Uterine Cancer

Sarcoma of the uterus, a very rare kind of cancer in women, is a disease in which cancer (malignant) cells start growing in the muscles or other supporting tissues of the uterus. Sarcoma of the uterus is different from cancer of the endometrium, a disease in which cancer cells start growing in the lining of the uterus. Women who have received therapy with high-dose X-rays (external-beam radiation therapy) to their pelvis are at a higher risk to develop sarcoma of the uterus. These X-rays are sometimes given to women to stop bleeding from the uterus.

A doctor should be seen if there is bleeding after menopause (the time when a woman no longer has menstrual periods) or bleeding that is not part of menstrual periods. Sarcoma of the uterus usually begins after menopause.

Our patients with uterine cancer are treated at the Moores Gynecological Cancer Unit. See the Gynecological Cancer Unit for more information.

You can also review the tabs at top of this page for information on uterine cancer symptoms and risks, diagnosis, and treatment.

The exact cause of uterine sarcoma is unknown, but there are certain factors that may increase a woman's chances of getting this disease, when compared to other women. Unfortunately, most cases of uterine sarcoma cannot be prevented.

Symptoms

  • Abnormal uterine bleeding or spotting
  • Discharge
  • Pelvic pain and/or mass
  • Pain and systemic symptoms are late manifestations of the disease

Risk factors

  • Prior pelvic radiation therapy
  • Estrogen replacement therapy
  • Tamoxifen
  • Early menarche
  • Late menopause
  • Never having children
  • History of failure to ovulate
  • Progesterone plus estrogen replacement therapy (called hormone Replacement therapy, or HRT)
  • Infertility
  • Diabetes
  • Gall bladder disease
  • Hypertension
  • Obesity
  • Hereditary non-polyposis colon cancer, a genetic syndrome
  • African-American heritage (the disease is twice as common in African Americans as in Caucasians or Asians)

In order to make a diagnosis of uterine sarcoma, your doctor may perform the following tests:

  • Blood tests
  • Endometrial biopsy: A small tissue sample is obtained with a thin, flexible tube inserted into the vagina and uterus
  • Hysteroscopy: A procedure that allows your doctor to look inside the uterus with a tiny telescope inserted into the vagina and uterus
  • Dilation and curettage (D&C): A dilation (opening) of the cervix and scraping of tissue from the uterus
  • Imaging tests: Such as a transvaginal ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, or chest X-ray

Staging

A process called staging is used to determine how much your cancer has spread and what treatment options will be considered.

  • Stage I: The cancer is only found in the uterus.
    • Stage IA: Cancer is in the endometrium only.
    • Stage IB: Cancer has spread into the inner half of the myometrium (muscular layer of the uterus).
    • Stage IC: Cancer has spread to the outer half of the myometrium.
  • Stage II: Cancer has spread from the uterus to the cervix.
    • Stage IIA: The cancer has spread to the glands where the cervix and uterus meet.
    • Stage IIB: The cancer has spread to the connective tissue of the cervix.
  • Stage III: The cancer has spread beyond the uterus or cervix but has not spread beyond the pelvic area.
    • Stage IIIA: The cancer has spread to the outermost layer of the uterus; and/or tissues just beyond the uterus; and/or the peritoneum.
    • Stage IIIB: The cancer has spread to the lymph nodes in the pelvic area and/or near the uterus.
  • Stage IV: The cancer has spread beyond the pelvic area.
    • Stage IVA: The cancer has spread to the lining of the bowel and/or bladder.
    • Stage IVB: The cancer has spread beyond the pelvis to other areas, such as the lymph nodes in the abdomen and/or groin.

Surgery

Surgery is the most common treatment for uterine sarcoma. UCSD’s gynecologic oncologists are specialists in all surgical procedures, including minimally invasive surgeries using the laparoscope and Da Vinci Robot. Depending on the type and stage of uterine sarcoma you have, your physician will determine whether these minimally invasive procedures may be an option.

Surgical procedures

  • Hysterectomy: A surgical procedure to remove the uterus, including the cervix.
  • Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.
  • Radical hysterectomy: A surgical procedure to remove the uterus, cervix, and part of the vagina. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.
  • Some patients may be given radiation therapy or chemotherapy after surgery to kill any cancer cells that may remain.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.

Radiation therapy

Radiation Therapy is used in the treatment of a wide variety of gynecologic cancers. It may be used alone in early stage tumors or combined with chemotherapy in locally advanced disease. In addition, it may be used before or after surgery.

High-Dose Brachytherapy is a form of internal radiation therapy where radioactive sources are placed inside the body, close to the tumor. Methods used at UCSD include cylinder, interstitial, tandem and ovoid, and tandem and ring.

Image Guided Radiation Therapy (IGRT) is a form of external-beam radiation that uses sophisticated technologies to locate the tumor and improve treatment accuracy so that healthy tissue is not harmed.

Intensity Modulated Radiation Therapy (IMRT) is another state-of-the-art external beam radiation therapy that improves delivery precision, thereby minimizing dosage to surrounding normal tissue. UCSD’s Dr. Arno Mundt pioneered the use of IMRT in gynecologic cancers.

Chemotherapy

Chemotherapy is the administration of drugs by mouth, injection, or IV to kills cancer cells. One of the unique aspects of gynecologic oncology is that specialists in this field are specially trained in chemotherapy for cancers of women’s reproductive organs. With their advanced knowledge, gynecologic oncologists can select the best drug combinations for each patient, manage complications and minimize side effects.