Endometrial stromal sarcoma

Endometrial Stromal Sarcoma (ESS) is a rare form of uterine cancer that originates in the connective tissue or stroma that forms the bulk of the endometrium, the inner lining of the uterus. This type of cancer is characterized by its slow growth and tendency to recur, often many years after the initial diagnosis and treatment. ESS represents a small fraction of all uterine sarcomas, which themselves are a rare group of uterine cancers.

Classification

Endometrial stromal sarcomas are classified into two main types based on their behavior and specific characteristics: low-grade and high-grade.

• Low-grade Endometrial Stromal Sarcoma (LGESS) is less aggressive, with cells that look somewhat similar to normal endometrial stromal cells and tend to grow slowly.
• High-grade Endometrial Stromal Sarcoma (HGESS), previously known as undifferentiated endometrial sarcoma, is more aggressive, with cells that look very different from normal cells and tend to grow and spread more quickly.

Symptoms

Symptoms of ESS may be non-specific and can mimic those of other more common uterine conditions. They may include:

• Abnormal uterine bleeding
• Pelvic pain or pressure
• An enlarged uterus palpable during a physical examination
• Frequent urination or constipation due to pressure on adjacent organs

Diagnosis

Diagnosis of ESS typically involves a combination of methods:

• Pelvic examination: To check for any abnormalities in the uterus or other pelvic organs.
• Ultrasound: To visualize the uterus and detect any masses or irregularities.
• Magnetic resonance imaging (MRI): To provide detailed images of the uterus and help distinguish ESS from other types of uterine masses.
• Biopsy: The definitive diagnosis of ESS is made through a biopsy, where a sample of the tumor is examined under a microscope.

Treatment

Treatment options for ESS depend on several factors, including the stage of the cancer, whether it has spread, and the patient's overall health. Common treatments include:

• Surgery: The primary treatment for ESS is surgery to remove the uterus (hysterectomy), ovaries, and fallopian tubes. In some cases, removal of nearby lymph nodes may also be necessary.
• Radiation therapy: May be used after surgery to kill any remaining cancer cells in the pelvic area.
• Hormone therapy: Since some ESS cells grow in response to estrogen, hormone therapy that blocks estrogen can help control the disease.
• Chemotherapy: May be recommended for high-grade tumors or if the cancer has spread to other parts of the body.

Prognosis

The prognosis for ESS varies depending on the grade of the tumor and the stage at diagnosis. Low-grade tumors have a relatively good prognosis, with a high rate of survival when detected early and treated appropriately. High-grade tumors, however, tend to have a poorer prognosis due to their aggressive nature and potential to spread to other parts of the body.

Prevention and Screening

There are no specific methods for preventing ESS. Regular gynecological exams and reporting any unusual symptoms early can aid in the detection of uterine abnormalities, including cancers. For women at high risk of uterine cancers, such as those with a family history of these cancers, more frequent monitoring may be recommended.

See Also

• Uterine cancer
• Sarcoma
• Hysterectomy
• Hormone therapy