Uterine Sarcoma: Treatment Choices

There are many treatment choices for uterine sarcoma. Which one may work best for you? It depends on a number of things, such as:

• The exact type of cancer you have

• The amount and location of the cancer (called the cancer stage)

• The speed at which the cancer is growing (called the grade of the cancer)

• Your age

• Your overall health

• Your personal concerns and preferences, like whether you want to have children and what side effects you’ll find acceptable

Uterine sarcoma should be treated by a gynecologic oncologist. This healthcare provider has had extra training in diagnosing and treating cancers that start in the female reproductive system.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may want to know how you’ll feel, how your body will work after treatment, and if you’ll have to change your normal activities. You might have questions about your fertility and sexual health, too. Be sure to talk with your healthcare team about anything that worries you. Know what to expect during and after cancer treatment.

Your healthcare provider is the best person to answer your questions. They can explain what your treatment choices are. They can tell you how well treatment is expected to work and how much it's likely to cost. They can also tell you what the risks and side effects may be.

Your provider may suggest a specific treatment. Or they may offer more than one1 and ask you to decide which treatment you’d like to use. It can be hard to make this decision. It's important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get a second opinion before deciding on your treatment plan to be sure you've covered all your options. You may also want to involve your partner, spouse, family, or friends in this process. Get any questions answered and learn as much as you can so you can make the decision that feels right for you.

Understanding the goals of treatment for uterine sarcoma

Treatment may control or cure uterine sarcoma. It can also improve your quality of life by helping to control the symptoms caused by the cancer. The goal of uterine cancer treatment is to do one or more of these things:

• Remove the primary (main) cancer tumor in the uterus

• Kill the cancer cells or stop them from growing and spreading

• Keep the cancer from coming back or delay its return

• Ease symptoms of the cancer, such as pain or pressure on nearby organs

Each type of treatment has a different goal. Talk to your healthcare provider about treatment goals so you know what to expect.

Types of treatment

There are 2 main types of cancer treatments: 

• Local treatments. These remove, destroy, or control cancer cells by focusing treatment on the part of the body where the cancer is. Surgery and radiation are local treatments. They work to either remove or destroy the tumor in the uterus and possibly in nearby areas. Most women with uterine sarcoma have surgery.

• Systemic treatments. These are treatments that can destroy or control cancer cells all over the body. Chemotherapy, immunotherapy, hormone therapy, and targeted therapy are systemic treatments. They travel through your blood to kill cancer cells or keep new ones from growing anywhere in your body.

You may have just one treatment. But in most cases a combination of treatments is used. 

Local treatments for uterine sarcoma

The local treatments include:                                                                               

• Surgery. Most women with uterine sarcoma have surgery as the first treatment. The goal of surgery is to fully remove the tumor. With uterine sarcoma, this often means that your whole uterus must be removed. This is called a hysterectomy. In most cases, the fallopian tubes and ovaries are also taken out. This is called a bilateral salpingo-oophorectomy. Some of the lymph nodes around your uterus may also be removed to check for the spread of cancer cells.

  There are different ways to do a hysterectomy. Sometimes it can be done through the vagina. Or it may be done through a cut (incision) in the skin over your lower belly (abdomen). It can also be done through small incisions using a long, thin tube with a tiny camera and light (called a laparoscope). Your healthcare provider may use a computer to operate the laparoscope. This is called robotic-assisted surgery.

• Radiation therapy. This is also called radiotherapy. It uses strong beams of energy, such as that found in X-rays, to kill cancer cells. Radiation therapy can be given using a machine outside the body that focuses the energy rays on the tumor inside the pelvis. This is called external radiation therapy. Or it may be done with tiny implants that are put into the uterus through the vagina. This is called internal radiation or brachytherapy. Some people get both types of radiation.

  If surgery can't be done, radiation therapy can be used by itself to kill all the cells of a tumor. It may also be used before surgery to shrink a tumor so it's easier to remove. In most cases, radiation is used after surgery to kill any cancer cells that may be left in the body.

Systemic treatments for uterine sarcoma

Systemic treatments are done with medicine. Common types include: 

• Hormone therapy. The goal of hormone therapy is to stop cancer cells from growing or slow their growth. Some cancer cells need hormones to grow. Certain medicines can reduce the level of these hormones in the body. Medicines can also be used to block the action of these hormones and keep them from working in cancer cells.

• Chemotherapy. The goal of chemotherapy (chemo) is to kill cancer cells throughout your body. It improves the chances of a cure in some people who might have small amounts of cancer left after surgery. Chemo might also be used before surgery to shrink the tumor. In some cases, it can be used as the only treatment.

• Immunotherapy. These medicines boost the body's own immune system to better find and kill cancer cells all over the body. Immunotherapy is most often used when other treatments don't work.

• Targeted therapy. This treatment uses medicines that target certain changes found in or on cancer cells. It's used to treat many kinds of cancer, but it is still new for uterine cancer. It may be used to treat certain types that spread or come back after treatment.

What is combination treatment?

Your healthcare provider may advise that you get more than one type of treatment. This is called combination therapy. It's common for treating uterine sarcoma. 

Treatment that's given before surgery is called neoadjuvant treatment. For instance, you may get radiation, chemotherapy, or hormone therapy before surgery. These treatments may help shrink the tumor so it's easier to remove.

Or you may get other treatments after surgery. This is called  adjuvant treatment. For instance, you may get radiation or hormone therapy after you've healed from surgery. The goal is to kill any cancer cells that may be left in your body. Even if there's no sign of cancer, your healthcare provider may still advise adjuvant treatment. It helps reduce the chance that the cancer may come back later.

Asking about clinical trials

Uterine sarcomas are often diagnosed in advanced stages. This means the cancer has already spread beyond the uterus when it's first found. It can make these cancers hard to treat. Researchers are always looking for new and better ways to treat uterine sarcoma. These newer types of treatment may be available only through a research study. These studies are called clinical trials. Taking part in a clinical trial means you get the best treatment available today. You might also get new treatments that are thought to be even better. Before starting treatment, talk with your healthcare provider to find out if there are any clinical trials you should think about.

Talking with your healthcare provider

At first, thinking about treatment options may seem overwhelming. Talk with your healthcare team and loved ones. Make a list of questions. Consider the benefits and possible side effects of each option. Discuss your concerns with your healthcare provider before making a decision.