Diseases & Conditions

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What is the uterus?

The uterus, or womb, is a part of a woman's reproductive system, located in the pelvic area between the bladder and the rectum. The uterus is the space in which a fetus grows.

The uterus is made up of two layers of tissue: the endometrium (lining or inner layer) and the myometrium (the outer layer of muscle).

What is uterine sarcoma?

Sarcomas are cancers that develop in tissues such as muscles, bone, fat, and fibrous tissue (tendons and ligaments). Carcinomas are cancers that develop in epithelial cells, or the cells that line organs.

Uterine cancer, also called endometrial cancer, is the most frequently-occurring cancer of the female reproductive system in the United States. Cancer of the endometrium is different than cancer of the myometrium, which is called uterine sarcoma. Uterine sarcoma, which is a very rare condition, develops in the muscle layer of the uterus, or in the tissues that support the uterus.

Risk factors

Risk factors for uterine sarcoma include:

• Earlier treatment with radiation directed at the pelvis
• Having taken tamoxifen for breast cancer. (It is especially important for women who have taken tamoxifen to tell their doctor about any bleeding that is not related to menstruation.)
• Being African-American. The American Cancer Society reports that uterine sarcoma is twice as common in African-Americans than in Caucasians.

What are the symptoms of uterine sarcoma?

Uterine carcinomas do not always show symptoms in early stages. However, the following symptoms may indicate some type of problem:

• Abnormal bleeding, such as non-menstrual bleeding (bleeding when you are not having your period) or bleeding after menopause
• Abnormal vaginal discharge
• A lump in the vagina
• Abdominal pain or feeling of fullness
• Having to urinate often

It is important to note that all of these symptoms can be, and usually are, caused by something other than uterine sarcoma. However, you should discuss these symptoms with your health care provider.

How is uterine sarcoma diagnosed?

Uterine cancer may be diagnosed and treated in one procedure. The following tests may be used to diagnose uterine sarcoma:

• Physical examination and medical history
• Pelvic examination : a procedure to examine pelvic organs externally and internally. During a typical exam, a speculum is inserted into the vagina and opened up so that the vagina, cervix, and uterus can be seen. A spatula or brush is used to take a sample of cells from the cervix and/or a sample of vaginal fluid. The doctor will also put one or two gloved fingers into the vagina while pressing down on the abdominal area. The doctor may also put a gloved and lubricated finger into the rectum to look for any abnormalities. (Pap tests or pap smears are very effective at finding cervical cancer, but less so at detecting uterine carcinoma.)
• Dilatation and curettage (D&C): This procedure involves dilating (widening) the cervix (opening to the uterus) in order to insert a spoon-shaped instrument called a curette to remove tissue samples from the uterine lining. The samples may then be biopsied (examined under a microscope for cancerous cells).
• Endometrial biopsy: A small tube is inserted into the cervix and into the uterus to take a tissue sample from the endometrium.

If a woman is found to have uterine sarcoma, she may have other tests to determine how far the cancer has spread. These tests may include:

• Transvaginal ultrasound A tubular probe is inserted into the vaginal canal and high-frequency sound waves are transmitted through body tissues. The echoes are recorded and transformed into video or photographs.
• Computed tomography (CT) scan Computed tomography uses X-rays and computers to produce images of a cross-section of the body.
• Chest x-ray
• Blood tests: These tests measure the levels of certain chemicals in the blood.
• CA 125 assay: This test measures the level of CA 125 (a substance released by cells into the bloodstream). An increased CA 125 level may indicate cancer or another condition.
• Cytoscopy This procedure allows your doctor to see the urethra and the bladder (the vessel that holds urine) through an instrument similar to a small telescope. This can help determine if the cancer has spread.
• Barium enema Barium is a liquid that is used to make the intestine show up better on the x-ray. The liquid is placed into the intestine through the rectum.
• Sigmoidoscopy: A sigmoidoscope (a thin, lighted tube) is inserted through the rectum into the sigmoid (lower) colon to look for polyps, abnormal areas, or cancer.

One of the biggest concerns about a cancer diagnosis is whether the cancer has spread (metastasized) beyond its original location. To determine this, the doctor assigns a number (I through IV) to the diagnosis. The higher the assigned number, the more the cancer has spread throughout the body. This is called "staging."

The stages of uterine sarcoma are:

• Stage I: Cancer is confined to the uterus.
• Stage II: Cancer has moved from the uterus to the cervix.
• Stage III: Cancer is found outside of the uterus and cervix, but only in the pelvic area.
• Stage IV: Cancer has spread to other organs or tissues outside the pelvic area.

Any cancer, including uterine sarcoma, can recur (come back).

How is uterine sarcoma treated?

There are four standard treatments for uterine sarcoma: surgery, chemotherapy, radiation therapy, and hormone therapy. Treatment depends on the stage of the cancer, as well as the general health of the patient.

Some of the treatments may be combined. For instance, a woman could receive radiation or chemotherapy after surgery. For stage IV uterine sarcoma and for recurrent uterine sarcoma, there is no standard treatment. Therapy may include treatments that are being studied in clinical trials.

Surgery

Surgical treatments include:

• Total hysterectomy: removal of the uterus and the cervix in one of three ways (through the vagina, via laparoscopy, or through a large incision in the abdomen)
• Radical hysterectomy : removal of the uterus, the cervix, and part of the vagina, along with (possibly) the ovaries, the fallopian tubes, or nearby lymph nodes
• Bilateral salpingo-oopherectomy : removal of both ovaries and both fallopian tubes
• Lymphadenectomy : removal of lymph nodes

Other surgical treatments may be considered for diagnosis and/or treatment. These include laparotomy (making an incision in the abdomen to view or remove internal organs), and abdominal and pelvic washings (putting saline solution into the abdominal and pelvic cavities, then removing the solution and examining it to see if there is any cancer.)

Chemotherapy

Chemotherapy uses drugs that kill cancer cells or stop them from multiplying as quickly. Chemotherapy drugs can be taken orally or as injections, or can be placed inside the body near the cancer.

Radiation therapy

Radiation therapy uses high-energy X-rays to kill cancer cells or stop them from reproducing. Radiation can be applied from a machine outside the body (external radiation) or from the placement of a radioactive substance inside the body (internal radiation).

Hormone therapy

Some hormones make it possible for certain cancers to grow. In this case, hormone therapy acts to remove these hormones or block their actions.