Uterine serous cancer or uterine papillary serous cancer are both names for the same disease. uterine serous cancer or uterine papillary serous cancer is an aggressive high-grade tumor distinguish from the more common cancers of the uterus. Most cancers of the uterus start on the surface inside the uterine cavity. That surface is named the endometrium. For that reason most uterine cancers are also endometrial cancers. Uterine serous cancer represents about 10% of all uterine cancers. It is an aggressive cancer that can be cured but requires additional therapy for successful treatment. This cancer often will spread to the abdominal cavity and to lymph nodes and this abdominal spread imitates ovarian cancer. Under the microscope it also has an appearance that imitates the most common ovarian cancer. This cancer is usually removed surgically and then treated with combinations of chemotherapy and radiation. Uterine serous cancer will recur in 60-70% of patients if no additional treatment is given after surgery. That recurrence risk is true even when it appears there is no disease outside the uterus. After clinical recognition of this aggressive behavior it became common to use chemotherapy and this achieved increased survival. Dr. Martin is very knowledgeable about this special type of uterine cancer. When this is suspected he will have a thorough discussion with the pathologist who can confirm this diagnosis. Patient's under our care will receive treatment tailored to their exact situation.
SARCOMAS OF UTERUS
Sarcoma and cancer are both malignant but truly different categories. They both can originate from the uterus. A sarcoma is far less common than cancer. A sarcoma is a malignancy originating from the support cells of the uterine tissue and different than the cells making up the surface lining of the endometrium. Some tumors are mixture tumors and they probably arise from a cancer that slowly loses the original tissue features and develops features of the sarcomas. Sarcomas are notable for their unpredictable behavior. The may spread from the uterus through either the blood or through the lymph node system. A uterine sarcoma will present with bleeding, pain, and an enlarged uterus similar to benign fibroids and similar to more common endometrial cancers. Evaluation would commonly be done with an ultrasound and an endometrial biopsy both of which can be done in the office. Special imaging such as an MRI may be done if there is an atypical feature of the uterine mass. Endometrial biopsy may reveal the sarcoma for some types of tumors, and may often have a negative report for a tumor that started deeper in the wall of uterus such as the leiomyosarcoma. Concerning tumors can be sampled with a needle biopsy prior to committing to surgery.
A leiomyosarcoma is the most common sarcoma of the uterus. Even when there is no known spread 25-30% of these patients will end up showing later recurrence confirming the prior spread of disease. This disease has recently been very controversial because it is hard to distinguish from the very common innocent fibroids. A common fibroid will enlarge, and cause bleeding and pain, but does not have any ability to act as a malignancy. If a leiomyosarcoma is handled inappropriately during surgery, such as with a morcellator, then recurrence may be very early and in a very unusual fashion involving the abdominal cavity. For that reason it is important to not presume that every uterine mass is a benign fibroid. Standard treatment is surgical removal of the uterus. If metastatic disease is confirmed chemotherapy can provide benefit. Newer agents are showing great promise for treating sarcomas.
Endometrial stromal sarcoma is a malignancy of the uterus. This disease originates in the cells that support the lining inside the uterus. As this condition progresses it invades deep into the wall of the uterus. This disease was previously named a low-grade endometrial stromal sarcoma. This sarcoma recurs in 25-60% of patients. It can occur in young ages. Recurrence may be delayed 5-10 years. Modern treatment has significantly reduced the recurrences and the deaths from this disease. Even if disease recurs it may be controlled for prolonged periods of time. The foundation of treatment is surgical removal of the uterus. Up to 10% of patients may have involvement of ovaries. Invasion of blood vessels is very common. Treatment may include hormone therapies. Any measurable spread of this malignancy should be removed surgically if this can be safely done.
Undifferentiated endometrial sarcoma is a malignancy of the uterus. This disease has a very aggressive behavior and a very high risk of recurrence even for early stage patients. Chemotherapy does not have the same benefit as would be expected for a common uterine cancer. Some chemotherapies do show response. The foundation of treatment is surgical removal of the uterus.