Uterine sarcoma is a rare type of cancerous tumor that affects the connective tissue or smooth muscle of the uterus. Symptoms include pain, abnormal vaginal discharge, and swelling. Treatment options include surgery, radiation therapy, chemotherapy, and hormone therapy. The prognosis is usually poor, and a hysterectomy is the preferred treatment.
A type of cancerous tumor in the uterus, a uterine sarcoma occurs in the connective tissue or smooth muscle, as opposed to the endometrium or uterine lining. Uterine sarcomas are relatively rare and comprise only about 100% of uterine cancers; most are endometrial sarcomas. A uterine sarcoma usually occurs after menopause. Treatment usually takes the form of surgical removal, radiation therapy, chemotherapy, and, or, hormone therapy.
Anatomically, the uterus consists of three layers. The innermost is the endometrium, a lining of columnar epithelial tissue that rests on a layer of connective tissue, the stroma. The next layer is the myometrium, which is made up of smooth muscle, the type of muscle tissue found in all organs of the body except the heart. Finally, the uterus is enclosed by the perimetrium, a serous membrane also made up of a layer of epithelial tissue and a layer of connective tissue. Uterine sarcoma affects the stroma or myometrium.
There are three main types of uterine sarcoma, classified according to the tissue from which they arise, although some uterine sarcomas do not fall into one of these groups. Endometrial stromal sarcomas arise from the endometrial stroma, which lies between the endometrium and smooth muscle. Uterine leiomyosarcomas arise from smooth muscle, and uterine carcinosarcomas, also called malignant mixed Müllerian tumors, contain cancerous cells of both epithelial and connective tissue origin. Uterine carcinosarcomas are further divided into two types: homologous, which contain only tissue types found in the uterus, and heterologous, which contain other tissue types including bone, cartilage, or skeletal muscle.
Symptoms of a uterine sarcoma include pain and pressure in the pelvis, abnormal vaginal discharge including postmenopausal or other unusual bleeding, and swelling of a nonpregnant uterus. Diagnosis often begins with imaging techniques such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI), but must be confirmed through microscopic inspection of the tumor. If possible, this inspection can be done via hysteroscopy, biopsy, or dilation and curettage (D&C). In the biopsy, a small portion of the tumor is removed for examination, usually through a needle. Hysteroscopy uses an endoscope, a tube with a system of lights and lenses, to look inside the uterus. In dilation and curettage, the opening to the uterus is dilated or widened and an instrument is used to scrape off the cells for examination.
The prognosis for uterine sarcoma is usually not very good. The preferred treatment is a hysterectomy, in which the entire uterus is removed. Radiation, chemotherapy, and hormone therapy are other treatments available if surgery isn’t possible for some reason.
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