Treatment for Uterine Sarcoma, by Type and Stage

Surgery to remove the uterus, sometimes along with the fallopian tubes and ovaries and to check the lymph nodes, is the main treatment for all uterine sarcomas. Sometimes this is followed by treatment with radiation, chemotherapy (chemo), or hormone therapy. Targeted therapy may also be used in advanced cancers.

Treatments given after the cancer has been completely removed with surgery are called adjuvant treatments. Adjuvant therapy is used 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, the value of adjuvant treatments for uterine sarcoma isn't clear.

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

Because uterine sarcoma is rare, it's 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. This way women can get the best treatment available now and may also get the treatments that are thought to be even better.

Leiomyosarcoma and undifferentiated sarcoma

Stages I and II

Most women have surgery to remove the uterus (hysterectomy), as well as the fallopian tubes and ovaries (bilateral salpingo-oophorectomy). Pelvic and para-aortic lymph node dissection or laparoscopic lymph node sampling may be done if swollen nodes are seen on imaging tests. During surgery, organs near the uterus and the thin membrane that lines the pelvic and abdominal cavities (called the peritoneum) are closely checked to see if the cancer has spread beyond the uterus.

Very rarely, young women with low-grade leiomyosarcomas (LMS) that have not spread beyond the uterus may be able to have just the tumor removed, leaving the uterus, fallopian tubes, and ovaries in place. This is not standard treatment, little is known about long-term outcomes , and it's not often offered. Still, it may be a choice for some women who want to be able to have children after cancer treatment. This option has risks, so women thinking about this surgery need to talk about the pros and cons with their treatment team before making a decision. It may also be possible to leave a young woman’s ovaries in place (but remove the uterus and fallopian tubes), since it isn’t clear that this will lead to worse outcomes. Again, this is not a standard treatment, and you should discuss the risks and benefits with your doctor. In either case, close follow-up is important, and morel surgery may be needed if the cancer comes back.

Women with stage I cancers may not need more treatment and are watched closely after surgery. In other cases, treatment with radiation, with or without chemo, may be needed after surgery if there's a high chance of the cancer coming back in the pelvis. This is called adjuvant treatment. The goal of surgery is to take out 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's less clear that it's really helpful. So far, results from studies of adjuvant chemo 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 in progress.

Stage III

Surgery is done to remove all of the cancer. This includes removing the uterus (a hysterectomy), removing both fallopian tubes and ovaries (bilateral salpingo-oophorectomy), and lymph node dissection or sampling. If the tumor has spread to the vagina, part (or even all) of the vagina will need to be removed as well.

After surgery, treatment with radiation (with or without chemo) may be offered to lower the chance that the cancer will come back.

Women who are too sick (from other medical problems) to have surgery may be treated with radiation and/or chemo.

Stage IV

This is divided into stage IVA and stage IVb.

Stage IVA cancers have spread to nearby organs and tissues, such as the bladder or rectum, and maybe to nearby lymph nodes. These cancers might be able to be completely removed with surgery, and this 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 the pelvis, most often to the lungs, liver, or bone. There's 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, given along with chemo, may also be an option.

These cancers might also be treated with targeted therapy when other treatments don't work. They're often given along with chemo.

Endometrial stromal sarcoma

Stages I and II

Early stage endometrial stromal sarcoma is treated with surgery: hysterectomy and bilateral salpingo-oophorectomy. (This means removal of the uterus, both fallopian tubes. and both ovaries.) Some young women may be given the option of keeping their ovaries, but this is not the standard treatment. Pelvic lymph nodes may be removed if they look swollen on imaging tests.

After surgery, most women don't need more treatment. These women are watched closely for signs that the cancer has returned. Others may be treated with hormone therapy and sometimes radiation to the pelvis. These can lower the chances of the cancer coming back, but they have not been shown to help patients live longer. This type of uterine sarcoma does not respond well to chemo, and it's not often used at these early stages.

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

Stage III

Surgery is done to remove all of the cancer. This includes removing the uterus (a hysterectomy), as well as removing both fallopian tubes and ovaries (bilateral salpingo-oophorectomy). Lymph nodes may checked if they look swollen. If the tumor has spread to the vagina, part (or even all) of the vagina will need to be removed too.

Women with endometrial stromal sarcomas might get radiation, hormone therapy, or both after surgery. Chemo may be used if other treatments don't work.

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

Stage IV

This stage 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 usually done if possible. If the cancer cannot be removed completely, radiation may be given, either alone or with chemo. Hormone therapy is also an option.

Stage IVB cancers have spread outside of the pelvis, most often to the lungs, liver, or bone. Hormone therapy can help for a time. Chemo and radiation are also options to help ease symptoms.

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 as a tumor 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.

Uterine sarcoma often comes back in the first few years after treatment.

Treatment options for recurrent uterine sarcoma are the same as those for stage IV. If the cancer can be removed, surgery may be done. If not already given, radiation may be used to reduce the size of the tumor and relieve the symptoms of large pelvic tumors. Easing symptoms caused by cancer is called palliative or supportive care.

Sarcoma often comes back in the lungs. If there are only 1 or 2 small tumors, these may be able to be removed with surgery. Chemo and/or radiation are options after surgery. They may also be used for distant recurrence that can't be taken out with surgery.

Women with recurrent uterine sarcomas might want to take part in clinical trials (scientific studies of promising treatments) testing new chemo or other treatments.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: October 12, 2017 Last Revised: November 13, 2017

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