The most common, and usually the first, treatment for uterine sarcoma is surgery to remove all of the cancer or as much cancer as possible. Some women need only surgery followed by checkups to monitor their condition. Others have radiation therapy or other treatments after surgery.
For a small minority of women with uterine sarcoma, doctors may advise against removing the cancer surgically. Your doctor may feel surgery is not the best treatment for you because of the size or location of the cancer or because you have other health problems. If your cancer cannot be removed surgically, you may have radiation therapy, chemotherapy, hormonal therapy, or a combination.
Most women with uterine sarcoma have a total hysterectomy—surgery to remove the uterus, including the cervix. If your cancer has spread to your cervix or the tissue around your cervix (parametrium), your surgeon will also remove the parametrium, the ligaments that connect your uterus to your sacrum, and the upper part of your vagina. This is called a radical hysterectomy.
With either type of hysterectomy, you will very likely have your fallopian tubes and ovaries removed (bilateral salpingo-oophorectomy) at the same time because these are places where uterine sarcoma may spread.
Lymph Node Removal
Your surgeon will also remove lymph nodes from your pelvic area and around the major artery (aorta) in your abdomen (pelvic and para-aortic nodes). The lymph nodes are biopsied to determine whether the cancer has spread through your lymph system.
At the start of your surgery, your surgeon may wash your abdominal and pelvic cavities with salt water (peritoneal lavage). This fluid is sent to a laboratory to be checked for cancer cells. The results can add another piece of information to help your doctor recommend a treatment plan for you. The surgeon may also remove abdominal fat (omentum) and small samples of the lining of your abdominal and pelvic cavities (peritoneum) for testing.
Laparoscopic & Robot-Assisted Surgery
Hysterectomies, lymph-node removals, and the other elements of surgery to stage uterine sarcoma can now be performed using minimally invasively techniques. The surgeon can operate laparoscopically, either inserting instruments directly through small incisions or using a robotic system, like the da Vinci Surgical System, to assist with the surgery. The da Vinci system allows surgeons to do surgery without a large incision. This has been shown to improve patient outcomes by reducing postoperative pain, infection, blood loss, and recovery time.
Open laparotomy—abdominal surgery with a larger incision—is still done, too. In certain situations, it is the best option. If you need open surgery, your surgeon will explain the reasons.
Surgery for Fred Hutch patients is performed at University of Washington Medical Center by gynecologic oncology surgeons.