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Uterine Sarcomas Uterine sarcomas are a group of disparate, highly malignant cancers developing from the uterine corpus. Sarcomas account for < 5% of uterine cancers. Risk factors are similar to those for endometrial carcinoma. The most common types are mixed mesodermal tumors (malignant mixed mullerian tumor, in which the sarcoma is mixed with adenocarcinoma), leiomyosarcomas, and endometrial stromal tumors. Most sarcomas present with abnormal vaginal bleeding and, less commonly, pelvic pain or a palpable pelvic mass. Symptoms usually prompt a transvaginal ultrasound and an endometrial biopsy or fractional D & C. Those in whom cancer is identified typically have CT or MRI preoperatively. Stage I disease is confined to the corpus; stage II to the corpus and cervix; stage III is spread outside the uterus but confined to the pelvis; and stage IV is spread outside the true pelvis or into the mucosa of the bladder or rectum. Prognosis is generally poorer than with endometrial cancer of similar stage; survival is generally poor when disease has spread beyond the uterus. In one study, 5-year survivals were 51%, 13%, 10%, and 3% for stages I through IV, respectively. Treatment is total abdominal hysterectomy and bilateral salpingo-oophorectomy with complete exploration of the abdomen and biopsy of suspicious nodes; nodal dissection is prognostic but not therapeutic. Adjuvant radiation therapy is typically employed and appears to delay local recurrence but does not improve overall survival rate. Chemotherapeutic agents vary with tumor type; overall response is poor, although progestational agents are frequently effective for endometrial stromal tumors. Recurrent disease occurs most commonly locally, in the abdomen, and the lungs.
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