Uterine Sarcoma

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Treating Uterine Sarcoma TOPICS

Treatment options for uterine sarcoma by stage

Surgery to remove the uterus, fallopian tubes, and ovaries and sample the lymph nodes is the main treatment for uterine sarcomas. Sometimes this is followed by treatment with radiation, chemotherapy (chemo), or hormone therapy. Treatments given after the cancer has been completely removed with surgery are called adjuvant treatments. Adjuvant therapy is given to help keep the cancer from coming back. This approach has helped patients with certain cancers like colon and breast cancer live longer. So far, though, adjuvant treatments for uterine sarcoma have not helped patients live longer. Since both types of uterine sarcoma are rare, it has been hard to study them well.

Women who can't have surgery because they have other health problems are may be treated with radiation, chemo, or hormone therapy. Often some combination of these other treatments is used.

Stages I and II

Leiomyosarcoma and undifferentiated sarcoma: Most women have surgery to remove the uterus, fallopian tubes and ovaries (hysterectomy and bilateral salpingo-oophorectomy). Pelvic and para-aortic lymph node dissection or laparoscopic lymph node sampling may also be done. During surgery, organs near the uterus and the peritoneum (the thin membrane that lines the pelvic and abdominal cavities) are carefully examined to determine if the cancer has spread beyond the uterus.

In young women with low-grade leiomyosarcomas (LMS) that have not spread beyond the uterus, the surgeon may—rarely--be able to leave the uterus, fallopian tubes, and ovaries in place, and instead remove only the tumor along with a rim of the normal tissue around it. This approach is not standard treatment, so it is not often offered. It may rarely be a choice for some women who want to still be able to have children after their cancer has been treated. This option has risks, however, so women considering this surgery need to discuss the possible risks and benefits with their gynecologic oncologist before making a decision. Close follow-up is important, and additional surgery may be needed if the cancer comes back.

After surgery, treatment with radiation (or sometimes chemo) may be recommended. This is called adjuvant treatment and may lower the chance that the cancer will come back in the pelvis. The goal of surgery is to remove all of the cancer, but the surgeon can only remove what can be seen. Tiny clumps of cancer cells that are too small to be seen can be left behind. Treatments given after surgery are meant to kill those cancer cells so that they don't get the chance to grow into larger tumors.

For LMS of the uterus, adjuvant radiation may lower the chance of the cancer growing back in the pelvis (called local recurrence), but it doesn't seem to help women live longer.

Since the cancer can still come back in the lungs or other distant organs, some experts recommend giving chemo after surgery (adjuvant chemotherapy) for stage II cancers. Chemo is sometimes recommended for stage I LMS as well, but it is less clear that it is really helpful. So far, results from studies of adjuvant chemotherapy have been promising in early stage LMS, but long-term follow-up is still needed to see if this treatment really helps women live longer. Studies of adjuvant therapy are still in progress. For anyone being treated for uterine LMS, entering a clinical trial is always a good option.

Endometrial stromal sarcoma: Early stage endometrial stromal sarcoma is treated with surgery: hysterectomy and bilateral salpingo-oophorectomy. Pelvic lymph nodes may be removed as well. After surgery, most patients do not need further treatment. These women are watched closely for signs that the cancer has returned. Some doctors give radiation to the pelvis, hormone therapy, or both to lower the chances of the cancer coming back, but this has not been shown to improve survival.

Patients who are too sick (from other medical conditions) to have surgery may be treated with radiation and/or hormone therapy.

Stage III

For all types of uterine sarcoma, surgery is done to remove all of the cancer. This includes a hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection or sampling. If the tumor has spread to the vagina (stage IIIB), part (or even all) of the vagina will need to be removed as well. Treatment after surgery depends on the type of sarcoma.

Adjuvant treatment with radiation (with or without chemo) may be offered for leiomyosarcomas and undifferentiated sarcomas.

Women with endometrial stromal sarcomas might receive radiation, hormone therapy, or both after surgery.

Patients who are too sick (from other medical conditions) to have surgery may be treated with radiation, chemo, and/or hormone therapy.

Stage IV

Stage IV is divided into stage IVA and stage IVb.

Stage IVA cancers have spread to nearby organs and tissues, such as the bladder or rectum. These cancers may be able to be completely removed with surgery, and this is is usually done if possible. If the cancer cannot be removed completely, radiation may be given, either alone or with chemo.

Stage IVB cancers have spread outside of the pelvis, most often to the lungs, liver, or bone. There is currently no standard treatment for these cancers. Chemo may be able to shrink the tumors for a time, but is not thought to be able to cure the cancer. Radiation therapy may also be an option. For endometrial stromal sarcomas, hormone therapy may help for a time.

Women with stage IV uterine sarcomas might consider taking part in clinical trials (scientific studies of promising treatments) testing new chemo or other treatments.

Recurrent uterine sarcoma

If a cancer comes back after treatment, it is called recurrent. If the cancer comes back in the same area as it was in the first place, it is called a local recurrence. For uterine sarcoma, the cancer growing back as a tumor in the pelvis would be a local recurrence. If it comes back in another area like the liver or lungs, it is called a distant recurrence.

Unfortunately, uterine sarcoma often comes back in the first few years after treatment. Treatment options are the same as those for stage IV. If the cancer can be removed, surgery may be done. Radiation may be used to reduce the size of the tumor and relieve the symptoms of large pelvic tumors. Sarcoma often comes back as spread to the lungs. If there are only 1 or 2 small tumors, these may be able to be removed with surgery. Some patients have been cured by this treatment.

Last Medical Review: 01/22/2013
Last Revised: 02/12/2014