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, 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, chemotherapy, 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 is recommended for most patients. 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 rarelybe 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 (sometimes with chemo) may be recommended. This treatment 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. When chemotherapy or radiation is used after surgery like this, it is called adjuvant therapy.

For LMS of the uterus, most studies have found that adjuvant radiation can reduce the risk of 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 using adjuvant chemotherapy. 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 survival is really improved. 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 (ESS) is treated with surgery - hysterectomy, bilateral salpingo-oophorectomy, and lymph node removal. 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 either type of uterine sarcoma, surgery is done to remove all of the cancer. This includes a hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection. 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.

Women with endometrial stromal sarcomas might receive radiation, hormonal treatment, or both after surgery.

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

Stage IV:

There is currently no standard treatment for these cancers. If the cancer can be completely removed with surgery, this is usually done. If the cancer cannot be removed completely, radiation may be given, either alone or with chemotherapy. Women with stage IV uterine sarcomas might consider taking part in clinical trials (scientific studies of promising treatments) testing new chemotherapy or other treatments. Preliminary studies have found that chemotherapy drugs can shrink some uterine sarcomas but usually cannot cure these cancers. For endometrial stromal sarcomas, hormone therapy and/or radiation may be helpful.

Recurrent uterine sarcoma:

If a cancer comes back after treatment it is called recurrent cancer. 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: 11/18/2009
Last Revised: 11/18/2009