Endometrial stromal sarcoma. Stromal endometrial sarcoma of the uterus Endometrial sarcoma

Uterine sarcoma is considered one of the most insidious diseases in women. The prognosis for life with this disease varies depending on the stage of the pathological process. However, most often it is disappointing. The five-year survival rate at the initial stage is 47% of all cases. If detected at the fourth stage - only 10%. There is no need to talk about positive dynamics even with timely diagnosis and proper treatment.

Description of the disease

Uterine sarcoma is a rare but insidious pathology. The neoplasm is formed from undifferentiated elements of the endometrium or myometrium. Cancer occurs in women of all ages, including little girls. It manifests itself as cyclic bleeding, abdominal pain, and general malaise. Sarcoma is difficult to diagnose initial stages development. The answer to the question of complete recovery depends on the stage of the pathological process, the patient’s age and her state of health. All forms of the disease are characterized by a high degree of malignancy. Therefore, they are difficult to treat.

Forms of uterine sarcoma

Depending on the location of malignant cells, the following forms of the disease are distinguished:

• Leimiosarcoma is the most aggressive tumor, which can reach a diameter of 5 cm. It forms exclusively in the soft tissues of the myometrium.
• Endometrial stromal sarcoma develops in the connective supporting structure of the uterus and is extremely rare (only 1% of all cases of malignant lesions). There are two categories of tumors: low-quality and undifferentiated. In the first case, the neoplasm is practically life-threatening and progresses slowly. accompanied by poor health, which affects the patient’s condition.
• Carcinosarcoma forms in the endometrium.

Many people confuse two diseases: uterine sarcoma and cancer. In fact, these are completely different pathologies. Cancerous tumors are formed from epithelial elements, and sarcomas affect only connective tissue.

Causes of cancer

Uterine sarcoma is a pathology of complex etiology. Scientists put forward several versions to explain its origin. Most of them are confident that the disease develops under the influence of a whole group of factors. This could be a failure in the hormonal system or numerous injuries to the body of the uterus, unsuccessful abdominal surgery, abortion or any other intervention.

The disease also occurs against the background of problems of embryonic development. An equally dangerous factor is the pathological proliferation of endometrial tissue. The development of pathology is sometimes caused by improper healing of the site, removal of a polyp or fusion of several formations. Neuroendocrine disorders are another cause of sarcoma. A significant role in predisposing factors is played bad habits, abuse medicines. Doctors should also be wary of a sudden cessation of ovulation.

Who is at risk?

Gynecologists try to draw the attention of women to the prevention of sarcoma, since it is extremely rare to completely cure this pathology. First of all, it is indicated for those who are included in the so-called risk group. These are women:

• those suffering from polycystic ovary syndrome (the disease provokes hormonal imbalance);
• those suffering from breast cancer;
• have never given birth;
• survivors of late menopause (menopause after age 50).

A huge role in this matter belongs to hereditary predisposition. It is recommended to pay special attention to the health of women over 40 years of age whose close relatives have been diagnosed with tumor diseases, including uterine sarcoma.

Symptoms and signs of the disease

Very often, sarcoma is called a silent pathology, since there are no obvious signs at the initial stage of development. Women are in no hurry to seek help from a doctor, perceiving worsening conditions as stress or less serious illnesses. Even in the later stages, sarcoma may not manifest characteristic symptoms, continuing to increase in size or masquerade as fibroids.

As the disease progresses and depending on the specific location of the pathological process, menstrual irregularities are observed. Women complain of pain in the lower abdomen, copious discharge with a putrid odor. Appetite also disappears, the skin takes on a yellowish tint. Changes are clearly visible in blood tests.

Late manifestations of sarcoma lead to anemia, constant weakness and ascites. As a result of metastasis, pleurisy develops in the lungs, and jaundice develops in the liver. The penetration of malignant cells into the spine is accompanied by the appearance of pain in its various parts.

Often, during a gynecological examination for preventive purposes, doctors diagnose “uterine sarcoma”. Signs indicating the onset of a pathological process may be absent. Such a coincidence of circumstances is considered successful, since timely treatment greatly increases the chances of a positive outcome. Gynecologists regularly remind us of the importance of periodic examinations of women after 40 years, especially before the onset of menopause.

Stages of sarcoma development

The disease is characterized by slow development.

• At the initial stage, sarcoma is a small tumor. It may be limited to the mucous or muscle layer.
• At the second stage, the tumor increases in size, but does not extend beyond the body of the uterus. Partial infiltration of the organ also occurs.
• At the third stage, the tumor grows into the body of the uterus, but remains within the pelvis. Sometimes metastasis to the ovaries and regional lymph nodes is observed. At this stage, the disease uterine sarcoma begins to manifest itself with characteristic symptoms, if they were absent up to this point.
• The fourth stage is the period of formation of metastases. Secondary lesions spread to any internal organ system, affecting the lungs and bone marrow.

Diagnostic methods

Detection of sarcoma in the initial stages is often difficult due to the lack of obvious symptoms. At the initial consultation with a gynecologist, anamnesis and related data on cases of cancer pathologies in close relatives are clarified. A gynecological examination can reveal changes in the color of the cervix and detect signs of neoplasm. Then a series of laboratory and hardware tests are prescribed (blood test, CT, MRI, hysteroscopy and ultrasound of internal organs).

Differential diagnosis of uterine sarcoma makes it possible to exclude diseases with similar clinical picture. These include genital formations and endometrial polyps. Confirmation of the final diagnosis is impossible without a biopsy. During this procedure, tumor tissue is examined in a laboratory setting.

Metastases in sarcoma

The neoplasm can spread metastases along with the bloodstream, as well as grow into adjacent organs. How does the process of spread of malignant elements occur? Sarcoma releases its particles into the blood, from where they penetrate the respiratory and skeletal systems, and the external genitalia. In this case, most often the lesion affects the left side of the lungs. Malignant cells often penetrate into the appendages. This complication usually occurs with a diagnosis of endometrial sarcoma of the uterus. Metastases quickly migrate throughout the body, which can cause rapid death.

Treatment Options

Several methods of treating uterine sarcoma are used in medical practice. Most often, patients are offered a combined option, which includes surgery and chemoradiotherapy. The operation is performed only at the initial stages of the pathological process. It allows you to determine the stage of the disease and remove the tumor. The extent of intervention depends on the location of the tumor and its size. In the best case, the uterus and appendages are removed, and in the worst case, all adjacent organs are removed. In advanced cases, surgical intervention alone will not be enough. Regarding the issue of radiation therapy, today it is one of the most effective options for combating uterine sarcoma disease. The prognosis in this case may also be disappointing. It is prescribed to destroy scattered cancer cells.

Chemotherapy

Chemotherapy courses for uterine sarcoma involve the use of anthracyclines (Idarubicin, Doscorubicin, Epirubicin). These are the so-called Currently, experts are actively studying the effects of the drug “Ifosfamide”, its use both in monotherapy and in combination with other medications. With chemotherapy, positive dynamics are observed in 30% of patients.

The use of combination treatment is much more effective, but it has a number of side effects. Positive dynamics are observed from combination therapy with Docetaxel and Gemcitabine. It is usually reused for relapses.

What other drugs are used for the diagnosis of uterine sarcoma? Treatment with hormonal drugs is justified only if the degree of malignancy of the neoplasm is low.

Forecast

What is the prognosis for uterine sarcoma? Photos of patients who managed to survive this insidious disease inspire hope. However, in most cases the outcome of the pathology is unfavorable, and the likelihood of relapse is high. What do the statistics say about this?

If the tumor is diagnosed in a timely manner and surgery is performed, the probability of relapse is 65%. If sarcoma is detected in late stages, the chances of re-development of the pathological process are 90%. As a rule, the patient's life expectancy after surgery is 2 years. Statistics confirm that five-year survival after treatment of sarcoma is observed in only 40% of cases.

Depending on the stage of the disease, this picture may look like this:

• first stage - 47%;
• second stage - 44%;
• third stage - 40%;
• fourth stage - 10%.

However, this is just data from a study during which scientists recorded cases of favorable outcomes after treatment for uterine sarcoma. It is difficult to say how long patients with this diagnosis live. When answering this question, it is necessary to know the stage of the disease, the treatment performed, and cases of relapse. Only those sarcomas that are formed from fibromatous nodes are characterized by a favorable course. And in this case, timely diagnosis and treatment are required.

Prevention measures

How to prevent the development of this dangerous disease? First of all, experts recommend an annual gynecological examination. It is also necessary to follow the doctor’s instructions when treating “female” diseases, especially those related to hormonal imbalances. A special role in prevention is given to the issue of pregnancy. Doctors do not recommend delaying planning your baby. If for some reason you do not want to take on the role of a mother, you should use contraception and avoid abortion. It is impossible not to mention proper nutrition. The diet should consist mainly of fresh vegetables and fruits. It is better to limit the amount of animal fats. Give up bad habits, spend more time outdoors and play sports.

Conclusion

The attention of scientists and doctors is still attracted by such a rare disease as uterine sarcoma. The prognosis for life with this disease is impossible to predict. Although sarcoma is a rare disease, it is included in the list of aggressive malignant neoplasms. Even with timely and competent treatment, one cannot hope for positive dynamics. Pathology can occur in women of all ages. If atypical symptoms or discomfort appear, you should consult a doctor. It is even better to undergo annual preventive examinations. Be healthy!

About 5% of all tumors affecting the genital organs are endometrial stromal sarcoma of the uterus. This pathology occurs in rare cases. Sarcoma differs significantly from cancer, both in its symptoms and in metastasis.

Collapse

What is endometrial stromal sarcoma?

Endometrial sarcoma is a malignant tumor. In most cases, a nodular form is diagnosed. The nodes located on the uterus are round, their border is unclear. If the disease is neglected, ulcers appear. Metastases are rare, but if this happens, the favorite places are bones, lungs, ovaries and liver.

Endometrial sarcoma of the uterus is diagnosed in most cases in patients 50-55 years old. Neoplasms are cells of the same type that are similar to normal endometrium. Endometrial sarcoma can be of high or low grade.

If the tumor is characterized by a low degree, in 45% of patients, by the time doctors make the diagnosis, it is already far beyond the uterus, in 55-65% it is still within the pelvis. A high degree has an aggressive course, the prognosis can be unpredictable, including hamatogenous metastasis.

The disease has 4 stages:

1. The initial one is characterized by a clear, small swelling that is limited to the muscles and mucous membranes. Only the 1st layer of the uterus is affected.
2. The second is a significant increase in the size of the sarcoma, but there is no extension beyond the cervix. The uterine organ is partially infiltrated.
3. Third - they begin to appear bloody issues, and the belly increases.
4. Fourth – there are metastases on distant organs, the condition worsens significantly.

ESS classification

Endometrial sarcoma is usually classified into:

• endometrial stromal nodules;
• low-grade endometrial stromal sarcomas;
• high-grade endometrial stromal sarcomas (HGSS).

Endometrial stromal nodules

Endometrial stromal nodules almost always appear in females under 50 years of age. Manifest in the form of uterine bleeding, looks like a yellowish or brownish node of five centimeters in diameter. If you look through a microscope, you can see that the formation has clear boundaries. All cells located in the tumor do not differ in size from the normal endometrium. The main feature that will prevent it from being confused with normal tissues is multiple vessels of the same diameter. Some nodes have necrosis and calcification.

Low grade tumor

A low-grade tumor is worm-shaped or similar in shape to a clear node, sometimes there are several of them. In structure it differs from the stromal node in the invasive nature of its growth. Formations are present even in the lumens of lymphatic and blood vessels.

High grade tumor

With high malignancy, there may be many nodules and polyps. In almost all cases there is hemorrhage and necrosis. The microscope shows oval or circle shaped cells with nuclear hyperchromatosis. The vascular components are not as monomorphic and there are much fewer of them. Sarcoma grows into veins and blood vessels.

Causes

The most common causes of pathology are:

• traumatism of the pelvic organs;
• pelvic irradiation;
• abortions or diagnostic curettages;
• chronic form of intoxication;
• harmful working conditions;
• the presence of hyperestrogenism;
• improper functioning of the endocrine system;
• environmental problems;
• proliferative pathologies;
• congenital defects.

The doctor will be able to find out the cause after a complete diagnosis and study of the patient’s medical history.

Symptoms

The disease can be asymptomatic, sometimes there is discharge with blood during menopause or between menstruation. If the tumor has reached a large size, pain appears and the size of the uterus increases. A woman can feel the organ growing and her abdomen enlarging. This is most often the reason for going to the doctor.

Diagnostics

If a doctor hears symptoms that resemble sarcoma, he is obliged to examine the patient in a gynecological chair with mirrors, palpate the abdomen and be sure to give a referral for further examination in order to clarify the diagnosis.

The diagnosis will be made based on all results.

The patient is referred to:

Sometimes additional research is required. As additional diagnostics, sigmoidoscopy, flow cytometry, irrigoscopy, cystoscopy, etc. are advisable.

Treatment

Endometrial stromal sarcoma of the uterus is treated surgically, comprehensively and in combination. Treatment can continue after surgery hormonal drugs, radiation or chemotherapy. Next, we will consider each treatment method in more detail.

Surgery

Surgery involves extirpation of the uterus and ovaries and removal of all metastasized organs (if this is possible).

If the neoplasm is benign, the sarcoma is located only on the body of the uterus and has not spread further, then the surgeon will perform a standard extraction of the uterus and appendages (SEM).

In the case of malignancy - extended hysterectomy according to Wertheim, chemotherapy is carried out beforehand and after surgery as well. Also, such an operation is indicated in the case of transfer of sarcoma to the cervical canal and infiltration of parametrial tissue. The uterus and lymph nodes are removed. Before and after, chemotherapy or radiation therapy is performed.

Chemotherapy

Chemotherapy is given as an adjunct to treatment, before or after surgery. Sometimes courses are combined with radiation and hormone therapy. It all depends on the situation, the woman’s condition, age and diagnosis.

Chemistry is needed if:

• the sarcoma has grown into the serous uterine membrane and the greater omentum must be removed, after which a course of Carminomycin is prescribed (combined with radiation);
• Previously they did a non-radical extermination, that is, the tumor had grown, and this was not noticed (they do relaparotomy and then chemotherapy).
• The sarcoma is malignant and has metastasized to distant organs.

The best drug used in chemotherapy, which is recommended by all oncologists, is Carminomycin. It can be used to treat all types and forms of sarcomas. The average dosage is 5 mg/m2, twice every 7 days. Total count – 25 mg/m2. Treatment is carried out in courses, a period of time is required, it can take 40-100 days. Then the patient takes a blood test, and based on the results, the doctor determines the further dose.

Other anthracycline drugs are also used, in the form of Idarubicin, Doscorubicin, Epirubicin, gemcitabine, Docetaxel and others. These are antitumor antibiotics.
Currently, polychemotherapy using Fluorouracil and Adriamycin is also used.
They are guided by the following schemes:

Scheme No. 1.

1. The drug Adriamycin in a dosage of 30 mg is administered into a vein on the first and eighth days.
2. Fluorouracil – 50 mg, according to the same schedule.
3. Cyclophosphamide – 500 mg per muscle, only on the first day.

Scheme No. 2.

1. Vincristine 1.5 mg into a vein on the first and eighth days.
2. Dactinamycin – 0.5 mg into a vein, every other day.
3. Cyclophosphamide – 400 mg per muscle, every other day.

Each patient should understand that self-prescription of all of the above drugs is unacceptable. Firstly, they are not issued by pharmacies without a prescription, and secondly, even if you get them, you will not be able to determine the dosage yourself. Only a qualified specialist can do this after studying your tests and other examination results.

Radiation therapy

Radiation irradiation is used in complex treatment before and after extermination. It often occurs alternating with chemotherapy.

This treatment is often used to prevent or eliminate relapse of the pathology.

Hormonal drugs

As an auxiliary treatment, hormone therapy can be added to surgical and combined treatment. Since endometrial sarcoma of the uterus is a hormone-dependent disease, the patient is prescribed progestogens or aromatase inhibitors. To decide on such prescriptions, the doctor conducts extensive diagnostics.

To date, there are very few cases where hormone therapy has given unsurpassed results.

It is advisable to use hormonal drugs if forms of ESS are widespread or metastatic.

Possible consequences

The tumor can lead to disturbances associated with the outflow of urine. As it grows, it compresses the mouth of the ureter. And in the future such wrong work genitourinary system will lead to pyelonephritis, urethrohydronephrosis or chronic renal failure. The latter can be recognized by systematic attacks of nausea, constant thirst, dry mouth, sudden weight loss, and loss of appetite.

The most insidious and irreversible consequences of sarcoma are metastases. Through the flow of blood or lymph, sarcoma spreads pathological cells to various organs.

Often affected:

• lung (namely the left one, the right organ rarely);
• respiratory system;
• liver;
• skeletal system;
• oil seal fabric;
• abdominal cavity (fluid accumulates in it);
• appendages (metastases to these organs are most common).

If the process of spreading metastases has begun, the outcome will be disastrous and very sudden. Death can occur either in a month or in six months.

Another complication is relapse of the disease. Repeated lesions appear even after the sarcoma has been removed. At the initial stage - 45% of cases, at the second - 55-60%, at the third even more often. In such cases, treatment continues, but only chemotherapy or radiation can be used.

ESS is a disease that has a fairly good prognosis. If the pathology is diagnosed in a timely manner and therapy is started, the survival rate of more than 5 years is 85%. In the case of a high degree of malignancy, the woman can only be on maintenance therapy and fight the disease to the last.

Uterine sarcoma treatment stages 1, 2, 3. Symptoms, signs, metastases, prognosis.

What is uterine sarcoma?

Sarcoma of the uterus is a malignant nonepithelial tumor that develops from the stroma of the mucous membrane, muscle and connective tissue of the myometrium, immature cellular elements, mesenchymal cells, heterotopic embryonic buds.

Uterine sarcomas account for 2–6% of malignant neoplasms of the uterus and less than 1% of malignant tumors of the genitals.

Over the past 30 years, the incidence of uterine sarcoma has not changed. According to statistics, 8 cases of the disease are detected per 1 million women in the world. In the USA - 17.1 per 1 million female population.

In the structure of sarcomas of the female genital organs, smooth muscle tumors predominate - leiomyosarcoma - 41.4%, endometrial stromal sarcomas account for 15%.

There are no methods for early diagnosis of sarcomas.

Currently existing methods make it possible to establish the diagnosis of sarcoma before surgery in only a third of patients.

Uterine sarcomas, as well as endometrial cancer, are more common during menopause. The average age of patients with sarcomas is 50 years.

Risk factors for ESS

1. late onset of menstruation, first birth;
2. a history of spontaneous abortions and numerous induced abortions;
3. late menopause,
4. carrying out RT to the pelvic area.

In patients with low-grade ESS, fibroids were observed in 58% of cases, disorders of carbohydrate and fat metabolism were detected in 32% of patients.

Patients with undifferentiated ESS do not have the usual risk factors for endometrial cancer. The 5-year survival rate for undifferentiated uterine sarcoma is 25-30%. In ESS with NC – 85.8%. Distant metastases of undifferentiated uterine sarcoma are observed in 20-30% of patients. Metastases in the retroperitoneal lymph nodes, ovaries, greater omentum (20%, 19.6%, 22%).

Leiomyosarcoma

The low incidence of uterine LMS makes it difficult to conduct randomized studies, so many questions of prognosis and treatment still remain open. Treatment methods aimed only at the primary tumor do not prevent hematogenous metastasis. Progression is observed in 45–73% of patients with uterine uterine lumbar tract. More than 80% of relapses and metastases are localized outside the pelvis.

How is sarcoma different from uterine cancer?

Cancer of the uterine body is a malignant tumor that develops from the superficial cylindrical epithelium of the endometrial glands; sarcoma develops from nonepithelial elements of the stroma, muscle and connective tissue elements of the uterus.

How is sarcoma classified?

According to the morphological classification of 2003, uterine sarcomas are divided into:

1. Endometrial stromal tumors
   1.1 Endometrial stromal sarcoma is a malignant tumor consisting of neoplastic cells resembling endometrial stroma in the proliferation phase;
   1.2 Stromal nodule;
   1.3 Low-grade ESS;
   1.4 Undifferentiated uterine sarcoma.
2. Smooth muscle tumors of uncertain malignant potential;
3. Leiomyosarcoma;
4. Mixed: endometrial stromal sarcoma and smooth muscle tumors;
5. Undifferentiated endometrial sarcoma;
6. Other soft tissue tumors.

According to the degree of differentiation they are divided:

1. poorly differentiated (consist of immature cells, there are a large number of vessels in the stroma). These include round-, spindle-, giant-, polymorphic cell sarcomas and rare lymphosarcoma, alveolar sarcoma, melanosarcoma;
2. moderately differentiated;
3. highly differentiated (consist of more mature cells. These include muscle cell and fibroplastic sarcomas).

According to the 2008 NCCN classification, sarcomas of the uterine body are divided into:

1. endometrial stromal sarcoma (ESS);
2. undifferentiated sarcoma (HGUD) (includes high-grade endometrial stromal sarcoma, and a group of rare tumors;
3. fibrous histiocytoma, rhabdomyosarcoma, angiosarcoma, liposarcoma, chondrosarcoma, etc.);
4. leiomyosarcoma (LMS).

For the classification of sarcomas of the uterine body by stages in 2009 (FIGO), see the section “Algorithms for diagnosis and treatment of malignant neoplasms.”

What symptoms should alert a woman or when is an emergency visit to a gynecologist necessary?

Clinical manifestations of the disease depend on the location and growth rate of the tumor.

For submucosal nodes(the tumor grows in the uterine cavity), pathological, intermenstrual bleeding appears, even bleeding, pain in the lower abdomen, leucorrhoea.

With intramural (intrawall) location the tumor may be asymptomatic; pain in the lower abdomen and acyclic bleeding are less common.

With subserous tumor growth(in the direction of the abdominal cavity) clinical manifestations can be observed from organs adjacent to the uterus: with pressure on the wall of the bladder - dysuric disorders, up to acute urinary retention, with pressure on the wall of the rectum - constipation, a feeling of incomplete emptying during defecation.

The development of the tumor process may be accompanied by general symptoms:

• weakness;
• loss of body weight;
• anemia;
• long-term low-grade fever.

Can the above symptoms occur with benign diseases of the uterus?

Yes. Most of the above symptoms are also characteristic of uterine fibroids, which rank first in frequency among neoplasms of the female genital organs.

Leiomyoma of the uterus

Uterine leiomyoma is the most common mesenchymal benign tumor in women.

Most patients with fibroids are characterized by hyperestrogenism. The tumor develops from smooth muscle cells and is characterized by enlargement of the uterus, its deformation by myomatous nodes, menorrhagia, etc.

It occurs in 25–30% of women over 35 years of age, and in 30–35% of women who have reached premenopausal age.

Myomatous nodes can be located subserosally (under the serous cover of the uterus), interstitially (in the thickness of the muscle) and submucosally (under the mucous membrane).

Leiomyoma consists of smooth muscle fibers; when connective tissue predominates, it is called fibromyoma; when muscle fibers are atrophied, it is called fibroma.

Bleeding and menstrual cycle disorders are observed more often with submucosal and intramural myomatous nodes.

Heavy and prolonged menstruation leads to secondary anemia. Pain occurs with rapid growth of nodes, necrosis, or torsion of the node’s stem. During the “birth” of a submucosal node, the pain can be cramping. Large fibroids can also put pressure on the pelvic organs, causing increased urination and difficulty emptying the rectum.

Myomas can also be asymptomatic and reach large sizes. Such tumors are detected independently by a woman in the form of a tumor in the lower abdomen or by a doctor during a physical examination.

Diagnosis of fibroids

For primary diagnosis fibroids are used:

1. gynecological examination;
2. transvaginal and transabdominal ultrasound;
3. hysteroscopy;
4. separate diagnostic curettage;
5. Subsequently, follow-up monitoring is carried out over time.

What methods of diagnosing sarcomas are used?

It is not possible to establish a diagnosis of uterine sarcoma based on anamnesis and clinical data. This tumor can be suspected based on the combination of the following symptoms:

1. tumor growth during menopause;
2. bleeding or spotting in pre- and postmenopause in combination with an increase in the size of the uterus;
3. cachexia, anemia not associated with uterine bleeding, increasing weakness;
4. rapid growth of uterine tumors at any age;
5. development of a tumor in the cervical stump after supravaginal amputation of the uterus.

Anamnesis and physical examination, including examination of the external genitalia, speculum examination of the vagina and cervix, and bimanual vaginal examination may suggest a malignant tumor of the genitals. A gynecological examination allows you to determine the presence of an enlarged tuberous uterus, emerging fibromatous nodes, and metastatic formations in the vagina.

Ultrasound examination for fibroids

The most common method of diagnosis and follow-up for uterine fibroids, which allows you to determine the location, size of nodes, deformation of the uterine cavity, and pathological changes in the endometrium.

The role of ultrasound in recognizing sarcomas is limited, since sarcoma does not have clear acoustic signs. However, an increase in tumor size during a control study (an increase in the tumor over a year by an amount corresponding to 5 weeks of pregnancy is considered rapid tumor growth), changes in the structure of the fibromatous node in combination with clinical manifestations in perimenopause and postmenopause are an indication for surgical treatment. An ultrasound examination also allows you to assess the condition of neighboring organs and regional lymph nodes.

Aspiration biopsy with cytological examination of discharge from the uterine cavity and rejected tumor fragments.

Hysteroscopy for fibroids

Depending on the location of the pathological changes (in the muscle or mucous membrane of the uterus), tumor formations of various sizes and shapes with smooth or intermittent irregular outlines are detected. It is possible to perform a targeted tumor biopsy.

Histological examination of fibroids

It is possible to establish a diagnosis of sarcoma at the preoperative stage based on separate diagnostic curettage of the uterine cavity mucosa with submucous tumor growth with endometrial invasion, with stromal endometrial sarcoma. With subserous and intramural location of sarcomatous nodes, no changes in the endometrium are detected.

Surgical treatment of fibroids

During surgical treatment of fibroids in reproductive age, when organ-preserving intervention is planned, a thorough revision of the removed tumor nodes is necessary. If macroscopic edema, necrosis, or hemorrhages in the node are detected, it is advisable to conduct an urgent histological examination.

This will allow the operation to be performed in an adequate volume. In the morphological diagnosis of sarcomas, immunohistochemical analysis is also used. ESS tumor cells are positive for vimentin (95.8%) CD – 10, locally for actin. Markers of mesenchymal differentiation include desmin, actin, vimentin, type IV collagen, and cytokeratins.

Additional research methods are performed according to indications in order to clarify the extent of the tumor process:

• general blood test (can detect accelerated ESR, low hemoglobin content);
• urinary tract examination;
• rectosigmoidoscopy or colonoscopy;
• chest x-ray;
• CT scan of the abdominal cavity and pelvis;
• MRI of the pelvis, etc.

The final diagnosis is made after histological examination of the removed tumor.

What treatments are there for sarcomas?

The main treatment method for genital sarcomas in women is surgery.

The operation allows you to clarify the stage of the disease and remove the bulk of the tumor (in case of a widespread tumor process). The optimal scope of surgical intervention is extended extirpation of the uterus with appendages; in case of undifferentiated sarcoma of the uterus, it is accompanied by omentectomy, pelvic and retroperitoneal LAE. For detailed treatment, see the section "Algorithms for diagnosis and treatment of malignant neoplasms."

RT is effective for ESS. It is performed for residual tumor in the pelvis or tumor recurrence. For undifferentiated uterine sarcoma, adjuvant RT is performed. For relapses and metastases of ESA, surgical, radiation, and cytostatic treatment are used. The choice of treatment method is individual.

ESS with ND contains a large number of steroid receptors and a number of researchers consider it to be a hormone-dependent tumor.

For relapses, RT and hormone therapy with progestogens are effective.

Treatment of patients with leiomyosarcoma and sarcoma against the background of malignancy of the myomatous node always begins with surgery. Extirpation of the uterus and appendages is the operation of choice.

Today, the histological structure of the tumor should be considered the most significant factor in the prognosis of life in patients with sarcomas. The localization of the tumor, the size and depth of invasion into the underlying tissue, the degree of malignancy and differentiation of the tumor, the number of mitoses and the presence of necrosis in the tumor are also important.

Almost half of patients with sarcomas in different terms after primary treatment, local relapses and distant metastases occur. The localization of sarcoma metastases depends on the histological structure.

LMS most often metastasize to the lungs, in second place in the frequency of metastasis are the lymph nodes of the pelvis and lumbar region, then the mesentery of the small and large intestine. Also metastases in the parietal and visceral peritoneum. Less commonly, damage to the greater omentum is observed.

LMS and ESS are characterized by relatively slow progression of the process.

Often the time frame for the appearance of tumor metastases is calculated in years. The presence of solitary or single metastases of the LMS without signs of dissemination throughout the peritoneum is an indication for their surgical removal.

Drug treatment and RT are used in the treatment of metastases and relapses of ESS. Sometimes both types of treatment are combined.

Low-grade endometrial stromal sarcoma occurs predominantly in premenopausal women and is much less common in younger women. Clinically, endometrial stromal sarcoma manifests itself as bleeding or increased menorrhagia. At the same time, the uterus increases in size. The tumor has a polypoid shape, the boundaries are not clear, the consistency is soft, and the color is dark brown. Endometrial stromal sarcoma often tends to grow invasively into the myometrium or is located in it. In the tumor parenchyma, necrosis often develops and hemorrhages are found. Low-grade endometrial stromal sarcoma is very similar in cellular composition to the stroma of normal endometrium. the differences lie in the invasive nature of the growth in the form of stripes or nodules. Mitotic activity is 3 or more in 10 fields of view. The tumor is well supplied with blood. The vessels resemble the spiral vessels of the endometrium. Endometrial stromal sarcoma is characterized by invasive growth into lymphatic spaces (another name is endolymphatic stromal miosis) and blood vessels. Occasionally, tissue hyalinosis and accumulations of foam cells can be observed. The tumor contains areas of smooth muscle differentiation. If this component occupies more than a third of the tumor volume, then the tumor is called a mixed smooth muscle-stromal tumor. Endometrial stromal sarcoma has a pattern between the size of the tumor node, cell atypia, the number of mitoses and the presence of vascular invasion. The final diagnosis is made after removal of the uterus. Some tumors contain single glands lined with normal epithelium. Endometrial stromal sarcoma differs from adenosarcoma in the presence of a polyploid structure of the glandular epithelium. Due to the detection of estrogen and progesterone receptors in tumor tissue, treatment with hormonal drugs reduces the incidence of relapse. A characteristic feature of endometrial stromal sarcoma is the occurrence of relapse many years (more than 20) after removal of the primary tumor. High-grade endometrial stromal sarcoma is a poorly differentiated tumor. Tumor cells have pronounced nuclear atypia, chromatin with large granules, and high mitotic activity (more than 20 per 10 fields of view). The invasive nature of growth with penetration into the myometrium remains, massive hemorrhages and areas of necrosis are noted. All this facilitates a differentiated diagnosis with low-grade endometrial stromal sarcoma, which is characterized by a monomorphic cellular composition and invasion into the lymphatic vessels. High-grade endometrial stromal sarcoma is characterized by a correlation between cell atypia and patient survival. The only form of tumor treatment is surgical removal of the uterus in the amount of extirpation with appendages. Both forms of endometrial stromal sarcoma very often recur when organ-sparing surgery is performed.

Tumor processes in the female genital area, unfortunately, are not uncommon. Poor lifestyle and diet containing various preservatives, pesticides and additives significantly increase the risk of developing cancer.

And if, in addition, a woman often goes for abortions or simply avoids pregnancy, then her reproductive system automatically falls into the risk group for development.

Malignant oncology of the uterine body has several varieties. One of the forms of oncology of such localization is uterine sarcoma.

Concept and statistics of sick people

Uterine sarcoma is considered a fairly rare uterine tumor, however, it is particularly insidious. This malignant uterine formation is becoming more common every year, is characterized by intensive development and, as a rule, ends in the death of patients.

Most often, this disease is found in women aged 45-57 years. Moreover, sarcoma prefers to be localized precisely in the uterine body, and not on the neck of the organ.

Unfortunately, even early detection of a malignant oncological process of this nature does not give the patient virtually any chance of positive treatment results.

In the early stages of development, sarcoma is practically impossible to detect, however, if the tumor is nevertheless diagnosed, then adequate and combined therapy can help prolong the patient’s life.

Symptoms and signs

In the early stages of formation, sarcoma of the body and cervix is ​​a latently developing tumor with scant symptomatic manifestations.

Oncologists call uterine sarcoma a “silent” tumor, because it often happens that even at the final stages of development this oncology does not manifest itself in any way.

It forms in myomatous nodes, which often leads to an erroneous diagnosis of benign uterine fibroids.

When the disease reaches its climax, a woman experiences such manifestations as:

• Bloody vaginal discharge;
• Interruptions and irregularity of menstruation;
• Uterine bleeding;
• The appearance of leucorrhoea;
• Purulent discharge;
• Paroxysmal aching pain in the pelvic area;
• Yellowness of the skin on the face;
• Long periods of lack of appetite;
• Signs of severe weakening of the body, constant fatigue and exhaustion;
• Structural changes chemical composition blood;
• Anemia, etc.

Intensive progression of sarcoma can be manifested by aching pain in the uterine area, menstrual cycle disorder and the appearance of specific unpleasant-smelling vaginal discharge.

At the terminal stage of uterine sarcoma, patients experience pronounced signs of intoxication of the body, fluid may accumulate in the retroperitoneal space, anemia occurs and interest in food disappears, the woman begins to rapidly lose weight, her body is depleted.

Reasons for development

Sarcoma of the uterine body is an insufficiently studied pathology, especially its etiological scope.

Experts suggest that the development of such an oncological process is influenced by a group of etiological factors such as recurrent traumatic injuries, dysembryoplasia and other processes that cause proliferation of regenerating tissues.

Such an oncological process may be preceded by pathologies such as:

1. Birth injuries;
2. Embryogenesis disorders;
3. Formation of polyps on the endometrium;
4. Surgical abortions;
5. Endometriosis;
6. Hormonal disorders;
7. Genital herpes;
8. Intrauterine curettage, etc.

A certain role in the development of uterine sarcoma is played by unfavorable professional and environmental conditions, chronic poisonings such as, or radiation therapy in the treatment of other oncologies (for example, cervical cancer), etc.

In addition, experts do not rule out that pathologically triggering the development of uterine sarcoma high production estrogen hormones (hyperestrogenism), endocrine disorders typical of menopause, as well as anovulation.

Kinds

In accordance with the localization of the tumor process, sarcoma of the cervix or uterine body is distinguished.

In accordance with the cellular composition, uterine sarcoma is divided into:

• Small cell;
• giant cell;
• Muscle cell;
• Round cell;
• Polymorphocellular;
• spindle cell;
• Fibroblastic standard form.

According to histology, sarcomas are classified into:

1. Leiomyosarcoma;
2. Carcinosarcinomas;
3. Mixed mesodermal formations;
4. Stromal endometrial sarcomas, etc.

In general, about 47.2% of sarcomas are formed from the myometrium, about 27.5% from the endometrium, and 25.3% from fibromatous nodular structures.

Uterine leiomyosarcoma and prognosis

Leiomyosarcoma is a malignant tumor formed from muscle tissue cellular structures. Similar types of sarcoma are formed from smooth muscles that make up a network of vascular walls and muscle intraorganic structures.

Uterine leiomyosarcoma is an extremely dangerous and highly malignant tumor, prone to early metastasis, severe course and rapid progression.

This pathology manifests itself as heavy vaginal or uterine bleeding, menstrual irregularities and a significant deterioration in the general condition of women's health.

Leiomyosarcoma of the uterine body develops mainly against the background of radiation, the action of carcinogenic substances and frequent traumatic injuries to the uterus (abortion, curettage, biopsy examinations, etc.)

The photo shows leiomyosarcoma of the uterus

Such a tumor formation requires early diagnosis and emergency therapy, otherwise the outcome of treatment will have extremely unfavorable prognoses.

In general, favorable prognostic characteristics of uterine leiomyosarcoma occur only with early diagnosis and proper timely treatment.

Endometrial stromal sarcoma

A similar type of uterine sarcoma is found in women 45-50 years old age group, with a third of cases observed in the postmenopausal period.

Uterine stromal sarcomas are formed from the same type of cells, similar to the cellular structures of the endometrial stroma. Such a sarcoma can be low or high level malignancy or is formed in the form of a stromal endometrial nodule.

The prognosis for treatment of this group of uterine body sarcomas is determined by the nature of the formation and depends on the degree of its malignancy.

Carcinosarcoma

This tumor is one of the rarest malignant nonepithelial tumors. Carcinosarcoma is a tumor containing two components: mesenchymal and epithelial in origin.

The mesenchymal component can be represented by two types of tissues:

1. According to physiological standards, tissues absent in the uterus, for example, bone, cartilage or striated muscle fibers. A heterological type of uterine sarcoma is diagnosed;
2. Similar to normal endometrial stroma, as occurs in homologous carcinosarcoma.

The epithelial component most often represents adenocarcinoma - malignant tumor tissue of epithelial-glandular origin. Macroscopically, carcinosarcinomas appear as large polyp-like dark red nodules lining the uterine cavity and growing into the myometrium.

Most often, carcinosarcinomas form in the postmenopausal period, therefore average age patients with a similar diagnosis are about 60-62 years old.

Often this type of sarcoma is combined with hypertension, diabetes or obesity. About 10-37% of patients, long before the development of carcinosarcoma, underwent courses of radiotherapy in the area of ​​the pelvic organs.

Carcinosarcinomas quite often metastasize into lymph node fractions, appendages, liver or lung tissues, and spread throughout the peritoneum. This type of sarkinoma typically develops aggressively with early metastasis to the lymph nodes and abdominal cavity.

Stages of the disease

Uterine sarcoma has a staged course:

• At the first stage of the oncological process, the tumor is limited to the mucous and muscle tissue of the uterus;
• At the second stage, the tumor process spreads to the uterine cervix, however, the cancer does not extend beyond the uterine body and the cervical canal;
• At the third stage of the disease, the oncological process spreads beyond the uterine body, however, it does not go beyond the perimeter of the pelvic region;
• At the fourth stage of cancer, sarcoma grows into the tissue of neighboring organs, after which the tumor penetrates beyond the pelvic localization, i.e., distant metastasis develops.

Metastasis

Metastasis in uterine sarcoma occurs through lymph flow and blood flow, or the tumor grows into nearby organs.

Typically, sarcomas penetrate the bloodstream and lymph flow, then from there they spread throughout the body, reaching the respiratory system, tissue and external genitalia. In addition, metastases can spread to the peritoneum, accompanied by.

When metastasis begins, there is a real threat of rapid death of the patient. Moreover, metastases can spread so chaotically that it is almost impossible to predict the sequence and speed of metastasis.

Diagnostics

In the early stages, as already mentioned, it is almost impossible to identify uterine sarcoma, because there are no indicative symptoms.

Diagnosis begins with a gynecological examination with a rectovaginal digital test. After which laboratory and hardware diagnostic procedures are prescribed:

• , general analysis and for the presence of specific protein compounds;
• Smear cytology;
• Ultrasound diagnostics;
• Cystoscopic examination;
• Excretory urography;
• Diagnostic curettage;
• Hysteroscopic examination;
• followed by sending for histological analysis.

Is this tumor curable?

The most effective option for sarcoma is considered to be removal of the uterus in combination with and.

The operation may involve removal of the uterus along with the ovaries (extirpation) or also with the removal of lymph node structures of regional significance. Sometimes there is a need to remove parametric infiltrates, which requires the maximum volume of surgery.

In general, the treatment approach is determined according to the type of tumor, however, surgery is considered the standard of care.

Video about the diagnosis and features of surgical treatment of uterine sarcomas:

If surgical intervention cannot be carried out according to indications, then a combination of chemotherapy, radiotherapy and medicinal techniques is resorted to.

Unfortunately, it often happens that chemotherapy and radiation do not live up to expectations, and then the prognosis for uterine sarcoma is negative.

How long do people live with this disease?

The life prognosis for uterine sarcoma is ambiguous. Thus, formations arising from fibromatous nodular neoplasms (provided that there are no widespread metastases) have a more positive course.

But endometrial sarcoma, on the contrary, is characterized by a very aggressive course.

Overall, the survival rate for uterine sarcoma is:

1. At the first stage of cancer pathology - 47%;
2. With the second – about 44%;
3. With the third – 40%;
4. For the fourth – 10%.

Relapse

Uterine sarcoma is often characterized by relapses of tumor formations. Moreover, experts say that half of the patients experience a resumption of the cancer process after therapy.

Due to early and rapid metastasis, patient survival is considered comparatively low compared to other forms of uterine cancer.

Prevention

Preventive measures are based on regular gynecological examinations. If benign neoplasms are detected, it is imperative to undergo the necessary treatment.

In addition, it is necessary to carefully treat all “female” diseases, especially problems with hormonal levels. It is not recommended to neglect the main female purpose - to give birth to children, and preferably two or three. If children are not planned, then it is necessary to use contraception to avoid unwanted pregnancy and then abortion.

Regularity and fullness of sexual life is also the prevention of uterine sarcoma and other oncological formations.

An active and healthy life, avoiding abortions, properly selected contraception, avoiding stress and hormonal imbalances, timely treatment of pathologies of the female genital area - compliance with all these conditions minimizes the development of uterine sarcoma.

The following video will tell you about the role of radiation therapy in the treatment of uterine sarcomas: