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Uterine Sarcoma

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What is sarcoma of the uterus?

Sarcoma of the uterus, a very rare kind of cancer in women, is a disease in which cancer (malignant) 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 tumor cells are growing, and the patientfs 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.

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Treatment Option Overview

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 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.

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fs 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.

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Stage I Uterine Sarcoma

Treatment may be one of the following:

  1. 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)

  2. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection, followed by radiation therapy to the pelvis.

  3. Surgery followed by chemotherapy.

  4. Surgery followed by radiation therapy.

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Stage II Uterine Sarcoma

Treatment may be one of the following:

  1. 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)

  2. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection, followed by radiation therapy to the pelvis.

  3. Surgery followed by chemotherapy.

  4. Surgery followed by radiation therapy.

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Stage III Uterine Sarcoma

Treatment may be one of the following:

  1. 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.

  2. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection, followed by radiation therapy to the pelvis.

  3. Surgery followed by chemotherapy.

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Stage IV Uterine Sarcoma

Treatment will usually be a clinical trial using chemotherapy.

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Recurrent Uterine Sarcoma

If the cancer has come back (recurred), treatment may be one of the following:

  1. Clinical trials of chemotherapy or hormone therapy.
  2. External radiation therapy to relieve symptoms such as pain, nausea, or abnormal bowel functions.

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Uterine Sarcoma