The sarcomas of the uterus is a rare type of cancer that develops mainly in the muscles of the uterus. Unlike the more common types of uterine cancer, which grow inside the uterus, uterine sarcomas originate in the myometrium (the muscle layer of the uterus) or in the supporting tissues of the uterus, such as the endometrial layer, smooth muscle cells or blood vessels. Uterine sarcomas can be classified into many different subtypes, which have different characteristics and treatment. Uterine sarcomas are relatively rare and account for less than 5% of all uterine cancers. They tend to be more aggressive and more difficult to treat than other types of uterine cancer and often have a worse prognosis. Treatment options for uterine sarcomas may include surgery, radiotherapy and chemotherapy, depending on the specifics of the cancer and how advanced it is.

What are the main types of uterine sarcomas?

There are several main types of uterine sarcomas, such as:

• Leiomyosarcoma: This is the most common type of uterine sarcoma, accounting for about 60-70% of cases. It develops from the smooth muscle cells of the uterus and can occur at any age, although it is most commonly found in postmenopausal women.
• Stromal endometrial sarcoma: This type of uterine sarcoma develops from the cells of the connective tissue (stroma) that support the endometrium (the inside of the uterus). It is a rare type of cancer, accounting for only about 10% of uterine sarcomas.
• Undifferentiated sarcoma: It is a rare and aggressive type of uterine sarcoma that has no clearly defined characteristics. It can be difficult to treat and has a worse prognosis than other types of uterine sarcoma.
• Adenosarcoma: This is a rare type of uterine sarcoma that develops from the glandular tissue of the uterus. It tends to occur in premenopausal women and has a relatively good prognosis compared to other types of uterine sarcoma.
• Carcinosarcoma (also known as a malignant mixed Mullerian tumour): this is a rare and aggressive type of cancer that contains components of both sarcoma and carcinoma. It can occur in various parts of the body, including the uterus, and has a poor prognosis.

It is important to note that these are only the main types of uterine sarcomas and there are other, less common subtypes. Each type of uterine sarcoma has its own unique characteristics, prognosis and treatment options. It is important to accurately diagnose the type of uterine sarcoma in order to determine the best course of treatment.

What are the most common symptoms caused by uterine sarcomas?

Uterine sarcomas may not always cause noticeable symptoms in the early stages of the disease. However, as the cancer grows and spreads, it can cause a range of symptoms, including:

• Abnormal vaginal bleeding: This is the most common symptom of uterine sarcoma and may include heavy or prolonged periods, bleeding between periods or bleeding after menopause.
• Pelvic pain or pressure: As the tumour grows, it may cause discomfort or pain in the pelvic area, including the lower abdomen or back.
• Swelling in the abdomen: In some cases, uterine sarcomas can cause the uterus to enlarge, leading to swelling or bloating in the abdomen.
• Pain during sexual intercourse: As the tumour grows, it may cause discomfort or pain during sexual activity.
• Anemia: If the uterine sarcoma causes heavy or prolonged bleeding, it can lead to anaemia (lack of red blood cells), which can cause fatigue, weakness and other symptoms.

It is important to note that these symptoms can also be caused by other, non-cancerous conditions, so it is important to see a doctor if you experience unusual symptoms or changes in your menstrual cycle. A doctor can perform tests to determine the cause of your symptoms and recommend appropriate treatment.

How are uterine sarcomas diagnosed?

Uterine sarcomas can be difficult to diagnose because they are rare and their symptoms may be similar to those of other, more common conditions. However, there are several tests and procedures that can be used to help diagnose uterine sarcomas, including:

→ Pelvic examination: A doctor may perform a physical examination to check for any lumps or abnormalities in the pelvic area.

→ Imaging tests: Imaging tests such as ultrasound, CT or MRI can be used to create images of the uterus and surrounding tissues to look for any abnormalities or signs of cancer.

→ Biopsy: A biopsy is a procedure in which a small sample of tissue is removed from the uterus and examined under a microscope for signs of cancer. This can be done using a fine needle or by removing a larger sample of tissue during a procedure called scraping.

→ Hysteroscopy: This is a procedure in which a thin, lighted tube is inserted into the uterus through the vagina to allow the doctor to see the inside of the uterus and look for any abnormalities. Once a diagnosis of uterine sarcoma has been made, further tests can be done to determine the extent of the cancer and whether it has spread to other parts of the body. This may include additional imaging tests, such as PET or bone scintigraphy, and blood tests to check for cancer markers or other indicators of cancer. The results of these tests can help determine the best treatment.

How are uterine sarcomas treated?

Treatment of uterine sarcomas depends on a number of factors, including the type and stage of the cancer, as well as the patient's overall health and preferences. Some common treatment options for uterine sarcoma include:

Surgery: Surgery is often the main treatment for uterine sarcoma. Depending on the extent and location of the tumour, the surgeon may remove the uterus (hysterectomy), as well as the ovaries and fallopian tubes. In some cases, nearby lymph nodes may also be removed to check for signs of cancer spread.

Radiotherapy: Radiotherapy involves the use of high-energy beams to kill cancer cells. It can be used before or after surgery or as the main treatment for tumours that cannot be removed surgically. In some cases, radiotherapy may be given as an internal treatment, known as brachytherapy, in which a radioactive source is placed inside the body near the tumour.

Chemotherapy: Chemotherapy involves the use of drugs to kill cancer cells. It may be used in combination with surgery or radiotherapy or as the main treatment for advanced or metastatic uterine sarcoma.

Hormonotherapy: Hormonotherapy can be used to treat certain types of uterine sarcoma, such as stromal endometrial sarcoma. This may include the use of medicines to block the effects of oestrogen or progesterone, which may stimulate the development of certain types of uterine sarcoma.

Targeted treatment: Targeted therapy involves the use of drugs that target specific molecules or pathways involved in the development of cancer. It can be used to treat certain types of uterine sarcoma, particularly those with specific genetic mutations. The choice of treatment will depend on a number of factors, including the type and stage of the cancer, the patient's overall health and their preferences. A team of physicians, including a gynecologic oncologist, will work together to develop an individualized treatment plan for each patient with uterine sarcoma.

What does surgery for uterine sarcomas involve?

The surgical approach for uterine sarcomas depends on the type, size and location of the tumour, as well as the overall health and preferences of the patient. Here are some of the surgical procedures that can be used to treat uterine sarcomas:

→ Hysterectomy: This is the most common surgery for uterine sarcoma. It involves removal of the uterus, cervix, fallopian tubes and ovaries.

→ Lymphadenectomy: This is the removal of lymph nodes near the uterus, which is done during a hysterectomy. The lymph nodes are checked for signs of spreading cancer.

→ Extermination: This is a more extensive surgery that can be used for advanced uterine sarcomas that have spread to nearby organs. It includes removal of the uterus, cervix, vagina, bladder, bladder, rectum and other nearby organs, depending on the extent of the cancer.

Surgery for uterine sarcomas can be performed through open surgery or can be done with minimally invasive techniques such as laparoscopy or robotic surgery. The choice of surgical approach will depend on the patient's parameters and the surgeon's experience. After surgery, patients will need to recover and may need additional treatments, such as radiation or chemotherapy, depending on the stage of the cancer and other factors.