Treatments for uterine sarcoma

The following are treatment options for early stage, advanced stage and recurrent uterine sarcoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

The following are treatments for stage 1 and 2 uterine sarcoma.

Surgery is the main treatment for early stage uterine sarcoma. Staging is done during surgery. The surgeon does a pelvic exam while you are under general anesthetic. Then the surgeon makes an incision, or cut, in the abdomen to examine the organs and see if the cancer has spread to them. This is called abdominal exploration (laparotomy). The surgeon may remove tissue samples and lymph nodes during surgery. The surgeon may also rinse the abdomen with saline and collect a sample (called pelvic washings). Tissue samples, lymph nodes and pelvic washings are sent to the lab and examined under a microscope to check for cancer cells. The same surgery can also be done using less invasive methods with laparoscopy or robotic surgery.

The most common surgery done is total hysterectomy (removal of the uterus and cervix) and bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries). The surgeon usually removes lymph nodes in the pelvis and around the aorta (called lymph node dissection).

You may be offered radiation therapy after surgery for early stage uterine sarcoma. It may also be used as the main treatment for women who cannot have surgery because of other medical problems. You may be given external beam radiation, brachytherapy or both.

You may be offered chemotherapy after surgery for early stage uterine sarcoma. The chemotherapy drugs used may include:

• doxorubicin (Adriamycin)
• ifosfamide (Ifex)
• cisplatin (Platinol AQ)
• paclitaxel (Taxol)
• docetaxel (Taxotere)
• gemcitabine (Gemzar)

A combination of drugs, such as docetaxel and gemcitabine, may be given.

You may be offered hormonal therapy after surgery for early stage endometrial stromal sarcoma. It is rarely given for other uterine sarcomas.

The hormonal therapy drugs used may include:

• tamoxifen (Nolvadex, Tamofen)
• megestrol (Megace, Apo-megestrol, Nu-megestrol, Lin-megestrol)
• medroxyprogesterone (Provera)

The following are treatments for stage 3 and 4 uterine sarcoma. Treatments offered for stage 4 uterine sarcoma are to control the disease and relieve the symptoms it is causing.

Surgery is the first treatment for stage 3 uterine sarcoma. The most common surgery is total hysterectomy and bilateral salpingo-oophorectomy. The surgeon may remove lymph nodes in the pelvis and around the aorta (called lymph node dissection). The surgeon also removes as much of the tissue that the cancer has spread to as possible.

Surgery may be offered for stage 4 uterine sarcoma. The types of surgery done might include pelvic exenteration and tumour debulking. Surgeons may also do surgery to remove small distant metastases.

Surgery is usually followed by radiation therapy. Chemotherapy or hormonal therapy may also be given.

You may be offered radiation therapy after surgery for advanced stage uterine sarcoma. If you can't have surgery because of other medical problems or if the cancer can't be completely removed, radiation therapy may be used as the main treatment. It can also be used to control the cancer and manage symptoms.

Radiation therapy may be followed by:

• chemotherapy for uterine leiomyosarcoma
• hormonal therapy for endometrial stromal sarcoma

You may be given external beam radiation, brachytherapy or both.

Chemotherapy may be offered for stage 3 uterine sarcoma after surgery and radiation therapy. It may be given to control the growth of and relieve the symptoms of stage 4 uterine sarcoma. Chemotherapy drugs may be given alone or in combination.

The chemotherapy drugs used may include:

• doxorubicin
• ifosfamide
• cisplatin
• paclitaxel
• docetaxel
• gemcitabine

A combination of drugs may be given, such as:

• doxorubicin and ifosfamide
• docetaxel and gemcitabine

You may be offered hormonal therapy for advanced stage endometrial stromal sarcoma. It is rarely given for other uterine sarcomas.

The types of hormonal therapy used include:

• tamoxifen
• megestrol
• medroxyprogesterone

There is no standard treatment for recurrent uterine sarcoma. Your healthcare team will offer the same treatments used for advanced uterine sarcoma based on where the cancer has come back.

You may want to consider a type of care to make you feel better rather than treat the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

You may be asked if you want to join a clinical trial for uterine sarcoma. Find out more about clinical trials.