Gynecological Cancer

At Loma Linda University Cancer Center, women battling gynecological cancer work with a team of physicians who understand the complexity of each patient's needs. With extensive training and experience in the subspecialty of gynecological oncology, each member of the medical team plays an essential role in providing comprehensive health care. By bringing together state-of-the-art diagnostic tools a team of physicians in one location and support services patients receive timely, efficient and high quality care.

Loma Linda University Medical Center has a vast array of resources available for cancer treatment. We work very closely with the LLU Robotic Surgery Department to provide our patients with technologically advanced treatment options and a seamless treatment experience.

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Uterine Sarcoma

What is cancer?

Cancer is when cells in the body change and grow out of control. To help you understand what happens when you have cancer, let’s look at how your body works normally. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not need them any longer.

Cancer is made up of abnormal cells that grow even though your body doesn’t need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasis).

Understanding the uterus

The uterus is an organ. It’s part of the female reproductive system. You may know it as the womb. The uterus is usually pear-shaped and about the size of a fist. It is located in the lower belly (pelvic area), between your bladder and your rectum. Your uterus is connected to your fallopian tubes. These tubes help carry eggs from your ovaries into the uterus. The small opening that connects the uterus to your vagina is the cervix.

  • The uterus is made up of 3 layers:
  • Endometrium. This is the inner lining.
  • Myometrium. This is the middle muscle layer.
  • Serosa. This is the outer smooth layer.

The uterus protects a growing baby during pregnancy. During labor, the myometrium muscle tissue helps push the baby out through the cervix. The smooth serosa makes it easy for the uterus to move in the pelvis as needed.

What is uterine sarcoma?                                                                                                                                                                        

Uterine sarcoma is a type of cancer that starts in the muscular wall of the uterus (myometrium). If uterine sarcoma spreads, it tends to first go to places near the uterus. It can spread to the cervix, vagina, ovaries, fallopian tubes, and lymph nodes. In later stages, it can spread to the bladder, bowel, lungs, liver, or bone. 

Cancer that spreads to other parts of the body is called metastatic cancer, and the process of spreading is called metastasis. Metastasis is a complex process. The cancer cells of the tumor invade normal tissues and blood and lymph vessels, and then travel through the bloodstream or the lymph system to reach other parts of the body. When the cancer cells reach other organs, they depend on the formation of new blood vessels to survive and grow.

Uterine sarcoma acts differently in each woman. Even women who have the same type of uterine cancer, in the same stage, and who get the same treatment can have different results. Some women are cured. Others have cancer that spreads or comes back. Sometimes the cancer appears to recur or come back, because some of the initial cancer cells were left behind after surgery. These cells were not found in the first surgery because they were too small to be seen.

Talk with your healthcare provider

If you have questions about uterine sarcoma, talk with your healthcare provider. Your healthcare provider can help you understand more about this cancer. 

What are the symptoms of uterine sarcoma?

The main symptom you may notice is unusual vaginal bleeding or other vaginal discharge. After menopause, it’s not normal for any amount of vaginal bleeding to occur. Report this to your doctor right away. Finding uterine sarcoma while it’s small and hasn’t spread makes it easier to treat.                                                                                                                                                                                    

Other rare but possible symptoms include: 

  • Pain or a feeling of fullness in the pelvic area or lower abdomen 
  • A mass or tumor that can be felt

When to see your healthcare provider

These symptoms may be caused by other health problems. But it’s important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

What is a risk factor?

A risk factor is anything that may increase your chance of having a disease. Risk factors for a certain type of cancer might include smoking, diet, family history, or many other things. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer.

Things you should know about risk factors for cancer: 

  • Risk factors can increase a person's risk, but they do not necessarily cause the disease.
  • Some people with 1 or more risk factors never develop cancer. Other people can develop cancer and have no risk factors.
  • Some risk factors are very well known. But there is ongoing research about risk factors for many types of cancer.

Some risk factors, such as family history, may not be in your control. But others may be things you can change. Knowing the risk factors can help you make choices that might lower your risk. For example, if an unhealthy diet is a risk factor, you may choose to eat healthy foods. If excess weight is a risk factor, your healthcare provider may check your weight or help you lose weight.

Who is at risk for uterine sarcoma?

Risk factors for uterine sarcoma include: 

  • Radiation therapy to the pelvic area. Treatment with radiation in this area for another type of cancer puts a woman at higher risk. Radiation damages even healthy cells, which may make cancer develop. When cancers do occur because of this exposure, it usually happens 5 to 25 years after the treatment.
  • Being African American. African American women are at higher risk than other women. Doctors don't know why.
  • Having had retinoblastoma. This a type of eye cancer caused by an abnormal gene. It’s linked to a higher risk of uterine sarcoma. 

What are your risk factors?

Talk with your healthcare provider about your risk factors for uterine sarcoma and what you can do about them. There are no screening tests for uterine sarcoma for women who don’t have symptoms. But regular pelvic exams and Pap smears can help find problems.

If your doctor thinks you are at high risk, he or she can check for uterine sarcoma in these 2 ways: 

  • Endometrial sampling. Your doctor takes a small sample of cells from the lining of your uterus. This sample is also called a biopsy. To do this, your doctor inserts a thin flexible tube through your vagina and cervix and into your uterus. Your doctor then removes some cells through this tube. A doctor looks at the cells under a microscope to check for cancer. This test may cause pain and bleeding. The procedure has a risk for possible infection. In rare cases, the wall of your uterus could be punctured. Another test called a dilation and curettage (D&C) is sometimes used to take larger endometrial samples. Endometrial sampling is not as good at finding uterine sarcoma as it is for finding endometrial cancer. 
  • Transvaginal ultrasound. Your doctor puts a probe into your vagina. The probe sends out sound waves that echo off the walls of your uterus and other pelvic organs. A computer turns these sound waves into an image on a screen. In this way, your doctor can see pictures of the inside of your uterus and the muscle wall of the uterus. The pictures may show if there is a tumor.

Neither of these tests is fully accurate. It’s possible that your doctor may not be able to find cancer, even if it’s there. It’s also possible that it might look like you have cancer when you don’t. If needed, your doctor can confirm if you have cancer by doing more tests. 

Uterine Sarcoma: Grades and Stages

Once your healthcare provider knows you have cancer, the next step is to find out the grade and stage of the cancer. Stage is a way to note the size of the tumor, and if it has spread. Grade is a way to note how abnormal the cancer cells look under a microscope. Staging and grading of cancer is important for deciding how to treat it, and how curable it is.

Grades of uterine sarcoma 

The grade refers to how the cancer cells look when compared to normal breast cells. The grade of your cancer will help your doctor predict how fast the cancer may grow and spread. A scale of 1 to 4 is used to grade uterine sarcoma. The lower the number, the more the cancer cells look like normal cells. This means the cancer is less likely to spread, and can be easier to treat and cure. This is because cancer cells that look more like normal cells tend to grow and spread slowly. Grade 4 cancer cells look very different from normal cells. This grade of cancer is more likely to spread.

The systems of staging  

Doctors use different rating systems to stage cancer. There are 2 systems used most often to stage endometrial cancer:

  •  FIGO staging system
  • TNM staging system

The two systems are very similar. The TNM system is:

  • T stands for tumor. This category notes details about the tumor itself.
  • N stands for nodes. Lymph nodes are small organs around the body. They help the body fight infections. This category notes if cancer cells have spread to the nearby lymph nodes.
  • M stands for metastasis. This category notes if the cancer has spread to distant lymph nodes, organs, or bones.

Stages of uterine sarcoma 

The stages for uterine sarcoma are:

  • Stage I. The cancer is only in the uterus. Stage IA means the cancer is not larger than 5 cm across. Stage IB means the cancer is larger than 5 cm across.
  • Stage II. The cancer has spread outside the uterus, but not outside the pelvis. Stage IIA means the cancer has spread to the ovaries and Fallopian tubes. Stage IIB means the cancer is growing into tissues of the pelvis other than the ovaries and Fallopian tubes. 
  • Stage III. The cancer has not spread to distant parts of the body. Stage IIIA means the cancer is growing into abdominal tissues in only one place, but not to nearby lymph nodes. Stage IIIB means the cancer is growing into abdominal tissues in two or more places, but not to nearby lymph nodes. Stage IIIC means the cancer is growing into tissues of the abdomen and/or pelvis, but not the bladder or rectum. It has spread to lymph nodes near the uterus.
  • Stage IV. The cancer has spread to the bladder or the rectum, or to distant organs, such as the bones or lungs. Stage IVA means the cancer has spread to the bladder or the rectum but not to distant organs, such as the bones or lungs. Stage IVB means the cancer may or may not have grown into tissues in the abdomen or pelvis, such as the bladder or rectum. It may or may not have spread to lymph nodes near the uterus, but has spread to organs that are not next to the uterus, such as the bones or lungs, or it has spread to distant lymph nodes.

Talking with your healthcare provider

When your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.

Uterine Sarcoma: Treatment Choices

There are various treatment choices for uterine sarcoma. Which one may work best for you? It depends on a number of factors. These include the stage of your cancer, as well as your age, overall health, and what side effects you’ll find acceptable. Treatment for uterine sarcoma should be done by a gynecologic oncologist. This is a doctor who has had extra training in the diagnosis and treatment of gynecologic cancer.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

The doctor is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your doctor may suggest a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision. Get any questions answered and learn as much as you can so you can make the decision that feels right for you.

The treatment plan your doctor will advise for you depends on these factors: 

  • Type of uterine sarcoma you have
  • Grade and stage of the cancer
  • Size and location of the tumor
  • Your overall health
  • Your age
  • If the cancer has spread to other parts of your body
  • The goal of treatment
  • Your personal concerns and preferences

Understanding the goals of treatment for uterine sarcoma

Treatment may control or cure the uterine sarcoma. It can also improve your quality of life by helping to control the symptoms of the disease. The goal of uterine cancer treatment is to do 1 or more of these things:

  • Remove the primary cancer tumor in the uterus
  • Kill or stop the growth and spread of uterine cancer cells
  • Prevent or delay the cancer's return
  • Ease symptoms of the cancer, such as pain or pressure on organs

Types of treatment

There are 2 main types of treatments: 

  • Local treatments. These remove, destroy, or control cancer cells by focusing treatment in a certain area. Surgery and radiation are local treatments. They work to either remove or destroy the tumor in the uterus. Most women with uterine sarcoma first have surgery followed by radiation or chemotherapy.
  • Systemic treatments. These are treatments that go throughout the body and can destroy or control cancer cells in the uterus, as well as other parts of the body. Chemotherapy and hormone therapy are systemic treatments. They work to kill cancer cells or prevent new ones from growing anywhere in your body.

You may have just one treatment. Or you may have a combination of treatments.  The order, intensity, and goals of treatment depend on the type and stage of cancer you have. 

Local treatments for uterine sarcoma

The local treatments include:                                                                               

  • Surgery. Most women with uterine sarcoma have surgery as the first treatment. The goal of surgery is to fully remove the tumor from your body. With uterine sarcoma, this often means that your entire uterus must be removed. This is called a hysterectomy. In most cases, the fallopian tubes and ovaries are also removed. The surgery may be done using one of several different methods. It may be done through the vagina. It may be done through a cut (incision) in the lower belly (abdomen). It may be done through small incisions with a long, thin tube with a tiny camera (laparoscope). Your doctor may use a precise machine to operate the laparoscope. This is called robotic-assisted. Some of the lymph nodes surrounding your uterus may be removed to check for cancer cells. If the tumor is found outside of the uterus and it can be removed, it will likely be removed during surgery. 
  • Radiation therapy. This is also called radiotherapy. The goal is to kill cancer cells using radiation such as that found in X-rays. Radiation therapy can be given from a machine directed at the pelvis. Or it may be done with tiny implants that are put in through the vagina (brachytherapy). In a few cases, radiation therapy may be used by itself to kill all the cells of a tumor. It may also be used before surgery to shrink a tumor or after surgery to get rid of any cancer cells that may remain.

Systemic treatments for uterine sarcoma

The systemic treatments include: 

  • Hormone therapy. The goal of hormone therapy is to stop cancer cells from growing. Some cancer cells need hormones to grow. Medicines can reduce these hormones in the body. Medicines can also be used to block these hormones and keep them from working in cancer cells.
  • Chemotherapy. The goal of chemotherapy is to kill cancer cells throughout your body. It improves the chances of a cure in some women who may have small amounts of cancer left after surgery.

What is combination treatment?

Your doctor may advise that you have more than one type of treatment. This is called combination therapy. It's common for treating uterine sarcoma. 

Treatments before surgery are called neoadjuvant treatment. For example, you may have radiation or hormone therapy before surgery. These treatments may help shrink the tumor and make it easier to remove. 

Or you may have other treatments after surgery. This is called adjuvant treatment. For example, you may have radiation or hormone therapy after you have healed from surgery. The goal is to kill any cancer cells that may be left in your body. Even if there is no sign of cancer cells, your doctor may still advise adjuvant treatment. It helps reduce the risk that the cancer may come back or spread.

Asking about clinical trials

Uterine sarcomas are often diagnosed in advanced stages when the cancer has already spread. This can make these cancers hard to treat. Researchers are looking for new ways to treat this cancer. These newer types of treatment may be available only through a research study. This is called a clinical trial. Talk with your doctor about what clinical trials may be an option for you.

Making a decision

Once you know the type, stage, and grade of your uterine sarcoma, it’s time to decide on a treatment plan. Meeting with your doctor to talk about your treatment choices will be one of the most important visits you’ll have with your doctor.

It may take time to decide on the best plan. Ask your doctor about how much time you can take to explore your options. You may want to get another opinion before deciding on a treatment. You may also want to talk with your family and friends.