Understanding Uterine Sarcomas: Types and Treatments

A uterine sarcoma is a highly malignant type of cancer that forms from the uterine corpus.¹ Uterine sarcomas comprise less than five per cent of uterine cancers, with risk factors similar to those for endometrial cancers. Sarcoma means a malignant tumour of connective or non-epithelial tissue.^2–5

Types of uterine cancers

Mixed mesodermal tumours – carcinosarcoma whereby the sarcoma is mixed with adenocarcinoma, previously known as malignant mixed mullerian tumour
Leiomyosarcomas⁶
Endometrial stromal tumours

Symptoms of uterine cancers

Abnormal vaginal bleeding
Sometimes pelvic pain
Sometimes pelvic mass can be felt

Staging of uterine cancers

Confined to the corpus
Confined to the corpus and cervix
Spread outside the uterus but confined to the pelvis
Spread outside the true pelvis or into the mucosa of the bladder or rectum

Outcomes for uterine cancers

Prognosis of uterine cancers such as these sarcomas is reasonably poor, with stage one survival rates sitting at about 50 per cent, while stage four cancers had just a three per cent survival rate.⁷ These cancers typically recur in the uterus, abdomen and lungs.

Treatments for uterine cancer

Treatments typically involve a total hysterectomy, removal of the ovaries and fallopian tubes (salpingo-oophorectomy) or complete removal of all pelvic organs (pelvic exenteration).^8,9 Radiation therapy delays recurrence, but doesn’t improve survival rates.

Chemotherapy may be used when tumours are recurrent or advanced, with the drug varying by tumour type.¹⁰ Chemotherapy isn’t very effective at increasing survival rates. Progestins may be effective for endometrial stromal tumours.

References

1.
Bessen T, Caughey GE, Shakib S, et al. A population-based study of soft tissue sarcoma incidence and survival in Australia: An analysis of 26,970 cases. Cancer Epidemiology. Published online December 2019:101590. doi:10.1016/j.canep.2019.101590
2.
Santos P, Cunha TM. Uterine sarcomas: clinical presentation and MRI features. Diagn Interv Radiol. Published online January 6, 2015:4-9. doi:10.5152/dir.2014.14053
3.
Mbatani N, Olawaiye AB, Prat J. Uterine sarcomas. Intl J Gynecology & Obste. Published online October 2018:51-58. doi:10.1002/ijgo.12613
4.
Tropé CG, Abeler VM, Kristensen GB. Diagnosis and treatment of sarcoma of the uterus. A review. Acta Oncologica. Published online July 2012:694-705. doi:10.3109/0284186x.2012.689111
5.
Wu TI, Yen TC, Lai CH. Clinical presentation and diagnosis of uterine sarcoma, including imaging. Best Practice & Research Clinical Obstetrics & Gynaecology. Published online December 2011:681-689. doi:10.1016/j.bpobgyn.2011.07.002
6.
Mao J, Pfeifer S, Zheng XE, Schlegel P, Sedrakyan A. Population-Based Estimates of the Prevalence of Uterine Sarcoma Among Patients With Leiomyomata Undergoing Surgical Treatment. JAMA Surg. Published online April 1, 2015:368. doi:10.1001/jamasurg.2014.3518
7.
Tanner EJ, Garg K, Leitao MM Jr, Soslow RA, Hensley ML. High grade undifferentiated uterine sarcoma: Surgery, treatment, and survival outcomes. Gynecologic Oncology. Published online October 2012:27-31. doi:10.1016/j.ygyno.2012.06.030
8.
Kho KA, Lin K, Hechanova M, Richardson DL. Risk of Occult Uterine Sarcoma in Women Undergoing Hysterectomy for Benign Indications. Obstetrics & Gynecology. Published online March 2016:468-473. doi:10.1097/aog.0000000000001242
9.
Lewis D, Liang A, Mason T, Ferriss JS. Current Treatment Options: Uterine Sarcoma. Curr Treat Options in Oncol. Published online May 31, 2024:829-853. doi:10.1007/s11864-024-01214-3
10.
Shah SH, Jagannathan JP, Krajewski K, O???Regan KN, George S, Ramaiya NH. Uterine Sarcomas: Then and Now. American Journal of Roentgenology. Published online July 2012:213-223. doi:10.2214/ajr.11.7287