Uterine Sarcoma

Uterine sarcoma is a rare cancer that affects the connective tissue and muscle in your uterus. There are two main types:

• Endometrial stromal sarcoma (ESS): Tumors develop in connective tissue (stroma) that supports the lining of your uterus (endometrium).
• Uterine leiomyosarcoma (LMS): Tumors develop in the muscle wall that forms your uterus (myometrium). Uterine leiomyosarcoma is the most common type of uterine sarcoma.

Uterine sarcomas often cause vaginal bleeding that isn’t typical. You may have postmenopausal bleeding or bleeding that isn’t related to menstruation. You may also experience:

• Bloated stomach.
• Constipation.
• Frequent urination.
• Pelvic pain.

What to expect at your first visit

At your first visit, we’ll start by asking you to tell your story. We’ll want to know what kind of symptoms you’re having, how long you’ve had them and how they’re affecting your life. Hearing what you’ve been going through — in your own words — can help us better diagnose your condition and build the most personalized treatment plan.

Depending on your specific condition, we may do a pelvic exam and take a Pap smear (Pap test) to check for abnormal cells in your cervix (the start of your uterus) and vagina. Based on the results of these tests and exam, you may need to have more tests. These could include:

Imaging tests for uterine sarcoma

These tests let us take a closer look at your uterus, ovaries, vagina, cervix and fallopian tubes to see if you have any cysts or tumors in these organs. We also use these tests to stage the cancer and see if it’s spread (metastasized). You may have one or more of the following:

• Pelvic ultrasound.
• Transvaginal ultrasound.
• CT scan (computed tomography scan).
• MRI (magnetic resonance imaging).
• PET scan (positron emission tomography scan).

Hysteroscopy

Your provider may recommend doing a hysteroscopy. During a hysteroscopy, we use a thin, lighted tube (hysteroscope) to look inside your uterus for masses and changes in tissue. We may also take a tissue sample that we can check out under a microscope to look for anything unusual.

Dilation and curettage

We may also do dilation and curettage (D&C) to take tissue samples from your uterus. We can then look at the tissue to see if we spot cancer cells, polyps and other changes that may cause vaginal bleeding.

Endometrial biopsy

Sometimes, we’ll do an endometrial biopsy during an office visit. Your provider will remove a sample of the lining in your uterus (endometrium). This lets us check to see if your uterus has cancer cells in it.

Second opinions for uterine sarcoma

Learning that you may have cancer can be an emotional moment. You’ll want to make sure you’re working with a team of healthcare providers you trust completely to give you the best possible treatment.

That’s why at Cleveland Clinic, we encourage second opinions. We work to provide priority appointments for anyone looking for a second opinion. Our team of experts will dive in and work together to help you through the process of finding the best personalized treatment plan.

Meet Our Uterine Sarcoma Team

If you choose to come to Cleveland Clinic for uterine sarcoma care, you’ll get a carefully selected care team of expert cancer providers from different specialties. All have one focus — you. We handpick your care team based on your unique diagnosis, needs and goals. This team could include:

• Gynecologists.
• Gynecologic oncologists.
• Radiologists.
• Gynecologic surgeons.
• Pathologists.
• Nurse practitioners.
• Physician assistants.
• Social workers.

Once we look at your test results and confirm your uterine sarcoma diagnosis, we’ll work with you to craft a customized treatment plan. Your treatment will depend on the cancer’s size and location, if it’s spread and your specific needs.

We treat most uterine sarcomas with surgery. Depending on the stage of the cancer, you may have surgery alone or surgery followed by other treatments.

Surgery

If surgery is the best treatment for you, our gynecologic surgeons use minimally invasive techniques whenever possible to remove the tumor and any affected organs. Depending on the location and stage of the cancer, we may do:

• Hysterectomy.
• Robotic-assisted hysterectomy.
• Total hysterectomy with removal of your ovaries (oophorectomy) and fallopian tubes (salpingectomy).

Systemic therapy

Our experts treat you with medications that destroy cancer cells throughout your body (systemic therapy) that may still be there after surgery. Or you may have systemic therapies to stop cancer from growing if surgery isn’t right for you. These treatments could include:

• Chemotherapy.
• Hormone therapy for cancer.
• Immunotherapy.
• Targeted therapy.

Radiation therapy

We sometimes use radiation therapy to destroy cancer cells and keep the cancer from spreading. Our specialists may recommend radiation treatment after surgery, after chemotherapy or if you’re unable to have surgery. You may have:

• External radiation therapy: We use a machine to send high-energy beams of radiation to the tumor.
• Internal radiation therapy: We use specialized instruments temporarily placed inside your body to send radiation directly to the tumors (brachytherapy).

Taking the Next Step

Finding out you have cancer is never easy. But when you come to Cleveland Clinic for uterine sarcoma treatment, you can rest a little easier knowing we’ll be right there with you. Not only do we offer expert cancer care, but we also make sure you get support for any challenge that comes your way — physically, emotionally, mentally and even financially. We’re here for you every step of the way.