Uterine sarcoma

The uterine sarcomas form a group of malignant tumors that grow out from the smooth muscle or connective tissue of the uterus.

Signs and symptoms

Uterine sarcomas and fibroids are alike. Both have an increased uterine size. Abdominal pain and vaginal bleeding happen in both. It can be difficult to tell them apart.[1] Unusual vaginal bleeding may be a sign of uterine sarcoma. Other signs of a uterine sarcoma can be pelvic pain, pressure, and unusual discharge. If a uterus is larger than normal this could also be a sign. There is no special test to detect a uterine sarcoma. A Pap smear is a screening test for cervical cancer and not designed to detect uterine sarcoma.

Diagnosis

MRI is able to find the differences between leiomyomas and uterine sarcomas.[1] Investigations by the physician include imaging (ultrasound, CAT scan, MRI) and, if possible, obtaining a tissue diagnosis by biopsy, hysteroscopy, or D&C. Ultimately the diagnosis is established by the histologic examination of the specimen. Typically malignant lesions have >10 mitosis per high power field. In contrast, a uterine leiomyoma as a benign lesion would have < 5 mitoses per high power field.

Management

Therapy is based on staging and patient condition. Surgery is the mainstay of therapy if feasible involving total abdominal hysterectomy with bilateral salpingo-oophorectomy. Other approaches include radiation therapy, chemotherapy, and hormonal therapy.

Prognosis is relatively poor.[2]

Epidemiology

Uterine sarcoma is rare. Out of all malignancies of the uterine body only about 4% will be uterine sarcomas.[3] Generally, the cause of the lesion is not known, however, patients with a history of pelvic radiation are at higher risk. Most tumors occur after menopause. Women who take long-term tamoxifen are at higher risk.[4]

References

  1. ↑ 1.0 1.1 Smith J, Zawaideh JP, Sahin H, Freeman S, Bolton H, Addley HC (September 2021). "Differentiating uterine sarcoma from leiomyoma: BET1T2ER Check!". Br J Radiol. 94 (1125): 20201332. doi:10.1259/bjr.20201332. PMC 9327746. PMID 33684303. S2CID 232159216.
  2. ↑ Gadducci A, Cosio S, Romanini A, Genazzani AR (February 2008). "The management of patients with uterine sarcoma: a debated clinical challenge". Crit. Rev. Oncol. Hematol. 65 (2): 129–42. doi:10.1016/j.critrevonc.2007.06.011. PMID 17706430.
  3. ↑ [1] Archived 2010-05-14 at the Wayback Machine American Cancer Society information, accessed 03-11-2006
  4. ↑ [2] National Cancer Institute information, accessed 03-11-2006

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