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Special Types of Endometrial Malignancy

Chapter 17 – Gynaecological Cancer in the Senior Patient

About 3% of endometrial malignancies are sarcomas. Uterine sarcomas can be classified as leiomyosarcoma, endometrial stromal sarcoma, high-grade undifferentiated sarcoma (HGUD), or pure heterologous sarcoma. The 2008 FIGO staging system is used. The treatment of leiomyosarcomas, endometrial stromal sarcomas, and adenosarcomas consists of a hysterectomy without lymph node dissection (see details below). A bilateral salpingo-oophorectomy is recommended for postmenopausal women or those with stromal sarcomas. The clinical course of uterine sarcomas is difficult to predict and the staging systems are likely not adequate to predict outcomes. Until today there are no proven adjuvant strategies to improve survival in patients diagnosed with early stage uterine sarcomas. Therefore, generally no adjuvant treatment is recommended.

Leiomyosarcomas and Endometrial Stromal Sarcomasa

Stage I: Tumour limited to uterus

  • IA ≤5.0 cm
  • IB >5.0 cm

Stage II: Tumour extends beyond the uterus, within the pelvis

  • IIA Adnexal involvement
  • IIB Involvement of other pelvic tissues

Stage III: Tumour invades abdominal tissues (not just protruding into the abdomen)

  • IIIA 1 site
  • IIIB >1 site
  • IIIC Metastasis to pelvic and/or para-aortic lymph nodes

Stage IV

  • IVA Tumour invades bladder and/or rectum
  • IVB Distant metastasis

aSimultaneous endometrial stromal sarcomas of the uterine corpus and ovary/pelvis in association with ovarian/pelvic endometriosis should be classified as independent tumours.

Adenosarcomas

Stage I: Tumour limited to uterus

  • IA Tumour limited to endometrium/endocervix with no myometrial invasion
  • IB Myometrial invasion ≤50%
  • IC Myometrial invasion >50%            

Stage II: Tumour extends beyond the uterus, within the pelvis

  • IIA Adnexal involvement
  • IIB Involvement of other pelvic tissues

Stage III: Tumour invades abdominal tissues (not just protruding into the abdomen)

  • IIIA 1 site
  • IIIB >1 site
  • IIIC Metastasis to pelvic and/or para-aortic lymph nodes

Stage IV

  • IVA Tumour     invades    bladder    and/or    rectum
  • IVB Distant metastasis

Carcinosarcomas should be staged and treated as carcinomas of the endometrium. The treatment includes hysterectomy and bilateral salpingo-oophorectomy and generally requires platinum based adjuvant chemotherapy with or without radiation therapy.

In advanced stages of leiomyosarcomas, chemotherapy and/or hormonal therapy should be used. The endometrial stromal sarcomas and adeno- sarcomas are preferably treated with hormonal therapy.

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