Uterine sarcoma: Difference between revisions

	WikiDoc Resources for Uterine sarcoma
Articles
Most recent articles on Uterine sarcoma Most cited articles on Uterine sarcoma Review articles on Uterine sarcoma Articles on Uterine sarcoma in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Uterine sarcoma Images of Uterine sarcoma Photos of Uterine sarcoma Podcasts & MP3s on Uterine sarcoma Videos on Uterine sarcoma
Evidence Based Medicine
Cochrane Collaboration on Uterine sarcoma Bandolier on Uterine sarcoma TRIP on Uterine sarcoma
Clinical Trials
Ongoing Trials on Uterine sarcoma at Clinical Trials.gov Trial results on Uterine sarcoma Clinical Trials on Uterine sarcoma at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Uterine sarcoma NICE Guidance on Uterine sarcoma NHS PRODIGY Guidance FDA on Uterine sarcoma CDC on Uterine sarcoma
Books
Books on Uterine sarcoma
News
Uterine sarcoma in the news Be alerted to news on Uterine sarcoma News trends on Uterine sarcoma
Commentary
Blogs on Uterine sarcoma
Definitions
Definitions of Uterine sarcoma
Patient Resources / Community
Patient resources on Uterine sarcoma Discussion groups on Uterine sarcoma Patient Handouts on Uterine sarcoma Directions to Hospitals Treating Uterine sarcoma Risk calculators and risk factors for Uterine sarcoma
Healthcare Provider Resources
Symptoms of Uterine sarcoma Causes & Risk Factors for Uterine sarcoma Diagnostic studies for Uterine sarcoma Treatment of Uterine sarcoma
Continuing Medical Education (CME)
CME Programs on Uterine sarcoma
International
Uterine sarcoma en Espanol Uterine sarcoma en Francais
Business
Uterine sarcoma in the Marketplace Patents on Uterine sarcoma
Experimental / Informatics
List of terms related to Uterine sarcoma

VisualWikitext

Latest revision as of 21:27, 9 December 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

A uterine sarcoma is a malignant tumor that arises from the smooth muscle or connective tissue of the uterus. If the lesion originates from the stroma of the uterine lining it is an endometrial stromal sarcoma, and if the uterine muscle cell is the originator, the tumor is a uterine leiomyosarcoma. A lesion that also contains malignant tumor cells of epithelial origin is termed uterine carcinosarcoma (formerly called malignant mixed mesodermal/mullerian tumor).

Classification

Cellular Classification of Uterine Sarcoma.^[1]

The most common histologic types of uterine sarcomas include:

Carcinosarcomas (mixed mesodermal sarcomas [40%–50%]).
Leiomyosarcomas (30%).
Endometrial stromal sarcomas (15%).

Endometrial stromal sarcoma
Malignant mixed müllerian tumor

Histology

Tumoral entities include leiomyosarcomas, endometrial stromal sarcomas, carcinosarcomas and "other" sarcomas.^[2]

If the lesion originates from the stroma of the uterine lining it is an endometrial stromal sarcoma.
If the uterine muscle cell is the originator the tumor is a uterine leiomyosarcoma.
Carcinosarcomas comprise both malignant epithelial and malignant sarcomatous components.

Epidemiology

The vast majority of malignancies of the uterine body are endometrial carcinomas - only about 4% will be uterine sarcomas.^[3]

Risk Factors

The only documented etiologic factor in 10% to 25% of these malignancies is prior pelvic radiation therapy, which is often administered for benign uterine bleeding that began 5 to 25 years earlier.
An increased incidence of uterine sarcoma has been associated with tamoxifen in the treatment of breast cancer.^[4]

Signs and Symptoms

Unusual or postmenopausal bleeding may be a sign of a malignancy including uterine sarcoma and needs to be investigated
Pelvic pain
Pelvic pressure
Unusual vaginal discharge

Diagnosis

Investigations by the physician include imaging (ultrasound, CAT scan, MRI) and, if possible, obtaining a tissue diagnosis by biopsy, hysteroscopy, or D&C. Ultimately the diagnosis is established by the histologic examination of the specimen. Typically malignant lesions have >10 mitosis per high power field. In contrast a uterine leiomyoma as a benign lesion would have < 5 mitosis per high power field.

Staging

Uterine sarcoma is staged using the FIGO cancer staging system.^[5]

Stage I: tumor confined to the corpus uteri

Stage IA: no or less than half myometrial invasion
Stage IB: invasion equal to or more than half of the myometrium

Stage II : tumor invades cervical stroma but does not extend beyond the uterus
Stage III: local and/or regional spread of the tumor

Stage IIIA: tumor invades the serosa of the corpus uteri and/or adnexae
Stage IIIB: vaginal involvement and/or parametrial involvement
Stage IIIC: metastases to pelvic and/or para-aortic lymph nodes

Stage IIIC1: positive pelvic nodes
Stage IIIC2: positive para-aortic nodes with or without positive pelvic lymph nodes

Stage IV: tumor invades bladder and/or bowel mucosa, and/or distant metastases

Stage IVA: tumor invasion of bladder and/or bowel mucosa
Stage IVB: distant metastasis, including intra-abdominal metastases and/or inguinal nodes

Therapy

Surgery is often the principal means of diagnosis and is the primary treatment for all patients with uterine sarcoma. If the diagnosis is known, the extent of surgery is planned according to the stage of the tumor.

Stage I Uterine Sarcoma

Standard treatment options:

Surgery (total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic and periaortic selective lymphadenectomy)
Surgery plus pelvic radiation therapy
Surgery plus adjuvant chemotherapy
Surgery is the mainstay of therapy if feasible involving total abdominal hysterectomy with bilateral salpingo-oophorectomy. Other approaches include radiation therapy, chemotherapy, and hormonal therapy

Stage II Uterine Sarcoma

Standard treatment options:

Surgery (total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and periaortic selective lymphadenectomy)
Surgery plus pelvic radiation therapy
Surgery plus adjuvant chemotherapy

Stage III Uterine Sarcoma

Standard treatment options:

Surgery (total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and periaortic selective lymphadenectomy, and resection of all gross tumor)
Treatment options under clinical evaluation:
Surgery plus pelvic radiation therapy
Surgery plus adjuvant chemotherapy

Stage IV Uterine Sarcoma

References

↑ "uterine sarcoma".
↑ Zagouri F, Dimopoulos AM, Fotiou S, Kouloulias V, Papadimitriou CA (2009). "Treatment of early uterine sarcomas: disentangling adjuvant modalities". World J Surg Oncol. 7: 38. doi:10.1186/1477-7819-7-38. PMC 2674046. PMID 19356236.
↑ [1] American Cancer Society information, accessed 03-11-2006
↑ "uterine sarcoma".
↑ "uterine sarcoma staging".

External links

Uni-Bonn site with detailed information, accessed 03-11-2006

Template:WikiDoc Sources

[1] "uterine sarcoma".

[pmid19356236-2] Zagouri F, Dimopoulos AM, Fotiou S, Kouloulias V, Papadimitriou CA (2009). "Treatment of early uterine sarcomas: disentangling adjuvant modalities". World J Surg Oncol. 7: 38. doi:10.1186/1477-7819-7-38. PMC 2674046. PMID 19356236.

[3] [1] American Cancer Society information, accessed 03-11-2006

[4] "uterine sarcoma".

[5] "uterine sarcoma staging".

[1]

[2]

[3]

[4]

[5]

@@ Line 1: / Line 1: @@
 {{SI}}
+__NOTOC__
+{{CMG}}{{AE}}{{MD}}
+==Overview==
+A '''uterine sarcoma''' is a malignant tumor that arises from the [[smooth muscle]] or [[connective tissue]] of the [[uterus]]. If the lesion originates from the stroma of the [[uterine lining]] it is an '''endometrial stromal sarcoma''', and if the uterine muscle cell is the originator, the tumor is a '''uterine leiomyosarcoma'''. A lesion that also contains malignant tumor cells of epithelial origin is termed '''uterine carcinosarcoma''' (formerly called malignant mixed mesodermal/mullerian tumor).
-==Overview==
+==Classification==
-A '''uterine sarcoma''' is a malignant tumor that arises from the [[smooth muscle]] or [[connective tissue]] of the [[uterus]]. If the lesion originates from the stroma of the [[uterine lining]] it is an '''endometrial stromal sarcoma''', and if the uterine muscle cell is the originator the tumor is a '''uterine leiomyosarcoma'''. A lesion that also contains malignant tumor cells of epithelial origin is termed '''uterine carcinosarcoma''' (formerly called malignant mixed mesodermal/mullerian tumor).
+:Cellular Classification of Uterine Sarcoma.<ref>{{Cite web | title = uterine sarcoma | url = http://www.cancer.gov/types/uterine/hp/uterine-sarcoma-treatment-pdq#section/_5 }}</ref>
+:The most common histologic types of uterine sarcomas include:
+:* Carcinosarcomas (mixed mesodermal sarcomas [40%–50%]).
+:* Leiomyosarcomas (30%).
+:* Endometrial stromal [[sarcomas]] (15%).
+<gallery>
+Image:Endometrial stromal sarcoma gross.jpg|Endometrial stromal sarcoma
+Image:Uterine carcinosarcoma.jpg|Malignant mixed müllerian tumor
+</gallery>
+==Histology==
+Tumoral entities include [[leiomyosarcoma]]s, endometrial stromal sarcomas, [[carcinosarcoma]]s and "other" [[sarcoma]]s.<ref name="pmid19356236">{{cite journal |author=Zagouri F, Dimopoulos AM, Fotiou S, Kouloulias V, Papadimitriou CA |title=Treatment of early uterine sarcomas: disentangling adjuvant modalities |journal=World J Surg Oncol |volume=7 |issue= |pages=38 |year=2009 |pmid=19356236 |pmc=2674046 |doi=10.1186/1477-7819-7-38 |url=http://www.wjso.com/content/7//38}}</ref>
+* If the lesion originates from the stroma of the [[uterine lining]] it is an endometrial stromal sarcoma.
+* If the uterine [[muscle]] cell is the originator the tumor is a uterine leiomyosarcoma.
+* [[Carcinosarcoma]]s comprise both malignant epithelial and malignant sarcomatous components.
+==Epidemiology==
+The vast majority of malignancies of the uterine body are [[endometrial cancer|endometrial carcinomas]] - only about 4% will be uterine sarcomas.<ref>[http://www.cancer.org/docroot/cri/cri_2_3x.asp?dt=63]  [[American Cancer Society]] information, accessed 03-11-2006</ref>
-==Prevalence==
+==Risk Factors==
-The vast majority of malignancies of the uterine body are [[endometrial cancer|endometrial carcinomas]] - only about 4% will be uterine sarcomas.<ref>[http://www.cancer.org/docroot/cri/cri_2_3x.asp?dt=63]  [[American Cancer Society]] information, accessed 03-11-2006</ref> Generally, the cause of the lesion is not known, however patients with a history of pelvic radiation are at higher risk. Most tumors occur after the [[menopause]].
+* The only documented etiologic factor in 10% to 25% of these malignancies is prior pelvic radiation therapy, which is often administered for benign uterine bleeding that began 5 to 25 years earlier.
-Women who take long-term [[tamoxifen]] are at higher risk. <ref>[http://www.cancer.gov/cancertopics/types/uterinesarcoma] [[National Cancer Institute]] information, accessed 03-11-2006</ref>
+* An increased incidence of uterine sarcoma has been associated with tamoxifen in the treatment of breast cancer.<ref>{{Cite web | title =uterine sarcoma| url=http://www.cancer.gov/types/uterine/hp/uterine-sarcoma-treatment-pdq#link/_87_toc}}</ref>
 ==Signs and Symptoms==
-Unusual or postmenopausal bleeding may be a sign of a malignancy including uterine sarcoma and needs to be investigated. Other signs include pelvic pain, pressure, and unusual discharge.  A nonpregnant uterus that enlarges quickly is suspicious. However, none of the signs are specific. Specific screening test have not been developed; a [[Pap smear]] is a screening test for [[cervical cancer]] and not designed to detect uterine sarcoma.
+* Unusual or postmenopausal bleeding may be a sign of a malignancy including uterine sarcoma and needs to be investigated
+* Pelvic pain
+* Pelvic pressure
+* Unusual vaginal discharge
 ==Diagnosis==
@@ Line 16: / Line 41: @@
 Ultimately the diagnosis is established by the histologic examination of the specimen. Typically malignant lesions have >10 [[mitosis]] per high power field. In contrast a [[uterine leiomyoma]] as a benign lesion would have < 5 mitosis per high power field.
 ==Staging==
-Uterine sarcoma is staged like endometrial carcinoma  at time of surgery using the [[International Federation of Gynecology and Obstetrics|FIGO]] [[cancer staging]] system.
+Uterine sarcoma is staged using the [[International Federation of Gynecology and Obstetrics|FIGO]] [[cancer staging]] system.<ref>{{Cite web | title = uterine sarcoma staging | url = http://www.cancer.gov/types/uterine/hp/uterine-sarcoma-treatment-pdq#section/_8}}</ref>
-*Stage IA: tumor is limited to the endometrium
+*'''Stage I''': tumor confined to the corpus uteri
-*Stage IB: invasion of less than half the [[myometrium]]
+:*'''Stage IA''': no or less than half myometrial invasion
-*Stage IC: invasion of more than half the myometrium
+:*'''Stage IB''': invasion equal to or more than half of the [[myometrium]]
-*Stage IIA: endocervical glandular involvement only
+*'''Stage II''' : tumor invades cervical stroma but does not extend beyond the [[uterus]]
-*Stage IIB: cervical stromal invasion
+*'''Stage III''': local and/or regional spread of the tumor
-*Stage IIIA: tumor invades serosa or adnexa, or malignant peritoneal cytology
+:*'''Stage IIIA''': tumor invades the serosa of the corpus uteri and/or adnexae
-*Stage IIIB: vaginal metastasis
+:*'''Stage IIIB''': vaginal involvement and/or parametrial involvement
-*Stage IIIC: metastasis to pelvic or para-aortic lymph nodes
+:*'''Stage IIIC''': metastases to pelvic and/or para-aortic lymph nodes
-*Stage IVA: invasion of the bladder or bowel
+::*'''Stage IIIC1''': positive pelvic nodes
-*Stage IVB: distant metastasis, including intraabdominal or inguinal lymph nodes
+::*'''Stage IIIC2''': positive para-aortic nodes with or without positive pelvic [[lymph nodes]]
+*'''Stage IV''': tumor invades bladder and/or bowel mucosa, and/or distant metastases
+:*'''Stage IVA''': tumor invasion of [[bladder]] and/or bowel mucosa
+:*'''Stage IVB''': distant metastasis, including intra-abdominal metastases and/or [[inguinal nodes]]
 ==Therapy==
-Therapy is based on staging and patient condition and utilizes one or more of the following approaches.
+Surgery is often the principal means of diagnosis and is the primary treatment for all patients with uterine sarcoma. If the diagnosis is known, the extent of surgery is planned according to the stage of the tumor.
-[[Surgery]] is the mainstay of therapy if feasible involving total abdominal [[hysterectomy]] with bilateral salpingo-oophorectomy. Other approaches include [[radiation therapy]], [[chemotherapy]], and [[hormonal therapy]].
+'''Stage I Uterine Sarcoma'''
+* Standard treatment options:
+:* Surgery (total abdominal hysterectomy, bilateral [[salpingo-oophorectomy]] and pelvic and periaortic selective [[lymphadenectomy]])
+:* Surgery plus pelvic radiation therapy
+:* Surgery plus adjuvant [[chemotherapy]]
+:* [[Surgery]] is the mainstay of therapy if feasible involving total [[abdominal]] [[hysterectomy]] with bilateral salpingo-oophorectomy. Other approaches include [[radiation therapy]], [[chemotherapy]], and [[hormonal therapy]]
+'''Stage II Uterine Sarcoma'''
+* Standard treatment options:
+:* Surgery (total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and periaortic selective lymphadenectomy)
+:* Surgery plus pelvic radiation therapy
+:* Surgery plus adjuvant chemotherapy
+'''Stage III Uterine Sarcoma'''
+* Standard treatment options:
+:* Surgery (total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and periaortic selective lymphadenectomy, and resection of all gross tumor)
+:* Treatment options under clinical evaluation:
+:* Surgery plus pelvic radiation therapy
+:* Surgery plus adjuvant chemotherapy
+'''Stage IV Uterine Sarcoma'''
 ==See also==
@@ Line 41: / Line 89: @@
 ==External links==
 * [http://www.meb.uni-bonn.de/cancer.gov/CDR0000062938.html Uni-Bonn site with detailed information], accessed 03-11-2006
 [[Category:Gynecology]]
 [[Category:Types of cancer]]
 {{WikiDoc Help Menu}}
 {{WikiDoc Sources}}