If you have been diagnosed with uterine sarcoma and you have been referred to Seattle Cancer Care Alliance (SCCA) for treatment, here are some of the treatment choices you may be offered. Remember, each woman’s cancer is different, as are her circumstances, preferences, and beliefs. A treatment that works well for another woman may not be right for you. Your team will explain your options and recommend a treatment plan that’s tailored to you.
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 Seattle Cancer Care Alliance patients is performed at University of Washington Medical Center by gynecologic oncology surgeons.
If you have uterine sarcoma, your first treatment is likely to be surgery. Then, after a pathologist examines your cancer, your doctor may recommend that you have radiation therapy. This may be a combination of external-beam radiation therapy and internal radiation therapy.
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. In this case, your doctor is likely to recommend that you be treated with radiation therapy.
External-Beam Radiation Therapy
Typically, external-beam radiation therapy is given five days a week (Monday to Friday) for five to six weeks using a machine called a linear accelerator. The procedure is not painful, and each treatment lasts only about five to seven minutes. Depending on your treatment needs, as a patient of Seattle Cancer Care Alliance (SCCA) you may receive external-beam radiation therapy for uterine sarcoma at one of these locations:
- SCCA Radiation Oncology at the SCCA clinic on Lake Union, under the supervision of UW Medicine radiation oncologist Wui-Jin Koh, MD, who specializes in treating women with gynecologic cancers
- SCCA Radiation Oncology at UWMC-Northwest
- Cancer Center/Radiation Oncology Services at University of Washington Medical Center (UWMC)
For some uterine sarcomas, intraoperative radiation therapy (IORT) may be an option. IORT is a method of delivering radiation therapy during surgery. It uses electron-beam radiation to treat tumors that cannot be completely removed from the pelvic or abdominal regions because they are attached to important organs or nerves. Or if cancer cells might have been left behind when a tumor was resected, surgeons can move normal structures out of the way during surgery to expose the area for this high-dose radiation treatment. IORT is a fast, effective treatment and uses only a fraction of the total radiation given over a traditional multi-week course of external-beam treatment. UWMC is the only hospital in the Pacific Northwest to offer IORT.
Internal Radiation Therapy
Internal radiation therapy, also known as brachytherapy, is a procedure that delivers radiation to a tumor using radioactive material placed inside the body. For uterine sarcoma, this means radioactive seeds are sealed in a rod that is inserted into the vagina or uterus.
Depending on your specific situation, you might need a high-dose radiation source that’s inserted for a short time (and then removed). Or you might need a low-dose radiation source that’s inserted and left for two to three days.
Learn more about external-beam radiation therapy, IORT, and internal radiation therapy, in the section on radiation oncology.
Radiation Plus Chemotherapy
Clinical trials are currently underway at Fred Hutchinson Cancer Research Center, an SCCA founding organization, and elsewhere to evaluate the combination of radiation therapy plus chemotherapy in the treatment of uterine sarcoma. All of our gynecologic oncologists and radiation oncologists are involved in this research.
Side Effects of Radiation Therapy
Radiation therapy can cause side effects, which may depend on exactly how and where the radiation is given. Your team at SCCA will talk with you about the specific side effects you might experience, and we will help you prevent, reduce, or manage these effects as best as possible. You can find general information in the symptom management section.
Some women have chemotherapy after their surgery for uterine sarcoma. Chemotherapy may also be one of your options if you don’t have surgery.
Usually chemotherapy is used to treat uterine sarcoma only if the cancer has already metastasized, or spread, outside of the uterus by the time of surgery or if the cancer has come back after earlier treatment. But your doctor may recommend chemotherapy for other reasons, including for early-stage uterine cancer if you have a type that tends to be aggressive (to grow and spread quickly).
You may receive one chemotherapy drug or a combination of two or more. Your chemotherapy drugs will be given by infusion into a vein. Then they enter your bloodstream and travel throughout your body, killing cancer cells that may have spread from the original site.
The reason chemotherapy works is that it kills fast-growing cells, which include cancer cells but also other cells, such as hair follicles, white blood cells, and platelets. This is one reason for many of the typical side effects of chemotherapy treatment, including hair loss and low levels of blood cells (low blood counts).
Uterine sarcoma may be treated with one or more of the following chemotherapy drugs (and possibly others):
Liposomal doxorubicin (Doxil)
Chemotherapy is given on various schedules, depending in part on which drugs you receive. Most women receive chemotherapy every three weeks. Some chemotherapy regimens require weekly treatments. Treatment typically continues for three to six months.
Chemotherapy treatments for gynecological patients are given at the University of Washington Medical Center. You may bring a friend or family member to sit with you during your treatment, which may last two to three hours.
Side Effects of Chemotherapy
The side effects of chemotherapy vary according to the drugs that are used. The most common side effects include nausea, vomiting, hair loss, and fatigue. Other possible side effects include mouth sores and an increased chance of bleeding, infection, or anemia. Patients tolerate chemotherapy much better than in the past because of new drugs that help control side effects. Your team at SCCA will talk with you about the specific side effects you might experience, and we will help you prevent, reduce, or manage these effects as best as possible. You can find general information in the symptom management section.
Like chemotherapy, hormonal therapy is a systemic therapy—one that circulates through the bloodstream to attack cancer cells throughout the body.
Hormonal therapy works because hormones can affect the growth of some cancer cells. Reducing or stopping hormone production helps prevent the growth of these cancer cells in women whose cancers are hormone-receptor positive.
Hormonal therapy is sometimes used for endometrial stromal sarcoma (and not for other types of uterine sarcoma because it’s not effective against them). It’s used mainly if the cancer has metastasized, or spread, beyond the uterus or if the cancer has come back after earlier treatment.
Your doctor may suggest using one of these hormonal therapies to slow the growth of your cancer:
Progestins: These drugs are the main hormonal therapies for endometrial stromal sarcoma. They are like the hormone progesterone that occurs naturally in your body. The most common are medroxyprogesterone acetate (Provera) and megestrol acetate (Megace).
Tamoxifen: This drug helps prevent any estrogens that are circulating in your body from stimulating the growth of the cancer cells.
Aromatase inhibitors: If your ovaries have been removed (or no longer function), your body fat still makes estrogen. Drugs called aromatase inhibitors can stop this estrogen from being made. Examples of aromatase inhibitors include letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin).
Gonadotropin-releasing hormone (GnRH) agonists: If you haven’t gone through menopause and your ovaries have not been not removed, you might get injections of these drugs to lower your estrogen levels. They turn off production of estrogen by your ovaries. Examples are goserelin (Zoladex) and leuprolide (Lupron).
Clinical trials are underway to evaluate the effectiveness of other hormonal therapies for endometrial stromal sarcoma.
Your team at Seattle Cancer Care Alliance (SCCA) offers long-term follow-up care for as long as you choose after your treatment for uterine sarcoma. Our patients find it reassuring to see the same team members who treated them—experts in gynecologic cancers—for their follow-up visits. This includes doctors as well as advanced registered nurse practitioners (ARNPs).
Typically, women come for checkups, including pelvic exams, every three months for the first two years after treatment. Some patients choose to have all these follow-up visits at SCCA; some alternate between coming to SCCA and seeing their local primary gynecologist.
Women who reach the two-year mark without having a recurrence of their disease are less likely to have a recurrence and can be seen less often. From that point, we usually ask you to come in every six months for a checkup until you are five years out from your primary treatment. After five years, an annual checkup is all that we recommend, and we offer long-term follow-up for as long as you choose to come here through our Women’s Wellness Clinic.