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 factors. These include the exact type of cancer you have, how much cancer there is, and where it is (called the cancer stage). It also includes your age, overall health, personal choices, and what side effects you’ll find acceptable.
Uterine sarcoma should be treated by a gynecologic oncologist. This is a doctor who has had extra training in diagnosing and treating cancers that start in the female reproductive system.
Learning about your treatment options
You will likely have questions and concerns about your treatment options. You may want to know how you’ll feel and function 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 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 tell you what your treatment choices are, how well they’re expected to work, and what the risks and side effects are. Your provider may suggest a specific treatment. Or they may offer more than one, and ask you to decide which one 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. You may want to discuss things with a family member or friend. You may want a second opinion to be sure you've covered all your options. Get any questions answered and learn as much as you can so you can make the decision that feels right for you.
The treatment plan your doctor will advise depends on these factors:
Type of uterine sarcoma you have
Grade of the cancer (how fast it's growing)
Size and location of the tumor (stage)
Your overall health
If the cancer has spread to other parts of your body and, if so, where
The goal of treatment (for instance, cure the cancer or control it)
Your personal concerns and preferences
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 1 or more of these things:
Remove the primary cancer tumor in the uterus
Kill the cancer cells or stop their growth and spread
Prevent or delay the cancer's return
Ease symptoms of the cancer, such as pain or pressure on nearby organs
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 first, and then radiation or chemotherapy.
Systemic treatments. These are treatments that go all over the body. They can destroy or control cancer cells in the uterus, as well as other parts of the body. Chemotherapy, immunotherapy, hormone therapy, and targeted therapy are systemic treatments. They work to kill cancer cells or keep new ones from growing anywhere in your body.
You may have just 1 treatment. But in most cases a combination of treatments is used. The order, intensity, and goals of treatment depend on the type and stage of cancer you have.
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 from your body. 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. There are different ways to do this surgery. It may be done through your vagina. It may be done through a cut (incision) in your lower belly (abdomen). It may be done through small incisions using a long, thin tube with a tiny camera (laparoscope). Your doctor may use a precise machine to operate the laparoscope. This is called robotic-assisted surgery. Some of the lymph nodes around your uterus may be removed to check for spread of cancer cells.
Radiation therapy. This is also called radiotherapy. This treatment uses radiation, such as that found in X-rays, to kill cancer cells. Radiation therapy can be given using a machine that directs the rays inside the pelvis. Or it may be done with tiny implants that are put in through the vagina (called brachytherapy). Sometimes radiation therapy is 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 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 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 women 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 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 is still new in uterine cancer. It may be used to treat certain types that spread or come back after treatment.
What is combination treatment?
Your doctor may advise that you get more than 1 type of treatment. This is called combination therapy . It's common for treating uterine sarcoma.
Treatments before surgery are called neoadjuvant treatment. For example, you may get radiation, chemotherapy, or hormone therapy before surgery. These treatments may help shrink the tumor and make it easier to remove all of it.
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 doctor may still advise adjuvant treatment. It helps reduce the chance that the cancer may come back or spread.
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. This can make these cancers hard to treat. Researchers are 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. They allow you to get the best treatments available today, as well as those that might be even better. Talk with your doctor about what clinical trials may be an option for you.
Making a decision
Once you know the type, stage, and grade of your uterine sarcoma, it’s time to decide on a treatment plan. Meeting with your doctor to talk about your treatment choices will be one of the most important visits you’ll have.
It may take time to decide on the best plan. At first, thinking about treatment options may seem overwhelming. Talk with your doctors and nurses. Make a list of questions. Consider the pros and cons of each option. Ask about possible side effects and what can be done about them.
Ask your doctor how much time you can take to explore your options. You may want to get another opinion before deciding on a treatment. You may also want to talk with your family and friends.