UTERINE SARCOMA

What is UTERINE SARCOMA?

Sarcoma of the uterus, a very rare kind of cancer in women, is a disease in which cancer (malignant) cells grow in the muscles or other supporting tissues of the uterus. The uterus is the hollow, pear-shaped organ where a baby develops. Only about 1-2 percent of uterine cancers are sarcoma. The majority (95 percent) are endometrial cancers, which develop in the lining of the uterus.

There are three types of uterine sarcomas:

Uterine carcinosarcomas develop in the endometrium and are the most common of the three types.
Endometrial stromal sarcomas are tumors in the connective tissue of the endometrium and are the rarest of the three types.
Uterine leiomyosarcomas are cancers in the muscular wall of the uterus.

UTERINE SARCOMA Risk Factors

The American Cancer Society estimates that about 40,100 women in the United States will be diagnosed with uterine cancer in 2008. Only about 1-2 percent of these cancers will be uterine sarcomas.
Women who have received therapy with high-dose X-rays (external beam radiation therapy) to their pelvis have an increased risk of developing sarcoma of the uterus later. High-dose X-rays are sometimes given to women to stop bleeding from the uterus.

Other risk factors may include the following:
Age: Middle-aged and older women are more likely than younger women to develop uterine sarcomas. The disease is most commonly diagnosed after menopause.

Race: African American women are more likely than whites or Asian Americans to develop leiomyosarcomas, which are cancers in the muscular wall of the uterus.

Hormonal risk factors: Uterine carcinosarcomas develop more frequently in women who have risk factors for endometrial cancer, such as obesity, estrogen replacement therapy, infertility, diabetes, late onset of menstruation or late onset of menopause, or treatment with tamoxifen.

Since there are few risk factors for uterine sarcomas and their cause is not yet well understood, most cases of the disease cannot be prevented.

UTERINE SARCOMA Symptoms

The symptoms of uterine sarcoma may vary depending on the type of sarcoma, and sometimes there are few symptoms in the early stages. The most common symptom of the disease is bleeding after menopause (the time when a woman no longer has menstrual periods) or bleeding that is not part of menstrual periods.

A woman should see a doctor if she experiences:

post-menopausal bleeding,
spotting between periods,
abnormal discharge without any visible blood, or pelvic pain

Although these symptoms may be caused by other conditions or problems, they should be evaluated.

If a woman has symptoms of uterine sarcoma, her 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 shape of the pelvic organs.

The doctor may also do a Pap test. Using a piece of cotton, a small wooden stick, or brush, the doctor gently scrapes the outside of the cervix (the opening of the uterus) and the vagina to pick up cells. Because sarcoma of the uterus begins inside the uterus, this cancer will not usually show up on the Pap test.

The doctor may want to 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. The tissue is then checked under a microscope for cancer cells.

The prognosis (chance of recovery) and choice of treatment for uterine sarcoma depend on the stage of the sarcoma (whether it is just in the uterus or has spread to other places), how fast the tumor cells are growing, and the patient’s general state of health.

UTERINE SARCOMA Stages

If a patient is diagnosed with uterine sarcoma, more tests will be done to find out if the cancer has spread from the uterus to other parts of the body. This process, called staging, helps the doctor to plan treatment.

The following stages are used to describe 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.

UTERINE SARCOMA Treatment Options and Side Effects

There are four primary treatments for patients with sarcoma of the uterus:

1. surgery
2. radiation therapy
3. chemotherapy
4. hormone therapy

Surgery	Surgery is the most common treatment of sarcoma of the uterus. Several types of surgery may be considered, depending on the type, location, and stage of the sarcoma, and may include one or more of the following operations: a hysterectomy (removal of the uterus), a bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries), and a lymphadenectomy (removal of some of the lymph nodes in the pelvis and around the aorta). Side effects of surgery: Recovery from a hysterectomy may take from two to six weeks (with a three- to seven-day hospitalization), depending on the type of hysterectomy performed. After a hysterectomy, a woman is no longer able to have children. If her ovaries have also been removed, she will enter menopause if she has not already done so.
Radiation Therapy	Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. 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. Side effects of radiation: The side effects of external beam radiation include fatigue; skin irritation, infection, and discoloration; and diarrhea. Radiation to the pelvic area can also cause irritation to the bladder, narrowing of the vagina due to scar tissue, and premature menopause.
Chemotherapy	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. Side effects of chemotherapy: Chemotherapy drugs generally target rapidly dividing cancer cells. However, other cells that also divide rapidly include blood cells, cells that line the digestive tract, and cells in hair follicles. Unfortunately, these healthy cells may also be impacted by the chemotherapy drugs, resulting in side effects such as infections, tiredness, temporary hair loss, mouth or vaginal sores, changes in the menstrual cycle, and infertility. Not all chemotherapy patients develop all of these symptoms, and they usually go away during the recovery period or after treatment stops. Medicines and other treatments are available to control or minimize many of these symptoms.
Hormone Therapy	Hormone therapy is the use of hormones, usually taken by pill, to kill cancer cells. It is used to change the way hormones in the body help cancers grow. This approach is not often used for uterine sarcomas.

(information from UMGCC - http://www.umgcc.org/gyn_program/us.htm)