Uterine Sarcoma
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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 patientfs
general state of health.
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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:
Cancer is found only in the main part of the uterus
(it is not found in the cervix).
Cancer cells have spread to the cervix.
Cancer cells have spread outside the uterus but
have not spread outside the pelvis.
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 disease means that the cancer has come
back (recurred) after it has been treated.
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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 of sarcoma of the uterus depends on the
stage and cell type of the disease, and the patientfs 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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Treatment may be one of the following:
- 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)
- Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node
dissection, followed by radiation therapy to the pelvis.
- Surgery followed by chemotherapy.
- Surgery followed by radiation therapy.
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Treatment may be one of the following:
- 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)
- Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node
dissection, followed by radiation therapy to the pelvis.
- Surgery followed by chemotherapy.
- Surgery followed by radiation therapy.
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Treatment may be one of the following:
- 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.
- Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node
dissection, followed by radiation therapy to the pelvis.
- Surgery followed by chemotherapy.
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Treatment will usually be a clinical trial using
chemotherapy.
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If the cancer has come back (recurred), treatment
may be one of the following:
- Clinical trials of chemotherapy or hormone therapy.
- External radiation therapy to relieve symptoms such as pain, nausea, or abnormal
bowel functions.
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Abnormal Vaginal Bleeding
