Uterine Sarcoma: Treatment Choices
There are many treatment choices for uterine sarcoma. Which one may work best for you? It depends on a number of factors. These include the stage of your cancer, as well as your age, overall health, and what side effects you’ll find acceptable. Treatment for uterine sarcoma should be done by a gynecologic oncologist. This is a doctor who has had extra training in the diagnosis and treatment of gynecologic cancer.
Learning about your treatment options
You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.
Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may suggest a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision. Get any questions answered and learn as much as you can so you can make the decision that feels right for you.
The treatment plan your doctor will advise for you depends on these factors:
Type of uterine sarcoma you have
Grade and stage of the cancer
Size and location of the tumor
Your overall health
If the cancer has spread to other parts of your body
The goal of treatment
Your personal concerns and preferences
Understanding the goals of treatment for uterine sarcoma
Treatment may control or cure the uterine sarcoma. It can also improve your quality of life by helping to control the symptoms of the disease. The goal of uterine cancer treatment is to do 1 or more of these things:
Remove the primary cancer tumor in the uterus
Kill or stop the growth and spread of uterine cancer cells
Prevent or delay the cancer's return
Ease symptoms of the cancer, such as pain or pressure on organs
Types of treatment
There are 2 main types of treatments:
Local treatments. These remove, destroy, or control cancer cells by focusing treatment in a certain area. Surgery and radiation are local treatments. They work to either remove or destroy the tumor in the uterus. Most women with uterine sarcoma first have surgery followed by radiation or chemotherapy.
Systemic treatments. These are treatments that go throughout the body and can destroy or control cancer cells in the uterus, as well as other parts of the body. Chemotherapy and hormone therapy are systemic treatments. They work to kill cancer cells or prevent new ones from growing anywhere in your body.
You may have just one treatment. Or you may have a combination of treatments. The order, intensity, and goals of treatment depend on the type and stage of cancer you have.
Local treatments for uterine sarcoma
The local treatments include:
Surgery. Most women with uterine sarcoma have surgery as the first treatment. The goal of surgery is to fully remove the tumor from your body. With uterine sarcoma, this often means that your entire uterus must be removed. This is called a hysterectomy. In most cases, the fallopian tubes and ovaries are also removed. The surgery may be done using one of several different methods. It may be done through the vagina. It may be done through a cut (incision) in the lower belly (abdomen). It may be done through small incisions with a long, thin tube with a tiny camera (laparoscope). Your doctor may use a precise machine to operate the laparoscope. This is called robotic-assisted surgery. Some of the lymph nodes surrounding your uterus may be removed to check for cancer cells. If the tumor is found outside of the uterus and it can be removed, it will likely be removed during surgery.
Radiation therapy. This is also called radiotherapy. The goal is to kill cancer cells. This treatment uses radiation such as that found in X-rays. Radiation therapy can be given from a machine directed at the pelvis. Or it may be done with tiny implants that are put in through the vagina (called brachytherapy). In a few cases, radiation therapy may be used by itself to kill all the cells of a tumor. It may also be used before surgery to shrink a tumor. Or it may be used after surgery to get rid of any cancer cells that may remain.
Systemic treatments for uterine sarcoma
The systemic treatments include:
Hormone therapy. The goal of hormone therapy is to stop cancer cells from growing. Some cancer cells need hormones to grow. Medicines can reduce these hormones in the body. Medicines can also be used to block these hormones and keep them from working in cancer cells.
Chemotherapy. The goal of chemotherapy is to kill cancer cells throughout your body. It improves the chances of a cure in some women who may have small amounts of cancer left after surgery. It also can be used before surgery to shrink the tumor. Or it can be used as the only treatment.
What is combination treatment?
Your doctor may advise that you have more than one type of treatment. This is called combination therapy. It's common for treating uterine sarcoma.
Treatments before surgery are called neoadjuvant treatment. For example, you may have radiation, chemotherapy, or hormone therapy before surgery. These treatments may help shrink the tumor and make it easier to remove completely.
Or you may have other treatments after surgery. This is called adjuvant treatment. For example, you may have radiation or hormone therapy after you have healed from surgery. The goal is to kill any cancer cells that may be left in your body. Even if there is no sign of cancer cells, your doctor may still advise adjuvant treatment. It helps reduce the risk that the cancer may come back or spread.
Asking about clinical trials
Uterine sarcomas are often diagnosed in advanced stages when the cancer has already spread. This can make these cancers hard to treat. Researchers are looking for new ways to treat this cancer. These newer types of treatment may be available only through a research study. These studies are called clinical trials. Talk with your doctor about what clinical trials may be an option for you.
Making a decision
Once you know the type, stage, and grade of your uterine sarcoma, it’s time to decide on a treatment plan. Meeting with your doctor to talk about your treatment choices will be one of the most important visits you’ll have with your doctor.
It may take time to decide on the best plan. At first, thinking about treatment options may seem overwhelming. Talk with your doctors and nurses. Make a list of questions. Consider the benefits and possible side effects of each option. Ask your doctor about how much time you can take to explore your options. You may want to get another opinion before deciding on a treatment. You may also want to talk with your family and friends.
March 16, 2019
NCCN Clinical Practice Guidelines in Oncology: Uterine Neoplasms Ver 2.2017 -- April 25, 2017. Natoinal Comprehensive Cancer Network.
Goodman, Howard, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS