Uterine Sarcoma - Causes, Symptoms and Treatment .MF .
uterine sarcomas - quite rare tumor of female genitalia.On average, they make up 2-6% of malignant tumors of the uterus.Sarcomas of the uterus - the most malignant tumors of the uterus, very different from endometrial cancer with the flow characteristics of metastasis and treatment.A characteristic feature is the fact that many patients in the past received radiation therapy to the pelvic area - such medical history meet at 7 - 20% of patients with uterine sarcoma.
most often occur following types of uterine sarcomas: endometrial stromal sarcoma, leiomyosarcoma, and carcinosarcoma, at least - pure sarcoma and angiosarcoma.Leiomyosarcoma and carcinosarcoma occur equally often, and add up to 80% of all uterine sarcomas, endometrial stromal sarcoma - 15%, a rare tumor - the remaining 5%.
The average age of patients with leiomyosarcoma 43-53 years.Prognosis is better in pre-menopausal women.The frequency of malignancy of uterine fibroids, according to different authors, is 0,13-0,81%.Suspected leiomyosarc
carcinosarcoma is more common in the elderly, 65 years and consists of two components - epithelial and mesenchymal.The epithelial component is usually represented by adenocarcinoma, and mesenchymal or resembles normal endometrium, or presented from tumor tissue, normally absent in the womb: the cartilage, bone, striated muscle.Most likely, carcinosarcoma develop from endometrial stromal cells.In most cases, carcinosarcoma occurs in postmenopausal women.In patients with uterine carcinosarcoma often are obesity, diabetes, hypertension.From 7 to 37% of patients in the past received external beam radiotherapy to the pelvic region.
endometrial stromal tumors occur mostly in women 45-50 years old, about 30% of cases they occur in postmenopausal women.
adenocarcinoma - a rare variant of carcinosarcoma.The epithelial component of this tumor presented a benign glandular tumor and mesenchymal - one of sarcomas.
symptoms of uterine sarcoma
For all types of sarcomas are most characteristic of the three main clinical manifestations of type:
1. bleeding from the genital organs in postmenopausal women, or between periods.
2. Less frequently, usually with a significant increase of the uterus, there are pain and symptoms of compression of adjacent organs.
3. Probably asymptomatic.
survey of suspected uterine sarcoma
• If bimanual examination revealed an increase in the uterus, and sometimes individual nodes and infiltrates in the parameter defines clearly.
• When aspiration biopsy of the endometrium of the uterus during curettage, hysteroscopy with biopsy.More effective in endometrial stromal tumors, at least leyomio- and kartsionosarkome.
• Often the disease is diagnosed after surgery for presumed uterine fibroids.In this case reveal an enlarged uterus filled with soft whitish-gray or yellow with tumor necrosis and hemorrhage extending to the pelvic veins.
• Ultrasound - allows you to see an increase in the size of the uterus, changes in the contours of the uterus, it ehostruktury;increase or decrease in the uterine cavity;changes in the endometrium.
• CT or MRI diagnosis - to identify metastases in distant organs
• can be attributed to additional methods of examination - barium enema, sigmoidoscopy, cystoscopy, etc.
Unfortunately, due to delays in seeking medical attention at the time of diagnosis in 40% of patients the tumor has spread beyond the uterus limits (this is especially characteristic for carcinosarcoma), but in 60-70% of cases, it has not yet moved beyond thepelvis.Dissemination on the upper part of the peritoneum abdominal metastases in the liver, lungs and lymph nodes are rare.Relapses occur in 50% of patients at a mean of 5 years after treatment.When relapse and metastasis are possible long-term remission and even cure.
Special mention should be noted that even in the early stages of clinical carcinosarcoma often detected metastases in the pelvic lymph nodes.Approximately half of patients with stage I uterine carcinosarcoma has deep myometrium invasion, significantly worsens the prognosis.It should be noted that virtually all patients with myometrial invasion by more than half its thickness die.Adverse prognostic factors also include large tumor size, presence of tumor emboli in lymphatic crevices, development carcinosarcoma after pelvic irradiation.Five-year survival rates for uterine carcinosarcoma low, is 20-30%.
Treatment of uterine sarcoma
Treatment of endometrial stromal sarcoma should begin with the operation.Perform hysterectomy with appendages and all visible metastases are removed as far as possible.Appendages, you can save only patients with leiomyosarcoma of the uterus of childbearing age.Necessarily combination with chemotherapy, especially in high grade tumors.Effective radiation therapy, but radiation therapy does not work for uterine LMS.It is carried out in the presence of residual tumor in the pelvis and in relapsed.
endometrial stromal sarcoma of low grade - hormone-dependent tumors may progestogen treatment.
Gynecologist Kupatadze DD