Uterine Sarcoma

Question 1

What are the types of uterine sarcoma, from commonest to least common?

Answer 1

Carcinosarcoma
Leiomyosarcoma
Endometrial stromal cell sarcoma (ESS)
Undifferentiated sarcoma

STUMP (smooth muscle tumours of uncertain malignant potential)

Question 2

What proportion of suspected fibroids are leiomyosarcoma after surgery?

Answer 2

0.1-0.3%

Question 3

What is the prognosis for leiomyosarcoma?

Answer 3

Poor.

15-25% 5 years survival.

70% risk of recurrence.

Question 4

What is the staging for leiomyosarcoma?

Answer 4

I - tumour limited to uterus
II - Tumour extends beyond uterus but limited to pelvis
III - Tumour involves abdominal sites (not just protruding into abdomen)
IV - invades bladder or bowel; OR distant metastases

Question 5

What are the principals for management for leiomyosarcoma?

Answer 5

TAH-BSO and removal of any clinically visible disease.

Usually surgical management is sufficient.

Early stage pre-menopausal women can consider ovarian conservation - evidence suggests similar survival outcomes.

High stage III or IV may benefit from adjuvant chemotherapy (e.g. doxorubicin).

Question 6

What are the principals of staging and management for carcinosarcoma?

Answer 6

Staging as per endometrial cancer.

Carcinosarcoma behaves like high grade aggressive endometrial cancer.

Surgery = comprehensive surgical staging including pelvic and para-aortic LN dissection.

Role for adjuvant chemotherapy though optimum regime unclear.

Question 7

What clinical-pathological features are suggestive of leiomyosarcoma rather than benign fibroid?

Answer 7

• Peri- / Post-menopausal status
• Size ≥ 10cm
• necrosis
• infiltrating border
• extrauterine spread
• Increased / abnormal mitotic figures