Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?

Uterine sarcoma is a rare cancer that starts in the muscle and supporting tissues of the uterus (womb).

Survival rates are often used by doctors as a standard way of discussing a person's prognosis (outlook). Some patients with cancer may want to know the survival statistics for people in similar situations, while others may not find the numbers helpful, or may even not want to know them. If you decide that you do not want to know about the survival rates for uterine sarcoma given in the next few paragraphs, skip to the next section.

The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured).

Five-year relative survival rates compare the survival of people with the cancer to the survival for people without the cancer. This is a way to take into account deaths from causes other than cancer. The 5-year relative survival rate is a better way to describe the impact of a particular type and stage of cancer on survival.

In order to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with uterine sarcoma.

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any particular person's case. Many factors may affect a person's outlook, such as:

• The stage of the cancer
• The type of sarcoma (leiomyosarcoma or endometrial stromal sarcoma)
• The grade of the sarcoma (low grade versus high grade)
• The woman's general state of health
• The treatment received

Your doctor can tell you how the numbers below may apply to you, as he or she is familiar with your particular situation.

The survival statistics noted below come from the National Cancer Institute's SEER program. They are based on women diagnosed with uterine sarcomas from 2004 to 2010. SEER doesn’t break down these statistics by AJCC or FIGO stage. Instead, SEER uses something called summary stages: localized, regional, and distant.

• Localized means the cancer is only in the uterus, and corresponds to stage I.
• Regional means the cancer has spread to nearby tissues or lymph nodes and includes stages II, and III.
• Distant means the cancer has spread further and includes stages IVA and IVB.

Leiomyosarcoma

Undifferentiated sarcoma

Endometrial stromal sarcoma

Many uterine sarcomas are diagnosed during or after surgery for what's thought to be benign fibroid tumors.

Some are diagnosed because of symptoms. If you have symptoms of uterine cancer, the first step is to see your doctor.

Consultation, medical history, and physical exam

Your doctor will ask you about your personal and family medical history, examine you, and might order some tests. You also will be asked about any symptoms, risk factors, and other health problems. A general physical and a pelvic exam will be done. An ultrasound may be used to look at the inside of your uterus.

 If your doctor suspects cancer, you may be referred to a gynecologist or a doctor specializing in cancers of the female reproductive system (called a gynecologic oncologist).

Sampling and testing endometrial tissue

To find the cause of abnormal uterine bleeding, a small piece of tissue (a sample) will be taken from the lining of the uterus and looked at with a microscope. The tissue can be removed by endometrial biopsy or by dilation and curettage (D&C). Often a hysteroscopy is done with the D&C..

These procedures let the doctor see if the bleeding is caused by a endometrial overgrowth that's not cancer (hyperplasia), endometrial carcinoma, uterine sarcoma, or some other problem. The tests will find many endometrial stromal sarcomas and undifferentiated sarcomas, but less than half of leiomyosarcomas (abbreviated LMSs). These tests don't find all LMSs because these cancers start in the muscle layer of the wall of the uterus. To be found by an endometrial biopsy or D&C, they need to have spread from the middle (muscle) layer to the inner lining of the uterus. In most cases, the only way to diagnose a LMS by removing it with surgery.

Endometrial biopsy

In this procedure, a very thin, flexible tube is put into the uterus through the cervix. Then, using suction, a small amount of the uterine lining (endometrium) is taken out through the tube. Suctioning takes about a minute or less. The discomfort is a lot like severe menstrual cramps and can be helped by taking a nonsteroidal anti-inflammatory drug like ibuprofen an hour before the biopsy. This procedure is usually done in the doctor's office.

Hysteroscopy

This procedure allows doctors to look inside the uterus. A tiny telescope is put into the uterus through the cervix. To get a better view, the uterus is then expanded by filling it with salt water (saline). This lets the doctor see and take out anything abnormal, such as a cancer or a polyp. This procedure is usually done with the patient awake, using local anesthesia (numbing medicine). But if a polyp or mass has to be removed, general or regional anesthesia is sometimes used. (General anesthesia means you are given drugs that put you into a deep sleep and keep you from feeling pain. Regional anesthesia is a nerve block that numbs a larger area of the body).

Dilation and curettage

If the results of the endometrial biopsy are not clear (meaning they can't tell for sure if cancer is present), a procedure called dilation and curettage (D&C) must be done. A D&C is usually done in the outpatient surgery area of a clinic or hospital. It's done while the woman is under general or regional anesthesia or conscious sedation (medicine is given into a vein to make her drowsy). It takes about an hour. In a D&C, the cervix is dilated (opened) and a special surgical tool is used to scrape the endometrial tissue from inside the uterus. A hysteroscopy may be done as well. Some women have mild to moderate cramping and discomfort after this procedure.

Testing endometrial tissue

Any tissue samples taken out are looked at under a microscope to see if cancer is present. If cancer is found, the lab report will say if it's a carcinoma or sarcoma, what type it is, and its grade.

A tumor's grade is based on how much it looks like normal tissue under the microscope. If the tumor looks a lot like normal tissue, it's called low grade. If it doesn't at all look like normal tissue, it's high grade. The rate at which the cancer cells appear to be growing is another important factor in grading a uterine sarcoma. High-grade sarcomas tend to grow and spread faster than low-grade sarcomas.

The tissue may also be tested to see if the cancer cells have estrogen receptors and progesterone receptors. These hormone receptors are found on many endometrial stromal sarcomas. Cancers with estrogen receptors on the cells are more likely to grow in response to estrogen, while those with progesterone receptors often have their growth decreased by progesterone. These cancers may stop growing (or even shrink) when treated with certain hormone drugs. Checking for these receptors helps predict which patients will benefit from treatment with these drugs.

Cystoscopy and proctoscopy

If a woman has signs or symptoms that suggest uterine sarcoma has spread to the bladder or rectum, the inside of these organs can be looked at through a lighted tube. These exams are called cystoscopy and proctoscopy, respectively. They are rarely done in the diagnosis and work-up of patients with uterine sarcoma.

Imaging tests

Transvaginal ultrasound

Ultrasound tests use sound waves to take pictures of parts of the body. For a transvaginal ultrasound, a probe that gives off sound waves is put into the vagina. The sound waves are used to create images of the uterus and other pelvic organs. These images can often show if there's a tumor and if it affects the myometrium (muscular layer of the uterus).

For an ultrahysterosonogram or saline infusion sonogram, salt water (saline) is put into the uterus through a small tube before the transvaginal sonogram. This allows the doctor to see changes in the uterine lining more clearly.

Computed tomography

The CT scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body.

CT scans are rarely used to diagnose uterine cancer, but they may be helpful in seeing if the cancer has spread to other organs.

CT-guided needle biopsy: CT scans can also be used to guide a biopsy needle precisely into a suspected tumor. For this procedure, the patient remains on the CT scanning table while the doctor moves a biopsy needle through the skin and toward the tumor. CT scans are repeated until the needle is within the tumor. A fine needle biopsy sample or a larger core needle biopsy sample is then removed to be looked at with a microscope. This isn’t done to biopsy tumors in the uterus, but might be used to biopsy areas that look like metastasis (cancer spread).

Magnetic resonance imaging

MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. MRI scans can help tell if a uterine tumor looks like cancer, but a biopsy is still needed to tell for sure.

MRI scans are also very helpful in looking for cancer that has spread to the brain and spinal cord.

Positron emission tomography scan

In a PET scan, radioactive glucose (sugar) is injected into the patient's vein. Because many cancers use glucose much faster than normal tissues, the radioactivity tends to collect in the cancer. A scanner can then spot the radioactive deposits. This test can be helpful for spotting small collections of cancer cells that have spread beyond the uterus (matastasized).

Chest x-ray

A regular (plain) x-ray of the chest may be done to see if a uterine sarcoma has spread to the lungs and as part of the testing before surgery.

Surgery to remove the uterus, sometimes along with the fallopian tubes and ovaries and to check the lymph nodes, is the main treatment for all uterine sarcomas. Sometimes this is followed by treatment with radiation, chemotherapy (chemo), or hormone therapy. Targeted therapy may also be used in advanced cancers.

Treatments given after the cancer has been completely removed with surgery are called adjuvant treatments. Adjuvant therapy is used to help keep the cancer from coming back. This approach has helped patients with certain cancers like colon and breast cancer live longer. So far, though, the value of adjuvant treatments for uterine sarcoma isn't clear.

Women who can't have surgery because they have other health problems are treated with radiation, chemo, or hormone therapy. Often some combination of these treatments is used.

Because uterine sarcoma is rare, it's has been hard to study it well. Most experts agree that treatment in a clinical trial should be considered for any type or stage of uterine sarcoma. This way women can get the best treatment available now and may also get the treatments that are thought to be even better.

Leiomyosarcoma and undifferentiated sarcoma

Stages I and II

Most women have surgery to remove the uterus (hysterectomy), as well as the fallopian tubes and ovaries (bilateral salpingo-oophorectomy). Pelvic and para-aortic lymph node dissection or laparoscopic lymph node sampling may be done if swollen nodes are seen on imaging tests. During surgery, organs near the uterus and the thin membrane that lines the pelvic and abdominal cavities (called the peritoneum) are closely checked to see if the cancer has spread beyond the uterus.

Very rarely, young women with low-grade leiomyosarcomas (LMS) that have not spread beyond the uterus may be able to have just the tumor removed, leaving the uterus, fallopian tubes, and ovaries in place. This is not standard treatment, little is known about long-term outcomes , and it's not often offered. Still, it may be a choice for some women who want to be able to have children after cancer treatment. This option has risks, so women thinking about this surgery need to talk about the pros and cons with their treatment team before making a decision. It may also be possible to leave a young woman’s ovaries in place (but remove the uterus and fallopian tubes), since it isn’t clear that this will lead to worse outcomes. Again, this is not a standard treatment, and you should discuss the risks and benefits with your doctor. In either case, close follow-up is important, and morel surgery may be needed if the cancer comes back.

Women with stage I cancers may not need more treatment and are watched closely after surgery. In other cases, treatment with radiation, with or without chemo, may be needed after surgery if there's a high chance of the cancer coming back in the pelvis. This is called adjuvant treatment. The goal of surgery is to take out all of the cancer, but the surgeon can only remove what can be seen. Tiny clumps of cancer cells that are too small to be seen can be left behind. Treatments given after surgery are meant to kill those cancer cells so that they don't get the chance to grow into larger tumors. For LMS of the uterus, adjuvant radiation may lower the chance of the cancer growing back in the pelvis (called local recurrence), but it doesn't seem to help women live longer.

Since the cancer can still come back in the lungs or other distant organs, some experts recommend giving chemo after surgery (adjuvant chemotherapy) for stage II cancers. Chemo is sometimes recommended for stage I LMS as well, but it's less clear that it's really helpful. So far, results from studies of adjuvant chemo have been promising in early stage LMS, but long-term follow-up is still needed to see if this treatment really helps women live longer. Studies of adjuvant therapy are in progress.

Stage III

Surgery is done to remove all of the cancer. This includes removing the uterus (a hysterectomy), removing both fallopian tubes and ovaries (bilateral salpingo-oophorectomy), and lymph node dissection or sampling. If the tumor has spread to the vagina, part (or even all) of the vagina will need to be removed as well.

After surgery, treatment with radiation (with or without chemo) may be offered to lower the chance that the cancer will come back.

Women who are too sick (from other medical problems) to have surgery may be treated with radiation and/or chemo.

Stage IV

This is divided into stage IVA and stage IVb.

Stage IVA cancers have spread to nearby organs and tissues, such as the bladder or rectum, and maybe to nearby lymph nodes. These cancers might be able to be completely removed with surgery, and this is usually done if possible. If the cancer cannot be removed completely, radiation may be given, either alone or with chemo.

Stage IVB cancers have spread outside the pelvis, most often to the lungs, liver, or bone. There's no standard treatment for these cancers. Chemo may be able to shrink the tumors for a time, but is not thought to be able to cure the cancer. Radiation therapy, given along with chemo, may also be an option.

These cancers might also be treated with targeted therapy when other treatments don't work. They're often given along with chemo.

Endometrial stromal sarcoma

Stages I and II

Early stage endometrial stromal sarcoma is treated with surgery: hysterectomy and bilateral salpingo-oophorectomy. (This means removal of the uterus, both fallopian tubes. and both ovaries.) Some young women may be given the option of keeping their ovaries, but this is not the standard treatment. Pelvic lymph nodes may be removed if they look swollen on imaging tests.

After surgery, most women don't need more treatment. These women are watched closely for signs that the cancer has returned. Others may be treated with hormone therapy and sometimes radiation to the pelvis. These can lower the chances of the cancer coming back, but they have not been shown to help patients live longer. This type of uterine sarcoma does not respond well to chemo, and it's not often used at these early stages.

Women who are too sick (from other medical conditions) to have surgery may be treated with radiation and/or hormone therapy.

Stage III

Surgery is done to remove all of the cancer. This includes removing the uterus (a hysterectomy), as well as removing both fallopian tubes and ovaries (bilateral salpingo-oophorectomy). Lymph nodes may checked if they look swollen. If the tumor has spread to the vagina, part (or even all) of the vagina will need to be removed too.

Women with endometrial stromal sarcomas might get radiation, hormone therapy, or both after surgery. Chemo may be used if other treatments don't work.

Women who are too sick (from other medical conditions) to have surgery may be treated with radiation, chemo, and/or hormone therapy.

Stage IV

This stage is divided into stage IVA and stage IVB.

Stage IVA cancers have spread to nearby organs and tissues, such as the bladder or rectum. These cancers may be able to be completely removed with surgery, and this is usually done if possible. If the cancer cannot be removed completely, radiation may be given, either alone or with chemo. Hormone therapy is also an option.

Stage IVB cancers have spread outside of the pelvis, most often to the lungs, liver, or bone. Hormone therapy can help for a time. Chemo and radiation are also options to help ease symptoms.

Recurrent uterine sarcoma

If a cancer comes back after treatment, it's called recurrent cancer. If it comes back in the same place as it was before, it's called a local recurrence. For uterine sarcoma, the cancer growing back as a tumor in the pelvis would be a local recurrence. If it comes back in another part of the body, like the liver or lungs, it's called a distant recurrence.

Uterine sarcoma often comes back in the first few years after treatment.

Treatment options for recurrent uterine sarcoma are the same as those for stage IV. If the cancer can be removed, surgery may be done. If not already given, radiation may be used to reduce the size of the tumor and relieve the symptoms of large pelvic tumors. Easing symptoms caused by cancer is called palliative or supportive care.

Sarcoma often comes back in the lungs. If there are only 1 or 2 small tumors, these may be able to be removed with surgery. Chemo and/or radiation are options after surgery. They may also be used for distant recurrence that can't be taken out with surgery.

Women with recurrent uterine sarcomas might want to take part in clinical trials (scientific studies of promising treatments) testing new chemo or other treatments.

In most cases, the possibility of uterine sarcoma is suggested by certain symptoms. These symptoms don't always mean that a woman has uterine sarcoma. In fact, they are more often caused by something else, such as non-cancerous changes in the uterus (like fibroids), pre-cancerous overgrowth of the endometrium, or endometrial carcinoma. Still, if you're having these problems, see a doctor to find the cause and get any needed treatment.

Abnormal bleeding or spotting

About 85% of patients diagnosed with uterine sarcomas have irregular vaginal bleeding (between periods) or bleeding after menopause. This symptom is more often caused by something other than cancer, but it's important to have any irregular bleeding checked right away.

If you've gone through menopause, any vaginal bleeding or spotting is abnormal, and it should be reported to your health care professional right away.

Vaginal discharge

About 10% of women with uterine sarcomas have a vaginal discharge that does not have any visible blood. A discharge is most often a sign of infection or another non-cancer condition, but it also can be a sign of cancer. Any abnormal discharge should be checked by a health care professional.

Pelvic pain and/or a mass

When they're first diagnosed, about 10% of women with uterine sarcomas have pelvic pain and/or a mass (tumor) that can be felt. You or your doctor may be able to feel the mass in your uterus, or you might have a feeling of fullness in your belly and/or pelvis.

Surgery is the main treatment for uterine sarcoma. The goal of surgery is to remove all of the cancer as one piece. This usually means removing the entire uterus (hysterectomy). In some cases the fallopian tubes, ovaries, and part of the vagina may also need to be removed. Some lymph nodes or other tissue may be taken out as well to see if the cancer has spread outside the uterus. What's done depends on the type and grade of the cancer and how far it has spread. (See How Is Uterine Sarcoma Staged?) The patient's overall health and age are also important factors.

In some cases, tests done before surgery let the doctor plan the operation in detail ahead of time. These tests include imaging studies, like ultrasound, as well as a pelvic exam, endometrial biopsy, and/or D&C. In other cases, the surgeon has to decide what needs to be done based on what's found during surgery. For example, sometimes there's no way to know for certain that a tumor is cancer until it's removed during surgery.

Simple hysterectomy

This surgery removes the whole uterus (the body of the uterus and the cervix). This also is sometimes called a total hysterectomy. In a simple hysterectomy, the loose connective tissue around the uterus (called the parametrium), the tissue connecting the uterus and sacrum (the uterosacral ligaments), and the vagina remain intact. Removing the ovaries and fallopian tubes is not really part of a hysterectomy -- officially it's a separate procedure known as a bilateral salpingo-oophorectomy (BSO). The BSO is often done along with a hysterectomy in the same operation (see below).

If the uterus is removed through an incision (cut) in the front of the abdomen (belly), the surgery is called an abdominal hysterectomy. When the uterus is removed through the vagina, it's called a vaginal hysterectomy.

If lymph nodes need to be removed and tested, this can be done through the same incision as the abdominal hysterectomy. If a hysterectomy is done through the vagina, lymph nodes can be removed using a laparoscope. A laparoscope is a thin lighted tube with a video camera at the end. It can be put into the body through a small incision and lets the doctor see inside the body without making a big incision. The doctor can use long, thin tools that are put in through other small incisions to operate. A laparoscope is sometimes used to help remove the uterus when the doctor is doing a vaginal hysterectomy. This is called a laparoscopic assisted vaginal hysterectomy. The uterus can also be removed through the abdomen with a laparoscope, sometimes with a robotic approach, in which the surgeon sits at a control panel in the operating room and moves robotic arms to operate. Laparoscopic procedures have shorter recovery times than regular abdominal hysterectomies, but often the surgery takes longer. Talk with your surgeon about how the surgery will be done and why it's the best plan for you.

Either general or regional anesthesia is used for the procedure. This means that the patient is in a deep sleep or is sedated and numb from the waist down.

For an abdominal hysterectomy the hospital stay is usually 3 to 5 days. Complete recovery takes about 4 to 6 weeks. A laparoscopic procedure and vaginal hysterectomy usually mean a hospital stay of 1 to 2 days and 2 to 3 weeks recovery.

After a hysterectomy, a woman cannot become pregnant and give birth to children. Surgical complications are rare but could include excessive bleeding, wound infection, and damage to the urinary or intestinal systems.

Radical hysterectomy

This operation removes the entire uterus as well as the tissues next to the uterus and cervix (parametrium and uterosacral ligaments) and the upper part (about 1 inch) of the vagina (near the cervix). This operation is not often used for uterine sarcomas.

Radical hysterectomy is most often done through an abdominal surgical incision, but it can also be done through the vagina or laparoscopically, with or without a robotic approach (in which the surgeon sits at a control panel in the operating room and moves robotic arms to operate). Most patients having a radical hysterectomy also have some lymph nodes removed, either through the abdominal incision or laparoscopically. Radical hysterectomy can be done using either general or regional anesthesia.

Because more tissue is removed by a radical hysterectomy than with a simple hysterectomy, the hospital stay may be longer.

This surgery leaves the woman unable to become pregnant and give birth to children.

Complications are much like, but more common than those associated with a simple hysterectomy, and could include excessive bleeding, wound infection, and damage to the urinary or intestinal systems. If some of the nerves of the bladder are damaged, a catheter will be needed to empty the bladder for some time after surgery. This usually gets better and the catheter can be taken out later.

Bilateral salpingo-oophorectomy

This operation removes both fallopian tubes and both ovaries. In treating uterine sarcomas, this operation is usually done at the same time the uterus is removed. If both of your ovaries are removed, you will go into menopause if you have not done so already.

Symptoms of menopause include hot flashes, night sweats, and vaginal dryness. These symptoms are caused by a lack of estrogen and may be improved with estrogen therapy. Estrogen therapy also lowers a woman's risk of osteoporosis (weakening and thinning of the bones). But estrogen can cause some types of uterine sarcoma to grow, so many doctors are concerned that it could increase the chance of the cancer coming back. Most experts in this field consider estrogen therapy too risky for most women who have had uterine sarcoma. Some doctors prescribe it only when the stage and grade of the cancer indicate a very low risk of the cancer coming back. A woman who has had uterine sarcoma should discuss the risks and benefits of estrogen therapy with her doctor before making a decision. Other treatments can be used to help relieve symptoms of menopause and prevent osteoporosis that do not affect the risk of the cancer coming back.

Lymph node surgery

Sometimes it looks like the cancer may have spread outside the uterus or nearby lymph nodes look swollen on imaging tests. In this case, your surgeon may do a lymph node dissection or a lymph node sampling, which removes lymph nodes in the pelvis and around the aorta (the main artery that runs from the heart down along the back of the abdomen and pelvis). These lymph nodes are then checked under a microscope to see if they have cancer cells. If cancer is found in the lymph nodes, it means that the cancer has already spread outside of the uterus. This isn't good and means the woman has a poor prognosis (outlook).

This operation is done through the same surgical incision in the abdomen as the simple abdominal hysterectomy or radical abdominal hysterectomy. If a vaginal hysterectomy has been done, the lymph nodes can be removed with laparoscopic surgery.

Removing lymph nodes in the pelvis can lead to a build-up of fluid in the legs, called lymphedema. This is more likely if radiation is given after surgery. You can find out more about this in Lymphedema.

Other procedures that may be done during surgery

• Omentectomy: The omentum is a layer of fatty tissue that covers the abdominal contents like an apron. Cancer sometimes spreads to this tissue. When this tissue is removed, its called an omentectomy. The omentum is sometimes removed at the same time the hysterectomy is done if cancer has spread there, or as a part of staging.
• Peritoneal biopsies: The tissue lining the pelvis and abdomen is called the peritoneum. Peritoneal biopsies remove small pieces of this lining to check for cancer cells.
• Pelvic washings: In this procedure, the surgeon "washes" the abdominal and pelvic cavities with salt water (saline) and then sends the fluid to the lab to see if it contains cancer cells.
• Tumor debulking: If cancer has spread throughout the abdomen, the surgeon may attempt to remove as much of the tumor as possible. This is called debulking. For some types of cancer, debulking can help other treatments (like radiation or chemotherapy) work better. Its role in treating uterine sarcoma isn't clear.

Sexual impact of surgery

If you are premenopausal, removing your uterus stops menstrual bleeding (periods). If your ovaries are also removed, you will go into menopause. This can lead to vaginal dryness and pain during sex. These symptoms can be improved with estrogen treatment, but this hormone isn't safe for all women with uterine sarcoma. Other medicines may be helpful for those women.

While physical and emotional changes can affect the desire for sex, these surgical procedures do not prevent a woman from feeling sexual pleasure. A woman does not need ovaries or a uterus to have sex or reach orgasm. Surgery can actually improve a woman's sex life if the cancer had caused problems with pain or bleeding during sex. See Sex and the Woman With Cancer for more on this.

Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs can be swallowed as pills or they can be injected by needle into a vein or muscle. Chemo is systemic therapy. This means that the drug enters the bloodstream and circulates throughout the body to reach and destroy cancer cells. This makes chemo a useful treatment for cancer that has spread beyond the uterus. When chemo is given to shrink the cancer before surgery, it's called neoadjuvant treatment. If it's given after the cancer has been removed with surgery, it's called adjuvant therapy. Here are some ways chemo may be used for uterine sarcoma:

• Adjuvant chemo is soften used to help keep the cancer from coming back later.
• Chemo can also be used as the main therapy to treat the cancer if a woman is unable to have surgery.
• Sometimes chemo is used to control uterine sarcoma that has spread to other parts of the body or came back after surgery. In this case, the goal may be to ease symptoms and try to keep the tumor from growing.

Chemo may not work for certain types of uterine sarcoma. Better results seem to be seen with earlier stages of this cancer, and types that are more likely to come back after surgery. And some types of uterine sarcoma have been found to respond better to certain drugs and drug combinations. The role of chemo, as well as the best chemo drugs to use are not clear. Still, there are a lot of clinical trials looking at this, and some studies have shown that chemo can help some women live longer after surgery.

Some of the drugs commonly used to treat uterine sarcomas include:

• Dacarbazine (DTIC)
• Docetaxel (Taxotere^®)
• Doxorubicin (Adriamycin^®)
• Liposomal doxorubicin (Doxil^®)
• Epirubicin (Ellence^®)
• Gemcitabine (Gemzar^®)
• Ifosfamide (Ifex^®)
• Paclitaxel (Taxol^®)
• Temozolomide (Temodar^®)
• Trabectedin (Yondelis^®)
• Vinorelbine (Navelbine^®)

In most cases, more than one drug is used. For example, gemcitabine and docetaxel are often used together to treat leiomyosarcoma.

These drugs kill cancer cells but can also damage some normal cells. This is what causes many side effects. Side effects of chemo depend on the specific drugs, the amount taken, and the length of time you are treated. Some common side effects include:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Low blood counts

Chemo can damage the blood-producing cells of the bone marrow, leading to low blood cell counts. This can cause:

• An increased chance of serious infection (from a shortage of white blood cells)
• Problems with bleeding or bruising (from a shortage of blood platelets)
• Feeling tired or short of breath (due to low red blood cell counts)

It's important to let your cancer care team know about any problems you have while on chemo, because many side effects can be prevented or treated. For instance, there are many good medicines to prevent or reduce nausea and vomiting. Most side effects of chemo go away over time when the treatment is over.

Some side effects from chemotherapy can last a long time. For example, the drug doxorubicin can damage the heart muscle over time. The chance of heart damage goes up as the total dose of the drug goes up, so doctors limit how much doxorubicin can be given. Cisplatin can cause kidney damage. Giving large amounts of fluid before and after chemo can help protect the kidneys. Both cisplatin and paclitaxel can cause nerve damage (called neuropathy). This can cause numbness, tingling, or even pain in the hands and feet.

For more information, see Chemotherapy.

Cancer survivors can be affected by a number of health problems, but often their greatest concern is facing cancer again. If a cancer comes back after treatment it is called a “recurrence.” But some cancer survivors may develop a new, unrelated cancer later. This is called a “second cancer.” No matter what type of cancer you have had, it is still possible to get another (new) cancer, even after surviving the first.

Unfortunately, being treated for cancer doesn’t mean you can’t get another cancer. People who have had cancer can still get the same types of cancers that other people get. In fact, certain types of cancer and cancer treatments can be linked to a higher risk of certain second cancers.

Survivors of uterine sarcoma can get any type of second cancer, but they have an increased risk of:

• Breast cancer
• Colon cancer
• Rectal cancer
• Small intestine cancer
• Bladder cancer
• Vaginal cancer
• Soft tissue cancer
• Acute leukemia

Colon and breast cancers are the second cancers most often seen.

The increased risks of acute myeloid leukemia (AML) and cancers of the rectum, bladder, and soft tissue seem to be linked to treatment with radiation.

Follow-up after treatment

After completing treatment for uterine sarcoma, you should see your doctor regularly. He or she will examine you to look for signs the cancer has come back. Experts do not recommend additional testing to look for second cancers in patients without symptoms. Let your doctor know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or second cancer.

Survivors of uterine sarcoma should follow the American Cancer Society guidelines for the early detection of cancer and stay away from tobacco products. Smoking increases the risk of many cancers.

To help maintain good health, survivors should also:

• Achieve and maintain a healthy weight
• Adopt a physically active lifestyle
• Consume a healthy diet, with an emphasis on plant foods
• Limit consumption of alcohol to no more than 1 drink per day

These steps may also lower the risk of some cancers.

See Second Cancers in Adults for more information about causes of second cancers.

The American Cancer Society's estimates for cancer of the uterine corpus (body of the uterus) in the United States for 2018 are:

• About 63,230 new cases of cancer of the uterine corpus will be diagnosed, but only about 5,058 of these cases will be uterine sarcomas.
• About 11,350 women in the United States will die from cancer of the uterine corpus.

Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers.

There are different kinds of risk factors. Some, such as your age or race, can’t be changed. Others may be related to personal choices such as smoking, drinking, or diet. Some factors influence risk more than others. But risk factors don't tell us everything. Having a risk factor, or even several, does not mean that a person will get the disease. Also, not having any risk factors doesn't mean that you won't get the disease.

These factors are known to change a woman's risk of developing a uterine sarcoma.

Pelvic radiation therapy

High-energy (ionizing) radiation used to treat some cancers can damage cells’ DNA, sometimes increasing the risk of developing a second type of cancer. If you've had pelvic radiation, your risk for developing uterine sarcoma is increased. These cancers usually are diagnosed 5 to 25 years after you've been exposed to the radiation.

Race

Uterine sarcomas are about twice as common in African-American women as they are in white or Asian women. The reason for this is unknown.

RB gene changes

Women who have had a type of eye cancer called retinoblastoma that was caused by being born with an abnormal copy of the RB gene have an increased risk of uterine leiomyosarcomas.

Remember, that these factors increase the risk for developing some uterine sarcomas, but they may not always cause the disease.

Doctors don't know exactly what causes most uterine sarcomas, but certain risk factors have been identified. Research is helping to learn more about this rare disease.

For instance, scientists have learned about changes in the DNA of certain genes when normal uterine cells develop into sarcomas. You can learn more about research being done in What's New in Uterine Sarcoma Research and Treatment?

Most cases of uterine sarcoma cannot be prevented. Although pelvic radiation increases the risk of developing a uterine sarcoma, the benefit of pelvic radiation in treating other cancers far outweighs the risk of developing a rare cancer such as uterine sarcoma many years later.

In some cases, knowing the signs and symptoms of uterine sarcoma and seeing a health care professional right away can help find it at an early stage (when it's small and hasn't spread). But many uterine sarcomas reach an advanced stage before signs and symptoms are present. The signs and symptoms for the main types of uterine sarcoma are different. (See How Is Uterine Sarcoma Diagnosed?)

Screening tests

Screening refers to testing to find a disease such as cancer in people who don't have symptoms of the disease. At this time, there are no tests or exams to detect uterine sarcomas in women without symptoms (asymptomatic women). The Pap test, which screens for cervical cancer, can sometimes find early uterine sarcomas, but it's not a good test for this type of cancer.

Still, the Pap test is very good at finding early carcinomas of the cervix (the lower part of the uterus). For information on finding cervical cancer early, see Cervical Cancer Screening Guidelines.

It is important for you to have honest, open discussions with your cancer care team. The following are some questions to consider:

• What type and grade of uterine sarcoma do I have?
• Has the cancer spread beyond my uterus?
• What is the stage of my cancer and what does that mean for me?
• What treatments are appropriate for me? What do you recommend? Why?
• Can I be evaluated by a gynecologic oncologist?
• Am I eligible for a clinical trial?
• What should I do to be ready for treatment?
• Should I get a second opinion?
• What risks or side effects should I expect?
• What are the chances my cancer will come back with the treatment options we have discussed?
• Should I follow a special diet?
• Will I be able to have children after my treatment?
• What is my prognosis, based on what you know about my cancer?
• When will I be able to return to daily activities?
• How will this affect my sex life?
• Does this cancer prevent me from considering estrogen replacement therapy?

In addition to these sample questions, be sure to write down some of your own. For instance, you may need specific information about anticipated recovery times so that you can plan your work schedule.