Leiomyosarcoma natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]
Overview
Leiomyosarcoma of uterus is an agressive soft tissue tumor which is diagnosed accidentally when they remove fibroid tumor and histology analysis reveal the aggressive nature of tumor. LMS most commonly metastasizes to the lungs, liver, abdomen, pelvis, and pelvic or paraaortic lymph nodes. Bone and brain metastases are less common sites of involvement. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary, in those that tumor spread beyond uterus and pelvic, prognosis is very poor. Overall survival rate ranges from 15% to 25% with a median survival of only 10 months. Prognosis depends mainly on the age of the patient, race, FIGO stage, mitotic index and hormonal receptor expression in the tumor.
Natural History
Most Leiomyosarcoma are diagnosed incidentally during hysterectomy of suspected fibroid tumors. A leiomyosarcoma, especially in the early stages, may not be associated with any obvious symptoms (asymptomatic).The majority of patients with leiomyosarcoma remain asymptomatic for decades. General symptoms associated with cancer may occur including fatigue, fever, weight loss, a general feeling of ill health (malaise), and nausea and vomiting. This heterogeneous group of mesenchymal neoplasms are relatively rare and may arise in soft tissue, skin or various organs, and show a broad range of differentiation, such as smooth muscle (leiomyosarcoma), adipocyte (liposarcoma), striated muscle (rhabdomyosarcoma), endothelium (angiosarcoma) or fibroblast (e.g., dermatofibrosarcoma). The prognosis of patients with uterine sarcomas has not changed in recent decades. Patients with leiomyosarcoma have overall 5‐year survival rate of between 17.5% and 54.7% in various studies.[1]
Complications
They are invariably aggressive that may metastasize to other areas of the body such as the lungs or liver, potentially causing life-threatening complications. Leiomyosarcoma has a high risk of recurring of about 53% to 71% after treatment, if not diagnosed early.[2]
Prognosis
The prognosis of leiomyosarcoma is poor and it depends upon different factors including site of tumor, size, and type, as well as the extent of tumor spread. Some patients with low grade tumors or with tumors that have not spread beyond Stage I have better prognosis. In general, high-grade tumors that have spread widely throughout the body have less favorable survival rates. Some of these progostic factors that affect survival rates of patients with leiomyosarcoma include:[3]
- FIGO stage at the time of the initial diagnosis (survival after initial diagnosis has been reported to be 50% in stage 1 and stage 2 disease)
- Age at the time of diagnosis
- Mitotic count
- Tumor size (tumors greater than 5cm has worse prognosis)
- Adjuvant therapies such as chemotherapy and radiation
References
- ↑ Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL, Yordan E, Brady MF (February 1993). "Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study". Cancer. 71 (4 Suppl): 1702–9. PMID 8381710.
- ↑ Gadducci A (2011) Prognostic factors in uterine sarcoma. Best Pract Res Clin Obstet Gynaecol 25 (6):783-95. DOI:10.1016/j.bpobgyn.2011.06.002 PMID: 21764643
- ↑ Koivisto-Korander, Riitta; Butzow, Ralf; Koivisto, Anna-Maija; Leminen, Arto (2008). "Clinical outcome and prognostic factors in 100 cases of uterine sarcoma: Experience in Helsinki University Central Hospital 1990–2001". Gynecologic Oncology. 111 (1): 74–81. doi:10.1016/j.ygyno.2008.06.002. ISSN 0090-8258.