung,
the cancer cells in the lung are actually uterine sarcoma cells. The
disease is metastatic uterine sarcoma, not lung cancer.
The
following stages are used for uterine sarcoma:
Stage
I
In stage I, cancer is found in the uterus only. Stage I is
divided into stages IA and IB, based on how far the cancer has spread.
- Stage IA:
Cancer is in the endometrium
only or less than halfway through the myometrium
(muscle layer of the uterus).
- Stage IB:
Cancer has spread halfway or more into the myometrium.
Stage
II
In stage II, cancer has spread into connective tissue of the cervix, but has not spread
outside the uterus.
Stage
III
In stage III, cancer has spread beyond the
uterus and cervix, but has not spread
beyond the pelvis.
Stage III is divided into stages IIIA, IIIB, and IIIC, based on how far
the cancer has spread within the pelvis.
- Stage IIIA:
Cancer has spread to the outer layer of the uterus
and/or to the fallopian tubes,
ovaries, and
ligaments of the uterus.
- Stage IIIB:
Cancer has spread to the vagina
or to the parametrium
(connective tissue
and fat around the uterus).
- Stage IIIC:
Cancer has spread to lymph nodes
in the pelvis
and/or around the aorta
(largest artery in
the body, which carries blood
away from the heart).
Stage
IV
In stage IV, cancer has spread beyond the
pelvis. Stage IV is
divided into stages IVA and IVB, based on how far the cancer has spread.
- Stage IVA:
Cancer has spread to the bladder
and/or bowel wall.
- Stage IVB:
Cancer has spread to other parts of the body beyond the pelvis, including the abdomen and/or lymph nodes in the groin.
Recurrent Uterine Sarcoma
Recurrent uterine sarcoma is cancer that has recurred
(come back) after it has been treated. The cancer may come back in the uterus, the pelvis, or in other parts of
the body.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
uterine sarcoma.
- Four types of standard treatment are used:
- Surgery
- Radiation therapy
- Chemotherapy
- Hormone therapy
- New types of treatment are being tested in clinical
trials.
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
There
are different types of treatment for patients with uterine sarcoma.
Different types of
treatments are available for patients with uterine
sarcoma. Some treatments are standard
(the currently used treatment), and some are being tested in clinical trials. A treatment
clinical trial is a research
study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When clinical trials
show that a new treatment is better than the standard treatment, the
new treatment may become the standard treatment. Patients may want to
think about taking part in a clinical trial. Some clinical trials are
open only to patients who have not started treatment.
Four
types of standard treatment are used:
Surgery
Surgery is the most common
treatment for uterine sarcoma, as described in the Stages of Uterine
Sarcoma section of this summary.
Even if the doctor
removes all the cancer that can be seen at the time of the surgery,
some patients may be given chemotherapy
or radiation therapy
after surgery to kill any cancer cells
that are left. Treatment given after the surgery, to lower the risk
that the cancer will come back, is called adjuvant
therapy.
Radiation
therapy
Radiation therapy is a
cancer treatment that uses high energy x-rays
or other types of radiation
to kill cancer cells or keep them from growing. There are two types of
radiation therapy:
- External radiation
therapy uses a machine outside the body to send radiation
toward the cancer.
- Internal radiation
therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters
that are placed directly into or near the cancer.
The way the radiation
therapy is given depends on the type and stage
of the cancer being treated. External and internal radiation therapy
are used to treat uterine sarcoma, and may also be used as palliative therapy to
relieve symptoms
and improve quality of life.
Chemotherapy
Chemotherapy is a cancer
treatment that uses drugs
to stop the growth of cancer cells, either by killing the cells or by
stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs
enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When
chemotherapy is placed directly into the cerebrospinal
fluid, an organ,
or a body cavity
such as the abdomen,
the drugs mainly affect cancer cells in those areas (regional chemotherapy). The
way the chemotherapy is given depends on the type and stage of the
cancer being treated.
Hormone
therapy
Hormone therapy is a cancer
treatment that removes hormones
or blocks their action and stops cancer cells from growing. Hormones
are substances produced by glands
in the body and circulated in the bloodstream. Some hormones can cause
certain cancers to grow. If tests show the cancer cells have places
where hormones can attach (receptors),
drugs, surgery, or radiation therapy is used to reduce the production
of hormones or block them from working.
New types of treatment are being tested in clinical trials.
Information about
clinical trials is available from the NCI website.
Patients
may want to think about taking part in a clinical trial.
For some patients,
taking part in a clinical trial
may be the best treatment choice. Clinical trials are part of the
cancer research process. Clinical trials are done to find out if new
cancer treatments are safe and effective or better than the standard treatment.
Many of today's
standard treatments for cancer are based on earlier clinical trials.
Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take
part in clinical trials also help improve the way cancer will be
treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and
help move research forward.
Patients
can enter clinical trials before, during, or after starting their
cancer treatment.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring (coming back) or
reduce the side effects
of cancer treatment.
Clinical trials are
taking place in many parts of the country. See the Treatment Options
section that follows for links to current treatment clinical trials.
These have been retrieved from NCI's
listing of clinical trials.
Follow-up
tests may be needed.
Some of the tests
that were done to diagnose
the cancer or to find out the stage
of the cancer may be repeated. Some tests will be repeated in order to
see how well the treatment is working. Decisions about whether to
continue, change, or stop treatment may be based on the results of
these tests.
Some of the tests
will continue to be done from time to time after treatment has ended.
The results of these tests can show if your condition
has changed or if the cancer has recurred
(come back). These tests are sometimes called follow-up tests or check-ups.
Treatment Options by Stage
Stage I Uterine Sarcoma
Treatment of stage I uterine sarcoma may
include the following:
- Surgery
(total abdominal hysterectomy,
bilateral
salpingo-oophorectomy, and lymphadenectomy).
- Surgery followed by radiation
therapy to the pelvis.
- Surgery followed by chemotherapy.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage I uterine sarcoma. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage II Uterine Sarcoma
Treatment of stage II uterine sarcoma may
include the following:
- Surgery
(total abdominal hysterectomy,
bilateral
salpingo-oophorectomy, and lymphadenectomy).
- Surgery followed by radiation
therapy to the pelvis.
- Surgery followed by chemotherapy.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage II uterine sarcoma. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage III Uterine Sarcoma
Treatment of stage III uterine sarcoma
may include the following:
- Surgery
(total abdominal hysterectomy,
bilateral
salpingo-oophorectomy, and lymphadenectomy).
- A clinical trial
of surgery followed by radiation
therapy to the pelvis.
- A clinical trial of surgery followed by chemotherapy.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage III uterine sarcoma. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Stage IV Uterine Sarcoma
There is no
standard treatment
for patients with
stage IV
uterine sarcoma. Treatment may include a
clinical trial using
chemotherapy.
Treatment Options for Recurrent Uterine Sarcoma
There is no standard treatment for recurrent uterine sarcoma. Treatment
may include a clinical trial
using chemotherapy.
For patients with
recurrent carcinosarcoma
(a certain type of tumor),
treatment may include the following:
- Radiation therapy
as palliative therapy
to relieve symptoms
(such as pain, nausea,
or bowel problems)
and improve the quality of life.
- Hormone therapy.
- A clinical trial of a new treatment.
-NIH
