The majority of endometrial cancers are uterine carcinomas, which are cancers that form in the tissues that line internal organs such as the uterus. Some women, however, develop a type of cancer called a uterine sarcoma. These cancers start in the muscle (the myometrium) or other connective tissues of the uterus.
The three main types of uterine sarcoma are carcinosarcoma (a malignant tumor that is a mixture of carcinoma and sarcoma), leiomyosarcoma (cancer that begins in smooth muscle cells of the uterine wall), and endometrial stromal sarcoma (cancer that begins in connective tissue cells). Although even rarer, two other types of uterine sarcomas are adenosarcomas (a mixed tumor made up of glandular and sarcoma cells) and high-grade undifferentiated sarcomas.
Less than 4 percent of all uterine cancers are uterine sarcomas. Because uterine sarcomas are so rare and the behavior of these tumors is so variable, expert pathological review is critical. It is important for women diagnosed with these cancers to receive treatment at a center with experience caring for such patients. Memorial Sloan-Kettering has experts who diagnose and treat uterine sarcomas, and we have an active research program working toward developing more effective therapies for these diseases.
Most women have surgery to treat uterine sarcoma. Depending on the stage of the disease and the type of sarcoma, surgery may include total abdominal hysterectomy (removal of the uterus through an incision in the abdomen), bilateral salpingo-oophorectomy (removal of both ovaries and both fallopian tubes), and/or lymphadenectomy (removal and examination of some of the pelvic lymph nodes).
Other treatment options include radiation therapy, hormone therapy, and chemotherapy — used either alone or in combination with another therapy. Treatment recommendations depend on the specific type of sarcoma, the stage of the cancer, and the patient's sarcoma history.
Our doctors developed a novel chemotherapy regimen that has demonstrated excellent efficacy in patients with leiomyosarcoma that has metastasized and cannot be removed surgically [PubMed Abstract]. The success of this regimen — a combination of gemcitabine and docetaxel — to treat leiomyosarcomas has led to additional research efforts, including two larger studies of our treatment regimen by the Gynecologic Oncology Group, which proved the efficacy of this regimen for metastatic uterine leiomyosarcoma. We have also shown that this regimen is effective in treating patients with other types of soft tissue sarcoma.We are actively investigating new treatments for advanced leiomyosarcoma.
For patients with early-stage leiomyosarcoma of the uterus that has been completely removed surgically, we are evaluating the role of adjuvant chemotherapy to reduce recurrence in women with high-risk types of the disease.