Uterine sarcoma occurs in less than 1 in 1000 women.
Uterine sarcoma is commonest in women in their mid to late fifties.
Uterine sarcoma occurs in all countries. Leiomyosarcoma is more common
in African countries. Mixed Mullerian cancer is commonest in the USA and
western countries but has an increasing incidence in Asian.
There are a number of types of uterine sarcoma. Leiomyosarcoma is a
sarcoma of a fibroid of the uterine. Stromal sarcoma is a tumor of soft
tissue fibers of the womb. A 'Mixed Mullerian' tumour of the uterus is a
mixed cancer consisting of a sarcoma and an endometrial cancer. These
'Mixed Mullerian' tumours are also called 'Carcinosarcomas' and behave
more like aggressive endometrial cancer.
Sometimes it is difficult to distinguish through a microscope whether a tumour is a benign fibroid or a malignant leiomyosarcoma. These tumours
are sometimes called STUMPs which stands for Soft Tissue Tumors of
Uncertain Malignant Potential.
A hormone called ‘oestrogen’ that is naturally produced in the ovaries
is thought to be associated with some sarcomas as with endometrial
cancer. These are predominantly the Mixed Mullerian tumors which behave
like aggressive endometrial cancers.
A healthy diet which is low in fat and sugar helps prevent against womb
cancer as does regular exercise. There is no screening test for womb
cancer but early presentation to a doctor when abnormal vaginal bleeding
occurs normally results in it’s detection at an early stage.
Mixed Mullerian cancer normally presents in a similar
way to pure endometrial cancers. Other sarcomas often present as either
abnormal bleeding or a lump in the pelvis. A fibroid that is growing
rapidly should be treated as a leiomyosarcoma until proven otherwise.
Treatment is initially by surgery with removal of the womb and ovaries.
Sometimes it is necessary to remove the glands in the pelvis also.
Most women also require radiotherapy. There are two types of
radiotherapy commonly used. The first is vaginal radiotherapy where a
probe is placed into the vagina for a period. This often occurs two or
three times on separate occasions. The other type of radiotherapy is
pelvic treatment where irradiation is used from the outside. This is
used in more advanced forms of womb cancer and usually involves spending
a period on the treatment couch daily for five or six weeks.
Chemotherapy is used for womb cancer when it has spread. The role of
chemotherapy in stromal sarcomas and leiomyosarcomas is limited.
Hormone treatment in the form of antioestrogens called GnRH analogues is
sometimes advised for some types of leiomypsarcoma and stromal sarcoma.
Some forms of advanced Mixed Mullerian tumours are treated with hormones
called GnRH analogues and progesterones.
Recurrent sarcoma cancer has a poor prognosis. If a woman has a single site
of recurrence at the top of the vagina it may be possible to excise it
surgically or use radiotherapy if a woman has not had it already. Other
treatments for recurrent womb cancer include chemotherapy and hormone
treatment.
This is dependant on the type of sarcoma and stage. Low grade stromal
sarcomas general have a good prognosis where as Mixed Mullerian and high
grade sarcomas so less well.
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