What are the symptoms and how to treat uterine stromal sarcoma

After a gynecological examination, women often see a diagnosis of uterine sarcoma in the report, among which uterine stromal sarcoma is a more common symptom. So what symptoms will uterine stromal sarcoma cause to patients, and will patients feel pain? There are currently many treatments for uterine stromal sarcoma, and you can learn about them one by one.

1. Abnormal vaginal bleeding

Vaginal bleeding is the most common symptom and can be manifested as abnormal menstruation or postmenopausal vaginal bleeding. Accounting for 65.5% to 78.2%.

2. Abdominal mass

It is more common in patients with uterine fibroids transforming into sarcomas; the mass grows rapidly, and if the sarcoma grows into the vagina, there is often a feeling of a mass protruding from the vagina. The uterus is often enlarged, irregular in shape, and soft in texture.

3. Abdominal pain

The most common symptom is abdominal distension or dull pain due to the rapid growth of fibroids.

4. Increased vaginal discharge

Vaginal discharge is mostly serous, bloody or white, and may be purulent and foul-smelling when accompanied by infection.

5. If the tumor is large

Compression of the bladder or rectum may cause irritation symptoms, and compression of veins may cause lower limb edema; 6. Late-stage patients

There may be weight loss, anemia, fever, general exhaustion, pelvic mass infiltrating the pelvic wall, and fixation and inability to move.

Gynecological examination: The uterus was significantly enlarged, multi-nodular, and soft. If the sarcoma prolapses from the uterine cavity into the cervix or vagina, a purple-red mass may be seen, and when it is infected, there may be purulent secretions on the surface. If it is a grape-like sarcoma, a soft, brittle, and easily bleeding tumor is found in the cervix or vagina.

Uterine sarcoma treatment

1. Surgery

The treatment of uterine sarcoma is generally based on surgical treatment. Simple hysterectomy and bilateral adnexectomy are the standard surgical treatment procedures. It is mainly reflected in whether the ovaries can be retained, whether lymph node resection is necessary, and the role of tumor cell reduction surgery in advanced lesions.

(1) Surgical resection of uterine leiomyosarcoma is the only treatment that has been proven to have curative value. The classic scope of surgery includes total abdominal hysterectomy and bilateral oophorectomy. If extrauterine lesions are found during the operation, tumor cytoreduction is required.

(2) The standard surgical procedure for low-grade endometrial stromal sarcoma includes total abdominal hysterectomy + bilateral salpingo-oophorectomy. Patients with extrauterine metastatic lesions should undergo tumor cytoreductive surgery.

Bilateral oophorectomy has become a standard surgical procedure for EMS because estrogen may be an agonist for EMS, stimulating tumor growth and potentially increasing the risk of tumor recurrence.

Nevertheless, the impact of ovarian-conserving surgery on survival of early-stage patients remains a controversial issue.

(3) High-grade endometrial stromal sarcoma is highly malignant, prone to extrauterine metastasis, and has a poor prognosis. The scope of surgery is total hysterectomy + bilateral salpingo-oophorectomy, and pelvic and para-aortic lymph node resection is recommended.

Lymph node metastasis is an obvious prognostic factor. The prognosis of patients with lymph node metastasis is significantly worse than that of patients without lymph node metastasis.

(4) Uterine adenosarcoma Uterine adenosarcoma is a tumor with low malignant potential and the incidence of distant metastasis is only 5%. The standard surgical procedure is total hysterectomy and bilateral salpingo-oophorectomy, which has a better prognosis compared with other pathological types of uterine sarcoma.

However, this type of tumor has a tendency to recur locally in the late stage, with approximately 20% of patients experiencing vaginal, pelvic, or abdominal recurrence; therefore, patients require long-term follow-up.

(5) Uterine carcinosarcoma has a highly malignant biological behavior, with dual biological behavior characteristics of cancer and sarcoma. It is very easy to metastasize outside the uterus through lymphatic and blood circulation. The lymph node metastasis rate is as high as 20% to 38%, and the prognosis is extremely poor.

2. Radiation therapy

Because uterine sarcoma has a low sensitivity to radiation, literature reports that there are very few 5-year survivors using radiotherapy alone. The efficacy of radiotherapy for endometrial stromal sarcoma and mixed mesodermal sarcoma of the uterus is better than that for leiomyosarcoma.

3. Chemotherapy

Many cytotoxic anticancer drugs have certain effects on the metastasis and recurrence of uterine sarcoma. Chemotherapy drugs can be used alone or in combination. The 2012 NCCN guidelines recommend drugs including doxorubicin and gemcitabine/docetaxel. Other optional single drugs include dacarbazine, docetaxel, epirubicin, gemcitabine, ifosfamide, liposomal doxorubicin, paclitaxel, temozolomide, etc.

Hormonal therapy is only indicated for endometrial stromal sarcoma and includes medroxyprogesterone acetate, megestrol acetate, aromatase inhibitors, GnRH antagonists, and tamoxifen.