Treatment for Uterine Sarcoma, by Type and Stage

The main treatment for early-stage uterine sarcoma is surgery to remove the uterus, sometimes along with the fallopian tubes and ovaries. In certain cases the lymph nodes might be removed and checked . Surgery might be followed by treatment with radiation, chemotherapy (chemo), or hormone therapy. Targeted drug therapy and immunotherapy might also be used in advanced cancers.

Women who can't have surgery because they have other health problems or because their cancer has spread are treated with radiation, chemo, or hormone therapy. Often some combination of these treatments is used.

Because uterine sarcoma is rare, it's has been hard to study it well. Most experts agree that treatment in a clinical trial when available should be considered for any type or stage of uterine sarcoma.

Leiomyosarcoma and undifferentiated sarcoma

Stages I (1) and II (2)

Most women have surgery to remove the uterus (hysterectomy), as well as the fallopian tubes and ovaries (bilateral salpingo-oophorectomy). The ovaries might not be removed in women who are still having regular menstrual cycles. Pelvic and para-aortic lymph node dissection or laparoscopic lymph node sampling might be done if swollen nodes are seen on imaging tests or felt during the operation. During surgery, organs near the uterus and the thin membrane that lines the pelvic and abdominal cavities (called the peritoneum) are checked to see if the cancer has spread outside the uterus.

Some stage I cancers might not need more treatment after surgery. Observation (being watched closely after surgery) is an option. In other cases, treatment with radiation, with or without chemo, might be needed after surgery if there's a high chance the cancer will come back. This is called adjuvant treatment. The goal of surgery is to take out all of the cancer, but the surgeon can only remove what can be seen. Cancer cells that are too small to be seen can be left behind. Treatments given after surgery can help kill those cancer cells so that they don't get the chance to grow. For leiomyosarcoma (LMS) of the uterus, adjuvant radiation may lower the chance of the cancer growing back in the pelvis (called local recurrence), but it doesn't seem to help people live longer.

Since the cancer can still come back in the lungs or other distant organs, some experts recommend giving chemo after surgery (adjuvant chemotherapy) for stage II cancers. Chemo is sometimes recommended for stage I LMS as well, but it's less clear that it's really helpful. Results from studies using adjuvant chemo have been promising in early-stage LMS, but so far it does not seem to help prolong life. Studies of adjuvant treatment are in progress.

Stage III (3)

Surgery is done when the surgeon feels they can remove all of the cancer. This includes removing the uterus (a hysterectomy), removing both fallopian tubes and ovaries (bilateral salpingo-oophorectomy), other organs that are involved with the tumor, and lymph node dissection or sampling. If the tumor has spread to the vagina, part (or even all) of the vagina will need to be removed as well.

After surgery, treatment with radiation or chemo might be offered to lower the chance that the cancer will come back.

People who are too sick (from other medical problems) to have surgery may be treated with chemotherapy, radiation and/or chemoradiation.

Stage IV (4)

Stage IVA cancers have spread to nearby organs and tissues, such as the bladder or rectum, and maybe to nearby lymph nodes. These cancers might be able to be completely removed with surgery, and this is usually done if possible. If the cancer cannot be removed completely, radiation might be given, either alone or followed with chemo.

Stage IVB cancers have spread outside the pelvis, most often to the lungs, liver, or bone. There's no standard treatment for these cancers. Chemo may be able to shrink the tumors for a time. Radiation therapy, followed by chemo, might also be an option.

These cancers might also be treated with targeted drug therapy or immunotherapy when other treatments don't work.

Endometrial stromal sarcoma

Stages I (1) and II (2)

Early-stage endometrial stromal sarcoma is commonly treated with surgery: hysterectomy (removal of the uterus) with or without bilateral salpingo-oophorectomy (removal of both fallopian tubes and both ovaries). Some young women who are still having regular menstrual cycles may be given the option of keeping their ovaries. Pelvic lymph nodes might be removed if they look swollen on imaging tests or feel abnormal during the operation, but this has not been shown to help women live longer.

After surgery, most women with stage I (1) cancer don't need more treatment. These women can be watched closely (observation) for any signs that the cancer has returned. Women with stage II (2) cancers might be treated with hormone therapy and sometimes radiation to the pelvis. These can lower the chances of the cancer coming back, but they have not been shown to help patients live longer. This type of uterine sarcoma does not respond well to chemo, and it's not often used at these early stages.

Women who are too sick (from other medical conditions) to have surgery may be treated with radiation and/or hormone therapy.

Stage III (3)

Surgery is done when the surgeon is able to remove all of the cancer. This includes removing the uterus (a hysterectomy), as well as removing both fallopian tubes and ovaries (bilateral salpingo-oophorectomy). Lymph nodes may be removed if they look swollen. If the tumor has spread to the vagina, part (or even all) of the vagina will need to be removed too.

Women with endometrial stromal sarcomas might get radiation, hormone therapy, or both after surgery. Chemo may be used if other treatments don't work.

Women who are too sick (from other medical conditions) to have surgery may be treated with radiation, chemo, and/or hormone therapy.

Stage IV (4)

Stage IVA cancers have spread to nearby organs and tissues, such as the bladder or rectum. These cancers may be able to be completely removed with surgery, and this is usually done if possible. If all of the cancer cannot be removed, radiation might be given, either alone or followed by chemo. Hormone therapy is also an option.

Stage IVB cancers have spread outside of the pelvis, most often to the lungs, liver, or bone. Hormone therapy can help. Chemo and radiation are also options to help ease symptoms. Targeted drug therapy and immunotherapy might also be recommended depending on certain features of the cancer. 

Recurrent uterine sarcoma

If a cancer comes back after treatment, it's called recurrent cancer. If it comes back in the same place as it was before, it's called a local recurrence. For uterine sarcoma, the cancer growing back as a tumor in the pelvis would be a local recurrence. If it comes back in another part of the body, like the liver or lungs, it's called a distant recurrence.

If uterine sarcoma recurs, it often comes back in the first few years after treatment.

Treatment options for recurrent uterine sarcoma are the same as those for stage IV (4) cancers. If the cancer can be removed, surgery might be done. If not already given, radiation might be used to reduce the size of the tumor and relieve the symptoms of large pelvic tumors. Chemotherapy, targeted drug therapy, immunotherapy, or hormone therapy are often needed when uterine sarcoma recurs. Easing symptoms caused by cancer is called palliative or supportive care.

 If uterine sarcoma comes back, you might want to take part in a clinical trial (scientific studies of promising treatments) testing new chemo or other treatments.