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Treatment for Uterine Sarcoma by Type
The main treatment for early-stage uterine sarcoma is surgery to remove the uterus, sometimes along with the fallopian tubes and ovaries. But based on their type and stage, uterine sarcomas are often treated differently. Learn how different types of uterine sarcoma might be treated.
Because uterine sarcoma is rare, it has been hard to study it well. Most experts agree that treatment in a clinical trial should be considered for any type or stage of uterine sarcoma when available.
Leiomyosarcoma and undifferentiated sarcoma
Most people with these diagnoses have a hysterectomy (surgery to remove the uterus) and a bilateral salpingo-oophorectomy or BSO (surgery to remove the fallopian tubes and ovaries). The ovaries might not be removed in people who are still having regular menstrual cycles.
Lymph node surgery might be done if swollen nodes are seen on imaging tests or during the operation. During surgery, organs and membranes near the uterus are checked to see if the cancer has spread outside the uterus.
After surgery
Stage I: After surgery, most people with stage I cancer don't need more treatment. These women can be observed over time for any signs that the cancer has returned.
Stage II or III: People with stage II or III cancers that were completely removed (negative margins) might also be observed after surgery with no further treatment, but are offered additional treatment (adjuvant) if cancer can’t be completely removed with surgery or has a high risk of coming back. This could include chemotherapy (chemo), targeted therapy, or immunotherapy, with or without radiation.
Stage IV: People with stage IVA or IVB cancers are often treated with chemotherapy, targeted therapy, or immunotherapy, with or without radiation.
Endometrial stromal sarcoma (ESS)
Low- and high-grade ESS are managed similarly, but there are some key differences in treatments available. Surgery is an important part of managing all early-stage ESS.
Early-stage low-grade ESS is commonly treated with hysterectomy and BSO surgeries. People who are still having regular menstrual cycles might be given the option of keeping their ovaries.
Pelvic lymph nodes might be removed if they look swollen on imaging tests or feel abnormal during the operation, but this has not been shown to help women live longer.
After surgery
Stage I: After surgery, most people with stage I cancer don't need more treatment. They can be observed over time for any signs that the cancer has returned.
Stage II-IV: People with stage II–IV cancers might be treated with hormone therapy and sometimes radiation to the pelvis. These treatments can lower the chances of the cancer coming back, but they have not been shown to help people live longer. This type of uterine sarcoma does not respond well to chemo, and it's not often used in initial treatment.
Early-stage high-grade ESS is also commonly treated with hysterectomy and BSO surgeries. Sometimes, people who are still having regular menstrual cycles might be given the option of keeping their ovaries, but this is not standard practice and has not been studied as much in high-grade ESS compared with low-grade ESS.
Pelvic lymph nodes might be removed if they look swollen on imaging tests or feel abnormal during the operation, but this has not been shown to help women live longer.
After surgery
Stage I: After surgery, most people with stage I cancer don't need more treatment. They can be observed over time for any signs that the cancer has returned.
Stage II or III: People with stage II or III cancers that were completely removed (negative margins) might also be observed after surgery with no further treatment. They will likely be offered additional treatment (adjuvant) if cancer can’t be completely removed with surgery or has a high risk of coming back. This could include chemo, targeted therapy, immunotherapy, or radiation treatments.
Stage IV: People with stage IVA or IVB cancers are often treated with systemic medicines like chemotherapy, targeted therapy, or immunotherapy, with or without radiation.
Adenosarcoma
Adenosarcoma treatment depends on the grade and presence or absence of sarcomatous overgrowth, which is when more than 25% of the cancer is made up of sarcoma cells. Tumors with sarcomatous overgrowth are typically more aggressive.
People with this type of adenosarcoma tend to get treatments similar to people with low-grade ESS.
Adenosarcoma without sarcomatous overgrowth is commonly treated with hysterectomy and BSO surgeries. It is not known if preserving the ovaries is safe in people with adenosarcoma. Pelvic lymph nodes might be removed if they look swollen on imaging tests or feel abnormal during the operation, but this is not done routinely.
After surgery
Stage I: After surgery, most people with stage I cancer don't need more treatment. They can be observed over time for any signs that the cancer has returned.
Stage II–IV: People with stage II–IV cancers might be treated with hormone therapy and sometimes radiation to the pelvis to lower the chances of the cancer coming back. This type of uterine sarcoma does not respond well to chemo, and it's not often used in initial treatment.
Adenosarcoma with sarcomatous overgrowth is commonly treated with hysterectomy and BSO surgeries. It is not known if preserving the ovaries is safe in people with adenosarcoma.
Pelvic lymph nodes might be removed if they look swollen on imaging tests or feel abnormal during the operation, but this is not done routinely.
After surgery
Stage I: After surgery, most people with stage I cancer don't need more treatment. They can be closely observed over time for any signs that the cancer has returned.
Stage II–IV: People with stage II– IV cancers, especially those where the cancer was not completely removed with surgery are often given treatments including chemotherapy, targeted therapy, or immunotherapy, with or without radiation.
Very few clinical studies have included people with adenosarcoma, so it is not clear if one treatment is better than another. Discuss with your doctor if clinical trials might be an option for you.
Recurrent uterine sarcoma
If a cancer comes back after treatment, it's called recurrent cancer. If it comes back in the same place as it was before, it's called a local recurrence. For uterine sarcoma, the cancer growing back in the pelvis would be a local recurrence. If it comes back in another part of the body, like the liver or lungs, it's called a distant recurrence.
If uterine sarcoma recurs, it often comes back in the first few years after treatment.
Treatment options
Treatment options for recurrent uterine sarcoma are the same as those for stage IV cancers. If the cancer can be removed, surgery might be done. If not already given, radiation might be used to reduce the size of the tumor and relieve the symptoms of large pelvic tumors.
Chemotherapy, targeted drug therapy, immunotherapy, or hormone therapy might be options when uterine sarcoma recurs, depending on the type of uterine sarcoma and prior treatments used.
If uterine sarcoma comes back, you might want to discuss with your doctor if clinical trials might be an option for you.
Your cancer care team might also recommend adding palliative or supportive care specialists to your care team. These professionals specialize in helping to alleviate symptoms from cancer and its treatment and help people manage feelings about their cancer coming back.
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- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
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Last Revised: June 9, 2026
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