Uterine Sarcoma
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.
Uterine sarcoma is a very rare kind of cancer that
forms in the uterine muscles or in tissues that support the uterus. Uterine
sarcoma is different from cancer of the endometrium, a disease in which cancer
cells start growing inside the lining of the uterus.
Being exposed to x-rays can increase the risk of developing 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.
People who think they may be at risk should discuss this with their doctor. Risk
factors for uterine sarcoma include the following:
- Past treatment with radiation therapy to the pelvis.
- Treatment with tamoxifen for breast cancer. A patient taking this drug
should have a pelvic exam every year and report any vaginal bleeding (other
than menstrual bleeding) as soon as possible.
Possible signs of uterine sarcoma include abnormal bleeding.
Abnormal bleeding from the vagina and other symptoms
may be caused by uterine sarcoma. Other conditions may cause the same symptoms.
A doctor should be consulted if any of the following problems occur:
- 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. The doctor or nurse inserts one or two lubricated,
gloved fingers of one hand into the vagina and the other hand is placed over
the lower abdomen to feel the size, shape, and position of the uterus and
ovaries. A speculum is also inserted into the vagina and the doctor or nurse
looks at the vagina and cervix for signs of disease. A Pap test or Pap smear
of the cervix is usually done. The doctor or nurse also inserts a
lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
- 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.
- Dilatation and curettage: Surgery to remove samples of tissue or the
inner lining of the uterus. The cervix is dilated and a curette
(spoon-shaped instrument) is inserted into the uterus to remove tissue.
Tissue samples may be taken and checked under a microscope for signs of
disease. This procedure is also called a D&C.
- 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
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:
- 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.
- 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.
- 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.
- 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 in the organ or tissue that makes it.
- 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.
- 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.
- Sigmoidoscopy: A procedure to look inside the rectum and sigmoid
(lower) colon for polyps, abnormal areas, or cancer. A sigmoidoscope is
inserted through the rectum into the sigmoid colon. A sigmoidoscope is a
thin, tube-like instrument with a light and a lens for viewing. It may also
have a tool to remove polyps or tissue samples, which are checked under a
microscope for signs of cancer.
- Barium enema: A series of x-rays of the lower gastrointestinal
tract. A liquid that contains barium (a silver-white metallic compound) is
put into the rectum. The barium coats the lower gastrointestinal tract and
x-rays are taken. This procedure is also called a lower GI series.
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.
- 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.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and
travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and
travels through the blood to other places in the body.
When cancer cells break away from the primary
(original) tumor and travel through the lymph or blood to other places in the
body, another (secondary) tumor may form. This process is called metastasis. The
secondary (metastatic) tumor is the same type of cancer as the primary tumor.
For example, if breast cancer spreads to the bones, the cancer cells in the
bones are actually breast cancer cells. The disease is metastatic breast cancer,
not bone 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 stage IA, stage IB,
and stage IC, based on how far the cancer has spread.
- Stage IA: Cancer is in the endometrium only.
- Stage IB: Cancer has spread into the inner half of the myometrium
(muscle layer of the uterus).
- Stage IC: Cancer has spread into the outer half of the myometrium.
Stage II
In stage II, cancer has spread from the uterus to the cervix. Stage II is divided into stage IIA
and stage IIB, based on how far the cancer has spread.
- Stage IIA: Cancer has spread to the glands where the cervix and uterus meet.
- Stage IIB: Cancer has spread into the connective tissue of the cervix.
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 stage
IIIA and stage IIIB, based on how far the cancer has spread within the pelvis.
- Stage IIIA: Cancer has spread to one or more of the following:
--the outermost layer of the uterus; and/or
--tissues just beyond the uterus; and/or
--the peritoneum.
- Stage IIIB: Cancer has spread to lymph nodes in the pelvis and/or near the uterus.
Stage IV
In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into stage IVA and
stage IVB, based on how far the cancer has spread.
- Stage IVA: Cancer has spread to the lining of the bladder and/or bowel.
- Stage IVB: Cancer has spread to other parts of the body beyond the
pelvis, including lymph nodes in the abdomen and/or 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 or
in other parts of the body.
Treatment Option Overview
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.
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
spinal column, 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 Web site.
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.
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. This is sometimes called re-staging.
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
For some types or stages of cancer, there may not be
any trials listed. Check with your doctor for clinical trials that are not
listed here but may be right for you.
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.
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.
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.
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.
Check for U.S. clinical trials from NCI's PDQ Cancer
Clinical Trials Registry that are now accepting patients with 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. General information about clinical trials is available from the NCI Web site.
For more information from the NCI, please write to this address:
NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
U.S. residents may call the National Cancer Institute's (NCI's)
Cancer Information Service toll-free at 1.800.4.CANCER (1.800.422.6237) Monday
through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with
TTY equipment may call 1.800.332.8615.
Information about ongoing clinical trials is available from the NCI Web site.
Source: National Institutes of Health; National Cancer Institute
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