What Are the Symptoms of Uterine Sarcoma?

Abnormal discharge or bleeding, vaginal pain or the feeling of a pelvic lump may all be symptoms of uterine sarcoma.

Uterine sarcoma is a rare cancer that occurs when cells in the muscle, fat, and fibrous tissues (the material that forms tendons and ligaments) of the uterus (womb) grow out of control.

Types of uterine sarcoma are based on the type of cell where they originate and include:

• Uterine leiomyosarcoma (LMS)
  • Forms in the muscular wall of the uterus (myometrium)
  • The most common type of uterine sarcoma
  • Tends to grow and spread quickly
• Endometrial stromal sarcoma (ESS)
  • Forms in the supporting connective tissue (stroma) of the lining of the uterus (the endometrium)
  • Rare
• Undifferentiated sarcoma
  • Forms in the endometrium or the myometrium
  • Tends to grow and spread quickly and usually has a poor prognosis

Symptoms of uterine sarcoma include:  

• Abnormal bleeding or spotting
  • Irregular vaginal bleeding (between periods)
  • Bleeding after menopause
• Vaginal discharge
• Pelvic pain 
• Mass (tumor) that can be felt
• Feeling of fullness in the abdomen and/or pelvis

Most of the time, these symptoms are caused by other conditions, such as non-cancerous changes in the uterus (like fibroids), pre-cancerous overgrowth of the endometrium, or endometrial carcinoma (another type of cancer of the uterus). If you have any of these symptoms, see a doctor to determine the cause.

The cause of uterine sarcoma is unknown. 

Risk factors for developing uterine sarcoma include: 

• Pelvic radiation therapy for other cancer
• Race: twice as common in African-American women as in white or Asian women
• Women who have had a type of eye cancer called retinoblastoma caused by being born with an abnormal copy of the RB gene are at higher risk for developing uterine sarcoma

Uterine sarcoma is diagnosed with a pelvic examination and patient history, along with tests such as: 

• Sampling and testing endometrial tissue
  • Endometrial biopsy
  • Hysteroscopy
  • Dilation and curettage (D&C)
  • Cystoscopy and proctoscopy
• Imaging tests
  • Transvaginal ultrasound
    • Ultrahysterosonogram 
    • Saline infusion sonogram
  • Computed tomography (CT) scan
    • CT-guided needle biopsy
  • Magnetic resonance imaging (MRI) scan
  • Positron emission tomography (PET) scan
  • Chest X-ray, to check if cancer has spread (metastasized) to the lungs and as part of testing before surgery

Treatment for uterine sarcoma may include one or more of the following: 

• Surgery 
  • Main treatment for uterine sarcoma
  • Total hysterectomy: removal of the body of the uterus and the cervix
  • Radical hysterectomy: removal of the entire uterus as well as the tissues next to the uterus and cervix (parametrium and uterosacral ligaments) and the upper part (about 1 inch) of the vagina (near the cervix)
    • Not often used for uterine sarcomas
  • Bilateral salpingo-oophorectomy: removal of both fallopian tubes and both ovaries. 
    • Usually done at the same time the uterus is removed
    • If both of ovaries are removed, a woman will go into menopause if it has not already occurred
• Lymph node surgery
  • Done when the cancer has already spread outside of the uterus
  • This usually means a poor prognosis (outlook)
• Other procedures that may be done during surgery
  • Omentectomy: removal of the layer of fatty tissue that covers the abdominal contents like an apron
  • Peritoneal biopsies: removal of small pieces of the tissue lining the pelvis and abdomen to check for cancer cells
  • Pelvic washings: the abdominal and pelvic cavities are “washed” with salt water (saline) and the fluid is sent to the lab to see if it contains cancer cells
  • Tumor debulking: Removal of as much of the tumor as possible if cancer has spread throughout the abdomen
    • Debulking may help other treatments such as radiation or chemotherapy work better
• Radiation therapy 
  • External beam radiation therapy
  • Internal radiation therapy (vaginal brachytherapy)
• Chemotherapy, used along or in combination
  • Dacarbazine (DTIC)
  • Docetaxel (Taxotere)
  • Doxorubicin (Adriamycin)
  • Liposomal doxorubicin (Doxil)
  • Epirubicin (Ellence)
  • Gemcitabine (Gemzar)
  • Ifosfamide (Ifex)
  • Paclitaxel (Taxol)
  • Temozolomide (Temodar)
  • Trabectedin (Yondelis)
  • Vinorelbine (Navelbine)
• Hormone therapy 
  • Progestins: megestrol (Megace) and medroxyprogesterone (Provera)
  • Gonadotropin-releasing hormone agonists: goserelin (Zoladex) and leuprolide (Lupron)
  • Aromatase inhibitors: letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin)
• Targeted therapy 
  • Pazopanib (Votrient)