What is Uterine Leiomyosarcoma?
Uterine Leiomyosarcoma is a cancer that begins in the smooth muscle cells of the uterus. It usually occurs after menopause and is one of two main types of uterine sarcoma – a rare type of uterine cancer
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Symptoms
Abnormal bleeding from the vagina and other symptoms may be caused by uterine sarcoma. Other conditions may cause the same symptoms. Talk to you doctor if any of the following occur:
- Bleeding that is not part of menstrual periods.
- Bleeding after menopause.
- A mass in the vagina.
- Pain or a feeling of fullness in the abdomen.
- Vaginal discharge.
- Frequent urination.
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Diagnosis
There are currently no recommendations for routine screening although regular visits to your gynecologist are recommended. If symptoms are present, the following tests can be used to examine the uterus and diagnose uterine sarcoma:
- Computed Tomography (CT) scan: CT scans use a computer to combine a series of x-rays and produce a three-dimensional image of internal organs and structures within the body. A CT scan is performed to see if there is a mass present. It does not differentiate between a benign fibroid and a Uterine Leiomyosarcoma so further follow-up exams may be necessary.
- Transvaginal ultrasound exam: A procedure used to examine the vagina, uterus, fallopian tubes, and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram.
- Physical exam and history: An examination of the body can be performed to check for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Pelvic exam: An examination of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
Most of the time, the symptoms are caused by fibroids in the uterus which is a common occurrence and is not cancer. However, if a fibroid starts to grow it is hard to differentiate it from Uterine Leiomyosarcoma, cancer that starts in the smooth muscle cell. Therefore the patient’s test results should be reviewed by an expert in Uterine Leiomyosarcoma prior to surgery. In this instance, surgery might be the next step. If cancer is a possibility, it is preferable that the patient undergo full abdominal surgery rather then laparoscopic surgery because Uterine Leiomyosarcoma can spread throughout the abdomen.
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Common Treatment Options
Treatment for uterine sarcoma is based on the type and stage of the cancer and your ability to tolerate certain medical procedures or medications. The goal of treatment is to preserve healthy tissue while destroying tumors at their point of origin, as well as any cancer cells that have spread throughout the body.
- Surgery
Surgery is usually the first line of treatment with the removal of the entire uterus including the cervix. Even with surgery, Uterine Leiomyosarcoma can recur in the abdomen, then spread to the liver, lungs and bones, so further treatment is recommended to reduce the chance of recurrence. Up until a few years ago, there was no chemotherapy regimen for Uterine Leiomyosarcoma, leiomyosarcoma is not sensitive to radiation therapy, and once the disease has spread to the liver (the most common secondary site) the cancer does not respond to other conventional treatments unless it is small enough to be removed surgically. Today, treatment options have improved
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Our Approach
Our multidisciplinary approach involves a combination of surgery and the latest in chemotherapy effective in many Uterine Leiomyosarcomas. Surgery remains the first line of treatment for new tumors. Tumors that are deemed to have a high potential of recurrence (large tumors, highly malignant tumors, or tumors on the surface of the uterus) receive intraperitoneal chemotherapy (chemotherapy drugs are put directly into the abdomen) to prevent the local spreading of the tumor in the abdomen after surgery. For patients who have already had surgery and had tumors that ruptured during surgery or in cases where the surgeon initially cut through the tumor and left positive surgical margins, it is recommended that we re-operate to remove any palpable tumors. The omentum (the fat pad in the abdomen where foreign objects including tumor cells can collect and grow) is removed and then intraperitoneal chemotherapy is administered which has been shown to reduce the chance of recurrence in the abdomen.
Following surgery, we repeat intraperitoneal chemotherapy through ports put in at the time of surgery. A port is a small round disc that is placed under the skin with a catheter that connects the port to a large vein. Chemotherapy is applied directly into the abdomen where it can be highly effective in preventing abdominal recurrences. Chemotherapy is a type of treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. This is done within three weeks of leaving the hospital and then the port is removed. Intravenous (IV) drugs that are usually used in treating soft tissue sarcomas such as Ifosfomide and Adriamycine are not effective in treating Uterine Leiomyosarcoma. Our team uses other chemotherapy drugs that have been shown to be effective for this disease.
With this multidisciplinary approach we not only achieve the maximum cure rate in patients with Uterine Leiomyosarcoma, but should the patient relapse we are able to use the above treatments and other modalities that are capable of turning inoperable Uterine Leiomyosarcoma into a slowly progressive disease that can be controlled for several years in many instances. However, our main objective is to cure this disease through a multidisciplinary approach of unique treatments that have been shown to be successful in treating the highly resistant Uterine Leiomyosarcoma where other conventional treatments for soft tissue sarcomas do not work.
Each individual patient is unique and different as to the extent of disease, history of prior treatment, histologic type of Uterine Leiomyosarcoma (grade of malignancy), and size of the tumor(s). Therefore an individual plan will be proposed for each patient after careful consideration of all of these factors.
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