Uterine Cancer
Services: Cancer
Uterine Cancer
Sarcomas are cancers that start from muscle, fat, bone, and fibrous tissue (the material that forms tendons and ligaments). Cancers that start in epithelial cells, line or cover most organs, are called carcinomas.
In most cases, the possibility of uterine sarcoma is suggested by specific symptoms. These symptoms don’t always mean that a woman has uterine sarcoma. They are more often caused by something else, such as non-cancerous changes in the uterus (like fibroids), pre-cancerous overgrowth of the endometrium, or endometrial carcinoma.
Many uterine sarcomas are diagnosed during or after surgery for what’s thought to be benign fibroid tumors.
- About
Cancers of the uterus and endometrium:
Sarcomas are cancers that start from muscle, fat, bone, and fibrous tissue (the material that forms tendons and ligaments). Cancers that start in epithelial cells, line or cover most organs, are called carcinomas.
More than 95% of uterine cancers are carcinomas. If a carcinoma starts in the cervix, it is a cervical carcinoma. Carcinomas starting in the endometrium, the lining of the uterus, are endometrial carcinomas. These types of cancer are covered Cervical Cancer and Endometrial (Uterine) Cancer.
Another type of cancer that starts in the uterus is called carcinosarcoma. These cancers begin in the endometrium and have both sarcomas and carcinomas. These cancers are also known as malignant mixed mesodermal tumors or malignant mixed Mullerian tumors.
Types of uterine sarcoma:
Most uterine sarcomas are put into categories based on the type of cell they start in:
Uterine leiomyosarcoma (LMS):
These tumors start in the muscular wall of the uterus (the myometrium). They are by far the most common type. These tumors can grow and spread quickly.
Endometrial stromal sarcoma (ESS):
ESS tumors start in the supporting connective tissue (stroma) of the uterus lining (the endometrium). These cancers are rare.
If the tumor is low grade, the cancer cells do not look very different from normal cells, and the tumor tends to grow slowly. Women with low-grade ESS have a better outlook (prognosis) than women with uterine sarcomas.
High-grade ESS means the cancer cells look very different from normal cells, and the tumor is growing quickly. This type of ESS is most often found when the tumor is already large and has spread. These tumors are hard to treat.
Undifferentiated sarcoma:
These cancers may start in the endometrium or the myometrium. They grow and spread quickly and tend to have a poor outlook.
Benign uterine tumors:
Several types of benign (not cancer) tumors can also develop in the connective tissues of the uterus. These tumors, such as leiomyomas, adenofibromas, and adenomyomas, are also known as fibroid tumors. Most of the time, these tumors don’t need to be treated. But treatment may be needed if they start causing problems, like pelvic pain, heavy bleeding, frequent urination, or constipation. In some cases, the tumor is removed, leaving the rest of the uterus. This surgery is called a myomectomy. Some treatments destroy these benign tumors without surgery by blocking the blood vessels that feed them, killing the tumor cells with electric current, or freezing them with liquid nitrogen. Another option is to remove the entire uterus. This surgery is called a hysterectomy.
- Symptoms
Signs and Symptoms of Uterine Sarcomas:
In most cases, the possibility of uterine sarcoma is suggested by specific symptoms. These symptoms don’t always mean that a woman has uterine sarcoma. They are more often caused by something else, such as non-cancerous changes in the uterus (like fibroids), pre-cancerous overgrowth of the endometrium, or endometrial carcinoma. Still, if you’re having these problems, see a doctor to find the cause and get any needed treatment.
- Abnormal bleeding or spotting
About 85% of patients diagnosed with uterine sarcomas have irregular vaginal bleeding (between periods) or bleeding after menopause. This symptom is more often caused by cancer, but it’s essential to have any irregular bleeding checked right away. If you’ve gone through menopause, any vaginal bleeding or spotting is abnormal, and it should be reported to your health care professional right away. - Vaginal discharge
About 10% of women with uterine sarcomas have a vaginal discharge with no visible blood. A discharge is most often a sign of infection or another non-cancer condition, but it also can be a sign of cancer. Any abnormal discharge should be checked by a health care professional. - Pelvic pain and a mass
When they’re first diagnosed, about 10% of women with uterine sarcomas have pelvic pain and a mass (tumor) that can be felt. You or your doctor may feel the mass in your uterus or feel fullness in your belly and pelvis.
- Diagnosis
How Is Uterine Sarcoma Diagnosed?
Many uterine sarcomas are diagnosed during or after surgery for what’s thought to be benign fibroid tumors.
Some are diagnosed because of symptoms. If you have symptoms of uterine cancer, the first step is to see your doctor.
Your doctor will ask you about your personal and family medical history, examine you, and might order some tests. You also will be asked about any symptoms, risk factors, and other health problems. A general physical and a pelvic exam will be done. An ultrasound may be used to look at the inside of your uterus.
If your doctor suspects cancer, you may be referred to a gynecologist or a doctor specializing in cancers of the female reproductive system (called a gynecologic oncologist).
Sampling and testing endometrial tissue:
To find the cause of abnormal uterine bleeding, a small piece of tissue (a sample) will be taken from the lining of the uterus and looked at with a microscope. The tissue can be removed by endometrial biopsy or by dilation and curettage (D&C). Often a hysteroscopy is done with the D&C..
These procedures let the doctor see if the bleeding is caused by a endometrial overgrowth that’s not cancer (hyperplasia), endometrial carcinoma, uterine sarcoma, or some other problem. The tests will find many endometrial stromal sarcomas and undifferentiated sarcomas, but less than half of leiomyosarcomas (abbreviated LMSs). These tests don’t find all LMSs because these cancers start in the muscle layer of the wall of the uterus. To be found by an endometrial biopsy or D&C, they need to have spread from the middle (muscle) layer to the inner lining of the uterus. In most cases, the only way to diagnose a LMS by removing it with surgery.
Endometrial biopsy:
In this procedure, a very thin, flexible tube is put into the uterus through the cervix. Then, using suction, a small amount of the uterine lining (endometrium) is taken out through the tube. Suctioning takes about a minute or less. The discomfort is a lot like severe menstrual cramps and can be helped by taking a nonsteroidal anti-inflammatory drug like ibuprofen an hour before the biopsy. This procedure is usually done in the doctor’s office.
Hysteroscopy:
This procedure allows doctors to look inside the uterus. A tiny telescope is put into the uterus through the cervix. To get a better view, the uterus is then expanded by filling it with salt water (saline). This lets the doctor see and take out anything abnormal, such as a cancer or a polyp. This procedure is usually done with the patient awake, using local anesthesia (numbing medicine). But if a polyp or mass has to be removed, general or regional anesthesia is sometimes used. (General anesthesia means you are given drugs that put you into a deep sleep and keep you from feeling pain. Regional anesthesia is a nerve block that numbs a larger area of the body).
- Treatment
Common treatment approaches:
A combination of treatments may be used to treat uterine sarcoma. The choice of treatment depends mainly on the type and stage of your cancer. Other factors might include your age, overall health, whether you plan to have children, and personal preferences.
Most women with uterine sarcoma have surgery to remove the cancer. Radiation, chemotherapy, and hormone therapy are sometimes used to help lower the risk of cancer coming back after surgery. These treatments may also be used for cancers that cannot be removed with surgery or when a woman can’t have surgery because of other health problems.
It’s important to discuss all of your treatment options and their possible side effects with your family and your treatment team to make the choice that best fits your needs. If there’s anything you don’t understand, ask to explain it.
It is often a good idea to seek a second opinion if time permits. A second opinion can give you more information and help you feel more confident about the treatment plan you choose.
What are BRCA1 and BRCA2 Genes?
BRCA1 and BRCA2 are tumor suppressor genes, which means that they keep cells from growing too rapidly. Everyone has these genes. Changes or mutations in these genes mean they do not work properly and cells can grow out of control, which can lead to cancer.
How much do BRCA mutations increase the risk of cancer?
The risk of breast cancer for the average American woman is about 12% in her lifetime. Having a BRCA mutation greatly increases the risk. The estimated risk of breast cancer in women with a BRCA mutation is 45–85% by age 70 years.
The risk of ovarian cancer for the average American woman is about 2% in her lifetime. The estimated risk of ovarian cancer in women with a BRCA1 mutation is 39–46% by age 70 years. For women with a BRCA2 mutation, the risk of ovarian cancer by age 70 years is 10–27%.
Women who have a BRCA mutation also have an increased risk of cancer of the fallopian tube, peritoneum, pancreas, and skin (melanoma). Men who have a BRCA mutation have an increased risk of cancer of the breast, prostate, and pancreas.
Why don’t doctors test everyone for BRCA mutations?
BRCA testing is only recommended for people with a high risk of having BRCA mutations. It is important to remember that most cases of breast and ovarian cancer are not caused by gene mutations. If there is a low chance of finding a BRCA mutation, your ob-gyn or other health care professional may not recommend genetic testing.
What is multigene panel testing?
Multigene panel testing is a type of genetic testing that looks for mutations in several genes at once. This is different from single-gene testing, which looks for a mutation in a specific gene. Single-gene testing is often used when a known gene mutation is already in a family. You may consider genetic testing if your personal or family history shows an increased cancer risk.
How can I prevent cancer if I test positive for a gene mutation?
If you test positive for a gene mutation, you can discuss cancer screening and prevention options with your ob-gyn, genetic counselor, or other healthcare professionals. It may be helpful to have earlier or more frequent cancer screening tests to find cancer at an early and more curable stage. Risk reduction steps like medication, surgery, and lifestyle changes also may be recommended.
If I have a gene mutation, should I tell my family?
Having a gene mutation means you can pass the mutation to your children. Your siblings also may have the gene mutation. Although you do not have to tell your family members, sharing the information could be life-saving. With this information, your family members can decide whether to be tested and get cancer screenings early.
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