Uterine Sarcomas
In the US, uterine sarcoma is rare; 5058 cases of uterine sarcomas were estimated to occur in 2018. Uterine sarcomas account for about 8% of all uterine cancers.
Risk factors for uterine sarcomas are
Uterine sarcomas include
Rare uterine mesenchymal sarcoma subtypes include
Carcinosarcomas used to be categorized as sarcomas but are now considered and treated as high-grade epithelial tumors (carcinomas).
High-grade uterine sarcomas tend metastasize hematogenously, most often to the lungs; lymph node metastases are uncommon.
Symptoms and Signs
Diagnosis
Symptoms suggesting uterine sarcoma usually prompt transvaginal ultrasonography and endometrial biopsy or fractional D & C. However, these tests have limited sensitivity. Endometrial stromal sarcoma and uterine leiomyosarcoma are often incidentally diagnosed histologically after hysterectomy or myomectomy.
If cancer is identified preoperatively, CT or MRI is typically done. If uterine sarcoma is diagnosed after surgical removal, imaging is recommended, and surgical re-exploration can be considered.
Screening for hereditary nonpolyposis colorectal cancer (Lynch syndrome) is not usually done when patients have uterine sarcoma; in contrast, such screening is done when patients have endometrial cancer.
Staging
Staging is done surgically (see tables FIGO Surgical Staging of Uterine Sarcoma: Leiomyosarcoma and Endometrial Stromal Sarcoma and FIGO Surgical Staging of Uterine Sarcoma: Adenosarcoma).
FIGO Surgical Staging of Uterine Sarcoma: Leiomyosarcoma and Endometrial Stromal Sarcoma
|
Stage |
Description |
|
I |
Limited to the uterus |
|
Tumor ≤ 5 cm in largest dimension |
|
|
Tumor > 5 cm |
|
|
II |
Extending beyond the uterus but within the pelvis |
|
Involving the adnexa |
|
|
Involving other pelvic tissues |
|
|
III |
Infiltrating abdominal tissues |
|
In one site |
|
|
> 1 site |
|
|
Regional lymph node metastasis |
|
|
IVA |
Invading bladder or rectum |
|
IVB |
Distant metastases |
|
Adapted from staging established by the International Federation of Gynecology and Obstetrics (FIGO) and American Joint Committee on Cancer (AJCC), AJCC Cancer Staging Manual, ed. 8. New York, Springer, 2017. (See also National Cancer Institute: Uterine Sarcoma Treatment.) |
|
FIGO Surgical Staging of Uterine Sarcoma: Adenosarcoma
|
Stage |
Description |
|
I |
Limited to the uterus |
|
Limited to the endometrium and/or endocervix |
|
|
Invading less than half the myometrium |
|
|
Invading more than half the myometrium |
|
|
II |
Extending beyond the uterus but within the pelvis |
|
Involving the adnexa |
|
|
Involving other pelvic tissues |
|
|
III |
Infiltrating abdominal tissues |
|
In one site |
|
|
> 1 site |
|
|
Metastasis to regional lymph nodes |
|
|
IVA |
Invading the bladder or rectum |
|
IVB |
Distant metastases |
|
*Based on staging established by the International Federation of Gynecology and Obstetrics (FIGO) and American Joint Committee on Cancer (AJCC), AJCC Cancer Staging Manual, ed. 8. New York, Springer, 2017. (See also National Cancer Institute: Uterine Sarcoma Treatment.) |
|
Prognosis
Prognosis is generally poorer than that with endometrial cancer of similar stage; survival is generally poor when the cancer has spread beyond the uterus. Histology is not an independent prognostic factor.
In one study, 5-year survival rates were
Most commonly, the cancer recurs locally, in the abdomen, or the lungs.
Treatment
Treatment of uterine sarcomas is total abdominal hysterectomy and bilateral salpingo-oophorectomy.
Uterine sarcomas should be removed en bloc; morcellation is contraindicated. If a specimen is fragmented during surgery, imaging is recommended, and re-exploration can be considered. Treatment with chemotherapy is also recommended.
The ovaries may be preserved in certain patients with early-stage uterine leiomyosarcoma if they wish to retain hormonal function. Additional surgical resection should be based on intraoperative findings.
The usefulness of lymphadenectomy in patients with leiomyosarcoma or endometrial stromal sarcoma is controversial; no therapeutic value has been shown.
For inoperable sarcomas, pelvic radiation therapy with or without brachytherapy and/or systemic therapy is recommended.
Adjuvant radiation therapy is typically used and appears to delay local recurrence but does not improve overall survival rate.
Chemotherapy drugs are typically used when tumors are advanced or recur; drugs vary by tumor type.
Combination chemotherapy regimens are recommended:
Overall, response to chemotherapy is poor.
Hormone therapy is used for patients with endometrial stromal sarcoma or hormone receptor–positive uterine leiomyosarcoma. Progestins are frequently effective. Hormone therapy includes
Key Points
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Uterine sarcomas are uncommon.
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Symptoms include abnormal vaginal bleeding, a mass in the vagina. pelvic pain, a feeling of fullness in the abdomen, and frequent urination.
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Prognosis is generally worse than that with endometrial cancer of similar stage.
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Treat most patients with total abdominal hysterectomy and bilateral salpingo-oophorectomy.
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Use hormone therapy for patients with endometrial stroma sarcoma and hormone receptor–positive leiomyosarcomas.
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Treat inoperable sarcomas with radiation therapy and/or chemotherapy.
Drugs Mentioned In This Article
| Drug Name | Select Trade |
|---|---|
Medroxyprogesterone |
PROVERA |
vinorelbine |
NAVELBINE |
gemcitabine |
GEMZAR |
dacarbazine |
DTIC-DOME |
ifosfamide |
IFEX |
Tamoxifen |
NOLVADEX |
Docetaxel |
TAXOTERE |
Megestrol |
MEGACE |
