A uterine sarcoma is a malignant tumor that arises from the smooth muscle or connective tissue of the uterus. Smooth muscle is a type of non- Striated muscle, found within the Tunica media layer of large and small Arteries and Veins, the bladder Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, Muscle, and Nervous tissue) The uterus (from the Latin word for womb) is the major Female reproductive organ of most Mammals including Humans One end the If the lesion originates from the stroma of the uterine lining it is an endometrial stromal sarcoma, and if the uterine muscle cell is the originator the tumor is a uterine leiomyosarcoma. The endometrium is the inner membrane of the Mammalian Uterus. A lesion that also contains malignant tumor cells of epithelial origin is termed uterine carcinosarcoma (formerly called malignant mixed mesodermal/mullerian tumor).
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Prevalence
The vast majority of malignancies of the uterine body are endometrial carcinomas - only about 4% will be uterine sarcomas. Endometrial cancer refers to several types of malignancy which arise from the Endometrium, or lining of the Uterus. [1] Generally, the cause of the lesion is not known, however patients with a history of pelvic radiation are at higher risk. Most tumors occur after menopause. Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan Women who take long-term tamoxifen are at higher risk. Tamoxifen is an orally active Selective estrogen receptor modulator (SERM that is used in the treatment of Breast cancer and is currently the world's largest [2]
Signs and Symptoms
Unusual or postmenopausal bleeding may be a sign of a malignancy including uterine sarcoma and needs to be investigated. Other signs include pelvic pain, pressure, and unusual discharge. A nonpregnant uterus that enlarges quickly is suspicious. However, none of the signs are specific. Specific screening test have not been developed; a Pap smear is a screening test for cervical cancer and not designed to detect uterine sarcoma. The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in Gynecology Cervical cancer is Malignant Cancer of the Cervix uteri or cervical area
Diagnosis
Investigations by the physician include imaging (ultrasound, CAT scan, MRI) and, if possible, obtaining a tissue diagnosis by biopsy, hysteroscopy, or D&C. Not to be confused with Supersonic. Ultrasound is cyclic Sound pressure with a Frequency greater than the upper Computed tomography (CT is a Medical imaging method employing Tomography. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Hysteroscopy is the inspection of the uterine cavity by Endoscopy. Ultimately the diagnosis is established by the histologic examination of the specimen. Typically malignant lesions have >10 mitosis per high power field. Mitosis is the process in which a Eukaryotic cell separates the Chromosomes in its Cell nucleus, into two identical sets in two daughter nuclei In contrast a uterine leiomyoma as a benign lesion would have < 5 mitosis per high power field. A leiomyoma (plural is 'leiomyomata' is a Benign Smooth muscle Neoplasm that is not Premalignant.
Staging
Uterine sarcoma is staged like endometrial carcinoma at time of surgery using the FIGO cancer staging system. The International Federation of Gynecology and Obstetrics, usually just FIGO as the acronym of its French name Fédération Internationale de Gynécologie et d'Obstétrique The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread
- Stage IA: tumor is limited to the endometrium
- Stage IB: invasion of less than half the myometrium
- Stage IC: invasion of more than half the myometrium
- Stage IIA: endocervical glandular involvement only
- Stage IIB: cervical stromal invasion
- Stage IIIA: tumor invades serosa or adnexa, or malignant peritoneal cytology
- Stage IIIB: vaginal metastasis
- Stage IIIC: metastasis to pelvic or para-aortic lymph nodes
- Stage IVA: invasion of the bladder or bowel
- Stage IVB: distant metastasis, including intraabdominal or inguinal lymph nodes
Therapy
Therapy is based on staging and patient condition and utilizes one or more of the following approaches. The myometrium is the middle layer of the uterine wall consisting of smooth muscle cells and supporting stromal and vascular tissue Surgery is the mainstay of therapy if feasible involving total abdominal hysterectomy with bilateral salpingo-oophorectomy. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental A hysterectomy (from Greek hystera "womb" is the surgical removal of the Uterus, usually performed by a gynecologist. Other approaches include radiation therapy, chemotherapy, and hormonal therapy. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Hormone therapy, or hormonal therapy is the use of Hormones in medical treatment
See also
References
- ^ [1] American Cancer Society information, accessed 03-11-2006
- ^ [2] National Cancer Institute information, accessed 03-11-2006
External links
- Uni-Bonn site with detailed information, accessed 03-11-2006
- Leiomyosarcoma Direct Research Foundation
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