Sarcoma of the uterus

The non-epithelial malignant neoplasm, formed from the basis of the mucous membranes, connective tissue and muscle fibers of the uterine walls, is called uterine sarcoma.

Sarcoma of the uterus is a rare, but rather insidious disease. It is a malignant tumor that enters the tragic list of progressive oncological diseases. Sarcoma of the uterus accounts for approximately 3-5% of all malignant tumors of the uterus, moreover, in the uterine body the disease occurs approximately 3 times more often than on the cervix. According to statistics, women with sarcoma are affected by the age of 45 to 57 years. It is impossible not to note such a sad fact that even with the timely detection of sarcoma in the initial stage of the disease, very rarely a positive result of treatment is observed.

The disease is difficult to diagnose in the early stages of development. However, the combination of treatment and the right approach have an effect in the fight against the disease.

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Causes of uterine sarcoma

The etiological and pathogenetic characteristics of the disease have not been sufficiently studied. Experts suggest that the formation of a sarcoma is a poly-therapeutic process that could provoke damage to the cellular structures of restorative tissues.

Sarcomatom formation is often preceded by other pathologies:

• benign fibromioma, which appeared due to hormonal failure;
• disorders of embryonic development;
• traumatization during labor activity;
• violation of the integrity of the tissues of the uterus after an artificial abortion or scraping for diagnostic purposes;
• disorders of tissue proliferation (development of endometriosis polyps, pathological proliferation of the endometrium).

An important role in the development of sarcoma is played by bad habits (nicotine, alcohol, excessive addiction to drugs), peculiarities of professional activity (the presence of intoxication, harmful production), ecology, radiation therapy.

Since pathology is most common in menopausal women, its appearance can be associated with the cessation of ovulation, increased estrogen content in the body, neuroendocrine disorders.

Women at risk of sarcoma disease may include:

• who had oncology of the breast;
• with the late onset of menopause (after 50 years);
• suffering from polycystic ovary syndrome;
• never giving birth.

A huge role can be attributed to heredity, as well as genetic predisposition to various tumors. Sarcoma affects those tissues and organs that were previously injured. In a risk zone, there may be women who have undergone chemotherapy, as well as those suffering from the herpes virus. There is a chronic intoxication, occupational diseases, bad habits, such as smoking and excessive alcohol addiction, as well as overweight.

[6], [7], [8], [9]

Symptoms of sarcoma of the uterus

As already noted above, women at the age of 43 to 55 are at risk. This age suggests the approach of menopause, or it has already come. Therefore, all women who are over 40 years of age should closely monitor their health, and if the first symptoms are found, immediately consult a doctor. If the disease is detected in the initial stage, then there is more chance of recovery.

It should be noted that with sarcoma of the uterus, very rarely there are any typical symptoms that could alert a woman. Sarcoma is considered a "silent tumor", since even in the last stage of the disease this insidious disease is not manifested. Sarcoma develops in the myomotic node, posing as a uterine fibroid. When bloody discharge from the vagina, menstrual irregularity, bleeding, pus or bleach, there are bouts of aching pain in the small pelvis, it can be assumed that the disease has gone beyond the uterus. At this stage of the disease, the appearance of the woman changes, the yellowness on the face, weakness, loss of appetite, which leads to exhaustion of the body, anemia, and the structure of the blood also changes.

At the initial stages of the disease for a long time can go unnoticed, which greatly complicates the diagnosis. If the sarcoma is formed inside the fibromatous nodular formations, the symptoms may resemble the clinical picture of one of the forms of the uterine fibroid (benign tumor).

Rapid development of the sarcoma can be manifested by the following signs:

• disorder of the monthly cycle;
• aching pain in the lower abdominal cavity;
• the appearance of pronounced watery discharge, which most often have an unpleasant odor.

The most vivid symptomatology is observed in the formation of endometriosis sarcoma, or in the defeat of submucous nodular formations.

At later stages, the signs of sarcoma become apparent. These include:

• anemia;
• loss of appetite, fatigue;
• symptoms of intoxication of the body, accumulation of fluid in the abdominal cavity.

When metastases appear, hepatitis, pleurisy, spinal cord injury and other pathologies may develop, depending on the organ in which the daughter cells of the tumor were transferred.

Varieties of uterine sarcoma

The World Health Organization allocates a sufficiently large number of varieties of uterine sarcoma. All of them have different localization in relation to the organ, as well as the course and rapidity of growth.

Consider the most common types of sarcomas.

Sarcoma of the cervix

A rare type of tumor, which begins its development from the cells of the muscular and connective tissue, from the body of fibroids, blood vessels or mucous membranes. If we consider such a tumor in a section, it resembles the kind of "boiled fish", and from the outside the formation has a matte structure with small necrotic zones and hemorrhages. Often, sarcoma can be confused with a polyp, which is capable of ulceration. Maternal sarcoma can form from the mucous membranes: in such cases, the formation resembles a bunch of grapes.

Sarcoma of the cervix is much less common than sarcoma of the uterus. In such cases, the diagnosis of "cervical cancer" is usually established, since during the examination of the sarcoma it is very similar to cancer, and only with the histological examination it is established the exact diagnosis of "cervical sarcoma". The tumor grows within the anterior and / or posterior lip, with the phenomenon of irreversible changes in the cells, the metabolism is broken, which can lead the cell to degeneration (necrobiosis). Usually, the development of a tumor occurs in the cervical canal. The development of the disease is preceded by fibroma of the cervix or polyps.

With regard to the duration of the course of the disease, it can be said that from the time of the first signs of sarcoma of the cervix, the patients live on average about 2 years. Patients die from sarcomatous pneumonia, as metastases enter the lungs. There may also be abundant uterine or intraperitoneal bleeding, pielonephritis, uremia (compression of the ureters), peritonitis (sarcoma rupture in the abdominal cavity) and liver failure.

Sarcoma of the body of the uterus

Sarcoma of the uterus body (leukemisarcoma) is a fairly common form of sarcoma that appears on the smooth muscles of the uterus, which is combined with uterine myoma. This insidious disease affects women aged 43 to 52 years. The tumor is localized in the wall or in the uterine cavity, less often - located under the mucous membrane of the uterus, or occurs in the outer part of the uterus, progressing to the lower cavity of the pelvis. The tumor spreads in the internal and parietal organs of the peritoneum, giving metastases. Later, metastases appear in the lungs, bones, liver, etc.

This disease begins its development in the tissues of the endometrium or myometrium, within the uterus. Gradually such a tumor progresses, spreading into the pelvic area, germinating in the parameter and sending metastases to the ovaries. In the absence of treatment, metastasis continues into the lymphatic system, the external genitalia.

Stromal uterine sarcoma

A tumor growing from the stroma of the mucous membranes of the uterine walls. The course of this disease can be both aggressive and relatively benign, which is due to the biological characteristics of the neoplasm (parameters, genomic disorders, rate of progression). Endometrial stromal uterine sarcoma, according to the most common version of specialists, develops from nascent stromal cells, or appears as a result of metaplasia of neoplastic cells. Such a tumor is clinically manifested by bloody discharge from the vagina, a two-handed study can reveal an increase in the size of the uterus, sometimes with a non-uniform consistency.

Endometrial stromal uterine sarcoma is distinguished by a high degree of malignancy. There is an aggressive course of the disease, as a result of which additional tumor nodes may appear, both in nearby and in distant organs (metastasis). The cause of death in about 90% of cancer patients is not a tumor, but a metastasis. Endometrial stromal uterine sarcoma is characterized by a rather unfavorable prognosis with a high degree of hematogenous locating, as a result of which the sarcoma spreads through the blood vessels to any human organs. The number of mitoses for an enlarged microscope is more than 10 in 10 fields of vision. Endometrial uterine sarcoma is observed in women aged 45 to 50 years. The disease progresses, mainly during the menopause and is a tumor in the form of an ecophytic form. With endometrial stromal sarcoma of the uterus, single-type cells are formed that resemble normal endometrial stromal cells. In medicine, there are three types of endometrial sarcomas. This is an endometrial stromal nodule, endometrial stromal sarcoma of high and low degree of malignancy. The most dangerous degree is an endometrial sarcoma of the lower degree, because at this stage the tumor is already noticeably spreading beyond the small pelvis, actively penetrating through the tissue barriers.

Metastases with uterine sarcoma

Sarcoma is able to spread metastases with a current of blood or lymph, or grow into neighboring organs.

The development of sarcomas from smooth muscles is slowest, so they can metastasize somewhat later. Such uterine sarcomas throw their particles into the blood, from where they enter the respiratory and bone system, the liver, the external genitalia. When the daughter cells spread to the lungs, the left side is more often affected: the right lung suffers less often. The metastatic lesion of the peritoneal and glandular tissues is usually accompanied by the accumulation of fluid in the abdominal cavity.

Most often, the sarcoma metastasizes into the appendages: this condition is especially common in endometrial sarcoma, a little less often - with a mixed form of mesodermal formation.

The process of spreading metastases can quickly provoke a fatal outcome. Dissemination of metastases can be chaotic, the sequence of such a process is difficult to determine.

Diagnosis of uterine sarcoma

Sarcoma of the uterus is extremely difficult to diagnose, based only on the collected history and clinical picture of the disease. The totality of the characteristic signs of the disease should be confirmed by other additional studies that provide more accurate information.

Examination of the external condition of the genital organs, mirror and two-handed examination may suggest the presence of oncological pathology. This conclusion is facilitated by the definition of nodal formations and tubercles in the uterus, daughter neoplasms in the vagina.

[10], [11], [12], [13]

Sarcoma of the uterus on ultrasound

Ultrasound is perhaps the most popular type of study and further control of myoma growth, determination of the size of pathology, degree of deformation and damage to the uterine walls. Sarcoma of the uterus on ultrasound does not give such a clear idea of the tumor that would have been required: such a pathology does not have bright acoustic symptoms. At the same time, stable growth of the neoplasm during the examination in dynamics (apparent development of the tumor during the year), as well as changes in the structure of fibromatous nodal formations simultaneously with the characteristic clinical signs, can be the reason for the use of surgical intervention. Ultrasound, in addition, helps to monitor the condition of nearby lymph nodes and organs, and evaluate the possibility of metastasis.

Of course, it is impossible to clearly define sarcoma with this method, but you can notice an increase in the focus of the tumor during a checkup, for example, during the year by an amount that corresponds to the gestation period of about 5 weeks. In this case, rapid growth of the tumor is considered. Also, using ultrasound, you can see how the fibromatous nodes change during menopause and during the postmenopause. Ultrasound examinations give a clear definition for making a decision for surgical intervention, and also help to examine adjacent organs for a tumor. The ultrasound method in sarcoma of the uterus determines pathological changes, localization, the size of the nodes and recognizes the uterine deformity.

The method of aspiration biopsy with the subsequent cytology of secretions allows to detect the exfoliated elements of the neoplasm.

The method of hysteroscopy provides an opportunity to pay attention to the pathological changes in the tissues: you can detect tumors with a different pattern of outlines, and also perform a targeted biopsy of the formation.

The method of histology is the "gold standard" in the diagnosis of malignant tumors in the uterus. The necessary material for analysis can be removed with the help of colposcopic biopsy, excision, curettage, etc. Sometimes there is separate analytical scraping of the mucosa of the uterine cavity, especially this method is relevant for the germination of endometrial tissue, with stromal endometrial neoplasm. In other variants of tumor location, changes in the structure of the inner shell of the uterus are not detected. Indicative is also an immunohistochemical test: malignant sarcoma cells are positively tuned to vimentin (almost 96%), and locally to actin. Markers of mesenchymal differentiation are represented by desmin, cytokeratins, actin, type IV collagen, vimentin.

Among the auxiliary methods can be identified magnetic resonance examination or computed tomography of the small pelvis, lung X-rays, colonoscopy, rectosigmoscopy, blood testing (the presence of anemia).

Final diagnosis can be established only on the basis of histology after removal of the sarcoma.

Treatment of uterine sarcoma

There are several methods for the treatment of uterine sarcoma, but the most common can be considered a surgical method followed by chemo-radiotherapy. Surgical treatment allows you to first determine the stage of the disease with the subsequent removal of the main part of the tumor. This method of treatment is used at an early stage of the disease. In other cases, when the disease is detected late, surgery is not enough. Other methods of treatment are needed here. As for radiation therapy, this is one of the most effective ways of treating uterine sarcoma today. It should be noted that surgical treatment or chemotherapy alone will not yield positive results. This method of treatment "works" only in a complex. The combination of these two methods of treatment allows you to get rid of the roots of the tumor. The popular method of treatment of uterine sarcoma is widely used. There is a huge variety of recipes for alternative medicine, however, there are different cases. For example, very hopeless patients who have tried all possible types of treatment for uterine sarcoma recover by applying this or that prescription of alternative healers. Very often it is recommended to use a scarlet flower. This remarkable plant can exert an antitumoral effect, while restoring its immunity. Take one large sheet of scarlet, grind it and pour one liter of alcohol. Infuse for two weeks, after which it is necessary to take one tablespoon before meals three times a day before meals.

As therapeutic measures in sarcoma of the uterus most often used chemotherapy, surgical removal of the tumor, or combined combined therapy of pathology.

Considering the fact that sarcoma tends to unimpeded lymphogenous metastasis, the best treatment option is considered by the specialists to be the surgical method. It is a large-scale extirpation of the uterus with ovaries, possibly involving a large omentum (a large possibility of spreading metastases). Lymph nodes can also be removed.

Depending on the stage, additional radiation and / or chemotherapy may be prescribed.

Chemotherapy for sarcoma of the uterus

Chemotherapy for sarcoma of the uterus is caused by the use of therapeutic schemes with the use of anthracyclines - the so-called antitumor antibiotics. These drugs include daunorubicin, doxorubicin, idarubicin, or epirubicin, actively used in the world. For this period, the effect and the presence of a positive effect of the drug Ifosfamide, its use both in monotherapy and in combination with other antitumor agents are studied.

The positive dynamics with such chemotherapy can be 15-30%.

The use of combination therapy is usually more effective, however, and more toxic. A positive effect is observed from the combined treatment of docetaxel and gemcitabine (53% efficiency), possibly repeated control treatment in case of suspected recurrence of the tumor.

In some cases, the use of hormone therapy, progestogen and antiestrogen preparations, large dosages of progesterone for the diagnosis of stromal sarcoma of a low degree of malignancy is allowed.

Combined radiation therapy and its role in the effectiveness of curing uterine sarcoma has not been sufficiently studied.

[14], [15], [16], [17]

Prevention of uterine sarcoma

First of all, the prevention of uterine sarcoma is a regular preventive examination by a gynecologist. If a benign uterine tumor is found, it is necessary to undergo timely treatment, but if the disease is not found, it is recommended to seek advice about 2-3 times a year. It is also necessary to comply with all the prescriptions and recommendations of a doctor in the treatment of female diseases, especially if it concerns hormonal disorders. Specialists also advise not to delay with childbirth, give birth to preferably two or three children. If your plans do not include the birth of children, you should use modern methods of protection from unwanted pregnancy, not to allow abortions. You should also stick to the diet, limiting the use of animal fats. Eat more fruits and vegetables. And, of course, we can not fail to mention the healthy way of life. Avoid bad habits, such as smoking, drinking alcohol, more out in the fresh air and go in for sports.

Preventive measures include regular visits to the gynecologist, medical examinations, both in childhood and in the menopausal period. It is important in time to detect and treat neuroendocrine disorders, inflammatory processes of the uterus and appendages, fibroids, polyposis.

A balanced hormonal background also plays a role in the prevention of the disease, so it is necessary to follow the following principles:

• correctly choose contraceptive drugs, always consulting with the doctor;
• Do not allow the appearance of unwanted pregnancy, avoid artificial abortion;
• to develop a full-fledged active sex life;
• avoid stressful situations, do not overwork, lead a healthy lifestyle;
• timely treat any infectious and inflammatory diseases.

Prognosis of uterine sarcoma

The prognosis of uterine sarcoma is ambiguous: tumors that form from fibromatous nodules (with non-distributed metastases) have a more favorable course, however, the endometrial sarcoma is not such a positive trend. According to statistics, the survival rate of patients during the five-year period is as follows:

• at the first degree of sarcoma - 47%;
• at the second degree - about 44%;
• at the third degree - 40%;
• at the fourth degree of a tumor - only 10%.

Intensive studies, currently conducted by specialists in molecular genetics, allow us to hope that in the near future we will receive an answer to the numerous questions that are associated with the diagnosis of uterine sarcoma. Scientists are working hard to allow the medicine to control the course of the pathology, to increase the adequacy of therapeutic measures and to preserve and prolong the life of patients.