Sarcoma of the uterus - Causes, symptoms and treatment. MF.
Jun 09, 2018
Sarcomas of the uterus are quite rare tumors of the female genital area. On average, they constitute 2-6% of malignant tumors of the uterus. Uterine sarcomas are the most malignant tumors of the uterus, which are very different from the cancer of the uterus body along the course, the features of metastasis and treatment. A characteristic feature is that many patients in the past received radiation therapy for the pelvic area - such anamnestic data are found in 7-20% of patients with uterine sarcoma.
The most common types of uterine sarcoma: endometrial stromal sarcoma, leiomyosarcoma and carcinosarcoma, less often - pure sarcomas and angiosarcomas. Leiomyosarcoma and carcinosarcoma occur equally frequently and together make up 80% of all uterine sarcomas, endometrial stromal sarcoma 15%, and less frequent tumors - the remaining 5%.
The average age of patients with leiomyosarcoma is 43-53 years. The prognosis is better in premenopause. The incidence of malignancy of uterine myoma, according to different authors, is 0.13-0.81%.Suspected of leiomyosarcoma follows with a rapid increase in the uterus, especially in postmenopausal women.
Carcinosarcoma is more common in the elderly, older than 65 years and consists of two components - epithelial and mesenchymal. The epithelial component is usually represented by adenocarcinoma, and the mesenchymal or resembles a normal endometrium, or is represented by a tumor from tissues normally absent in the uterus: cartilaginous, bony, striated muscles. Most likely, carcinosarcomas develop from the stromal cells of the endometrium. In most cases, carcinosarcoma occurs in postmenopausal women. Patients with carcinosarcoma of the uterus often have obesity, diabetes, arterial hypertension. From 7 to 37% of patients in the past received remote radiation therapy for the pelvic area.
Endometrial stromal tumors occur mainly in women aged 45-50 years, in about 30% of cases they occur in postmenopausal women.
Adenosarcoma is a rare variant of carcinosarcoma. The epithelial component of this tumor is represented by a benign glandular tumor, and the mesenchymal component is one of the sarcomas.
Symptoms of uterine sarcoma
For all types of sarcomas, three main clinical manifestations are most common:
1. Bloody discharge from the genitals in postmenopause or between menstruation.
2. Less often, usually with a significant increase in the uterus, there are pain and symptoms of compression of neighboring organs.
3. There may be an asymptomatic course.
Examination for suspected uterine sarcoma
Diagnosis is established:
• Bimanual examination reveals an increase in the uterus, sometimes individual nodes and infiltrates in the parameter are clearly identified.
• With aspiration biopsy of the endometrium, with curettage of the uterine cavity, hysteroscopy with biopsy. More effective in endometrial stromal tumors, less with leiomyo- and carcionosarcoma.
• Often the disease is diagnosed after surgery for an alleged uterine myoma. In this case, an enlarged uterus is found, filled with a soft whitish-gray or yellow tumor with necrosis and hemorrhages, extending to the pelvic veins.
• US - allows you to see the increase in the uterus in size, changing the contours of the uterus, its echostructure;increased or decreased uterine cavity;changes in the endometrium.
• CT or MRI diagnostics - for detection of metastases in remote organs of
• Additional methods of examination include irrigoscopy, sigmoidoscopy, cystoscopy, etc.
Unfortunately, due to untimely contact with a doctor at the time of diagnosis in 40% of patients, the tumor has already spread beyond the uterus( this is especially true for carcinosarcoma), but in 60-70% of cases it has not yet reached the small pelvis. Dissemination along the peritoneum of the upper abdominal cavity, metastases to the liver, lungs and lymph nodes are rare. Relapses occur in 50% of patients, an average of 5 years after treatment. With relapses and metastases, long-term remissions and even cure are possible.
It should be especially noted that even in the early clinical stages of carcinosarcoma, metastasis to the pelvic lymph nodes is often detected. Approximately half of the patients with stage I carcinosarcoma have a deep invasion of the myometrium, which significantly worsens the prognosis. It should be noted that almost all patients with myometrium invasion more than half of its thickness die. Adverse prognostic factors include also large tumor sizes, the presence of tumor emboli in the lymphatic fissures, the development of carcinosarcoma after irradiation of the pelvis. The five-year survival rate for uterine carcinosarcoma is low, 20-30%.
Treatment of uterine sarcoma
Treatment of endometrial stromal sarcoma should begin with surgery. Perform an extirpation of the uterus with appendages and, if possible, remove all visible metastases. Attachments can be preserved only by patients with leiomyosarcoma of the uterus of childbearing age. Compulsory combination with chemotherapy, especially with a high degree of malignancy of the tumor. Radiation therapy is effective, but radiation therapy does not help with uterine leiomyosarcoma. It is carried out in the presence of a residual tumor in the small pelvis and with relapses.
Endometrial stromal malarial sarcoma is a hormone-dependent tumor, possibly treatment with progestogens.
Doctor gynecologist Kupatadze D.D.