Disease Description (Causes and Symptoms)
- Definition: A group of malignant tumors that arise from the muscle or connective tissue (stroma) of the uterus, occurring mainly in the uterine corpus (body). The main histologic types include uterine leiomyosarcoma, carcinosarcoma (malignant mixed Müllerian tumor), endometrial stromal sarcoma, and undifferentiated sarcoma.
- Causes and risk factors: Although the exact cause is unknown, older age, obesity, nulliparity (having never given birth), and a history of pelvic radiation exposure are associated with an increased risk of developing the disease.
- Pathophysiology: The tumor originates in the muscular layer or stroma of the uterus and causes local invasion and metastasis. Hematogenous metastasis is relatively common, with a tendency to spread to the lungs and abdominal cavity (abdominal organs), while lymph node metastasis varies by tumor type.
- Main symptoms: Abnormal vaginal bleeding (including postmenopausal bleeding), pelvic or abdominal pain or pressure, and rapid enlargement of the uterus (pelvis) or a feeling of a mass. Some cases are asymptomatic and discovered incidentally.
- Staging (clinical classification): Stage 1 (confined to the uterus) → Stage 2 (extends to the cervix) → Stage 3 (extends beyond the uterus but remains within the pelvis) → Stage 4 (invasion of the bladder or rectum, or distant metastasis).
Treatment Methods and Precautions
- Standard treatment
- Surgery: In early-stage disease, total hysterectomy and bilateral salpingo-oophorectomy are performed as the standard treatment, with pelvic lymph node dissection if necessary.
- Radiation therapy: Adjuvant radiation therapy may be considered to reduce the risk of local recurrence (depending on the stage and histologic type).
- Chemotherapy: Used to reduce the risk of systemic recurrence or for advanced/metastatic disease. For uterine sarcoma, doxorubicin, ifosfamide, and gemcitabine+docetaxel are used; for carcinosarcoma, endometrial cancer-based regimens such as carboplatin+paclitaxel may also be used.
- Metastatic or unresectable cases: Systemic treatment, primarily chemotherapy, is used; radiation or procedures for symptom relief (for example, local treatment for lung metastases) may be considered.
- Adjuvant treatment/management
- Follow-up examinations including imaging (CT/MRI and chest imaging) and blood tumor markers (such as CA125) before and after treatment.
- For hormone receptor-positive disease (some endometrial stromal sarcomas), hormone therapy (such as aromatase inhibitors) may be helpful.
- Precautions/complications
- High recurrence rate: Even in Stage 1, approximately 50% of cases recur; in Stages 2–4, the recurrence rate may be higher (varies according to the literature). Recurrence most commonly occurs in the abdominal cavity and lungs.
- General side effects of surgery, chemotherapy, and radiation therapy may occur, including hematologic toxicity, infection, impaired organ function, and pulmonary or cardiac toxicity.
- Fertility preservation: Radical treatment (hysterectomy) is necessary in most cases, so anyone wishing to become pregnant should consult a specialist before treatment.
- Post-treatment self-care: Seek medical attention immediately if signs of bleeding, infection, or thrombosis (chest pain, shortness of breath, or leg swelling) occur.
Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)
- Recommended items to bring
- A list of currently used medications (including prescription drugs, over-the-counter drugs, herbal medicines, and supplements)
- Copies of records of previous surgeries and pathology (biopsy) results, and previous imaging results (pelvic ultrasound, CT, MRI, chest X-ray, etc.)
- Menstruation and bleeding records (when it began, frequency and pattern, accompanying symptoms), and a pain diary (location, intensity, and frequency)
- Information on any history of pelvic radiation exposure, allergies, and whether pregnancy is desired
- Key points to check during the outpatient visit (example questions)
- When the symptoms began and how they have changed (bleeding pattern and characteristics of the pain)
- Whether the size of the uterus (pelvis) has recently changed (abdominal bloating or a feeling of a mass)
- Previous diagnoses (whether diagnosed with fibroids) and treatment history
- Family history (including gynecologic cancers), smoking, alcohol consumption, and other lifestyle habits
Examples of General Questions to Ask the Doctor
- What is my stage, and what is the treatment goal according to the stage (cure or palliation)?
- How is the recommended extent of surgery and the need for adjuvant treatment (radiation or chemotherapy) after surgery determined?
- What treatment side effects can be expected, and what methods can be used to reduce them?
- What is the likelihood of recurrence, and how will follow-up testing (frequency and methods) be carried out?
- What effect will treatment have on fertility (pregnancy), and is fertility preservation possible?
Examples of Disease-Specific Questions
- How do the recommended chemotherapy or radiation treatment strategies differ according to the biopsy results (pathology report)? (For example, leiomyosarcoma vs. endometrial stromal sarcoma vs. carcinosarcoma)
- If there are metastases to the lungs or abdomen, or if the disease has recurred, what local treatment options (surgery, radiation, or procedures) are available and what benefits can be expected?
(Additional information) Biopsy and imaging examinations are essential to confirm the diagnosis, and the treatment plan varies according to the stage and histologic type. Before and after treatment, it is important to consult a gynecologic oncologist and establish an individualized treatment strategy.