Uterine sarcoma

Other Names: Sarcoma of the uterus

Uterine sarcoma is a disease in which malignant (cancer) cells form in the muscles of the uterus or other tissues that support the uterus. The uterus is part of the female reproductive system. The uterus is the hollow, pear-shaped organ in the pelvis, where a fetus grows. The cervix is at the lower, narrow end of the uterus, and leads to the vagina.

Uterine sarcoma is a very rare kind of cancer that forms in the uterine muscles or in tissues that support the uterus. Uterine sarcoma is different from cancer of the endometrium, a disease in which cancer cells start growing inside the lining of the uterus.

Types

The two main types are leiomyosarcoma (cancer that begins in smooth muscle cells) and endometrial stromal sarcoma (cancer that begins in connective tissue cells).

Risk factors

The exact cause is not known. But there are certain risk factors:

• Past radiation therapy. A few women develop uterine sarcoma 5 to 25 years after they had radiation therapy for another pelvic cancer.
• Past or current treatment with tamoxifen for breast cancer.
• Race. African American women have twice the risk that white or Asian women have.
• Genetics. The same abnormal gene that causes an eye cancer called retinoblastoma also increases the risk for uterine sarcoma.
• Women who have never been pregnant.

Symptoms

The most common symptom of uterine sarcoma is bleeding after menopause. Let your health care provider know as soon as you can about:

• Any bleeding that is not part of your menstrual period
• Any bleeding that happens after menopause
• Most likely, the bleeding will not be from cancer. But you should always tell your provider about unusual bleeding.

Other possible symptoms of uterine sarcoma include:

• Vaginal discharge that does not get better with antibiotics and may occur without bleeding
• A mass or lump in the vagina or uterus
• Having to urinate often
• Some of the symptoms of uterine sarcoma are similar to those of fibroids. The only way to tell the difference between sarcoma and fibroids is with tests, such as a biopsy of tissue taken from the uterus.

Diagnosis

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas

Pap test: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap smear. Because uterine sarcoma begins inside the uterus, this cancer may not show up on the Pap test.

Transvaginal ultrasound exam: A procedure used to examine the vagina, uterus, fallopian tubes, and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram.

Dilatation and curettage: A procedure to remove samples of tissue from the inner lining of the uterus. The cervix is dilated and a curette (spoon-shaped instrument) is inserted into the uterus to remove tissue. The tissue samples are checked under a microscope for signs of disease. This procedure is also called a D&C.

Endometrial biopsy: The removal of tissue from the endometrium (inner lining of the uterus) by inserting a thin, flexible tube through the cervix and into the uterus. The tube is used to gently scrape a small amount of tissue from the endometrium and then remove the tissue samples. A pathologist views the tissue under a microscope to look for cancer cells.

Treatment

Surgery is the most common treatment for uterine cancer. Surgery may be used to diagnose, stage, and treat uterine sarcoma all at one time. After surgery, the cancer will be examined in a lab to see how advanced it is.

Depending on the results, you may need radiation therapy or chemotherapy to kill any cancer cells that remain. You also may have hormone therapy for certain kinds of tumors that respond to hormones. For advanced cancer that has spread outside the pelvis, you may want to join a clinical trial for uterine cancer. With cancer that has come back, radiation may be used for palliative treatment. Palliative care is meant to relieve symptoms and improve a person's quality of life.

The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition

• Pazopanib (Brand name: Votrient)Advanced soft tissue sarcoma (STS) who have received prior chemotherapy.

Prognosis

Your prognosis depends on the type and stage of uterine sarcoma you had when treated. For cancer that has not spread, at least 2 out of every 3 people are cancer-free after 5 years. The number drops once the cancer has started to spread and becomes harder to treat.

Uterine sarcoma is often not found early, therefore, the prognosis is poor. Your provider can help you understand the outlook for your type of cancer.

NIH genetic and rare disease info

• NIH info on Uterine sarcoma

Uterine sarcoma is a rare disease.

Uterine sarcoma Resources
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