Sarcoma is rare cancer that affects the organs internally and externally while gynaecological sarcoma primarily affects the uterus and in the later stages, if undetected, it can spread to the ovary, vulva, vagina and other reproductive organs. Sarcomas are one of the less common but important gynaecological cancers and of all the sarcomas, sarcomas of the uterus (baby bag) are the most common.

It is also referred to as uterine cancer as it is formed in the muscle layer of the uterus and is comparatively more aggressive than other forms of cancer. The cancer tumour in the gynaecological sarcoma is initially formed in the uterus, which can spread beyond the pelvis to distant areas like the bladder and rectum in later stages.

In an interview with HT Lifestyle, Dr Rohit Ranade, Consultant-Gynaec Oncology Surgeon, Robotic-assisted Surgery at Narayana Health City, explained, “Uterine sarcoma is a malignant condition of the uterus where cancer cells form in the muscles of the uterus or other tissues that support the uterus. It is a rare condition that accounts for 3-7% of all uterine malignancies. It occurs primarily in perimenopausal women between the ages of 45-53 years.”

He added, “The risk factors associated with uterine sarcoma mainly are past history of pelvic radiation, long use of tamoxifen for breast cancer, hormonal replacement therapy in postmenopausal women and genetics. The incidence of sarcoma transformation of fibroid is around 0.13%-0.81%, and a rapid increase in the size of the fibroid is a possible sign of malignancy. It grows faster and spreads quickly to other parts of the body.”

Symptoms

According to Dr Garima Jain, MBBS, DNB, Consultant Obstetrics and Gynaecology at Apollo Cradle and Children’s Hospital in Bengaluru’s Brookefield, “The symptoms of the gynaecological sarcoma start to present themselves gradually with the progress and the growth of cancer. The initial signs of the sarcoma include non-menstrual and post-menopause bleeding, pain and a feeling of fullness in the area, vaginal discharge beyond normal rate, and pelvic pain. The other symptoms of gynaecological sarcoma also include peeing more often and constipation. In some cases, the symptoms of the gynaecological sarcoma can be completely invisible until the cancer has progressed.”

Echoing the same, Dr Rohit Ranade said, “Usually, the symptoms start in an advanced stage. The symptoms include menstrual disturbances, pain abdomen, postmenopausal bleeding, mass per abdomen, and pressure effects like urinary disturbances and constipation. Detailed patient history, physical examination, tests like imaging techniques, and endometrial biopsy will be required for the diagnosis.”

Treatment

Dr Garima Jain advised, “The primary treatment for gynaecological sarcoma is to remove the cancer-causing tumour from the affected area through surgical hysterectomy. The surgery is performed to remove the uterus and the ovaries, too, in some conditions where cancer has spread beyond the ovaries. We also check for the lymph nodes during the surgery.”

She added, “Adjuvant treatments follow the surgery if cancer has progressed from stage one. The adjuvant treatments are the treatments after surgery like radiation, chemotherapy, hormone therapy etc., to keep cancer in check and to avoid relapse. For some women who can’t undergo surgery due to other underlying medical conditions, the combination of radiation, chemotherapy, and hormone therapy is used to keep cancer in check.”

Bringing his expertise to the same, Dr Rohit Ranade revealed, “The management depends on the stage of cancer. Surgery is the primary mode used for the diagnosis and staging of the tumour. Other modalities of treatment such as chemotherapy, radiation therapy, and hormonal therapy are given based on the type and stage of the tumour, the patient’s performance status, and whether cancer has just been diagnosed or has recurred. Other types of less common gynaecological sarcomas are Endometrial stromal sarcomas, broad ligament (Uterine appendages), Ovarian, and sometimes sarcomas arising from pelvic musculature. Their treatment is on similar lines to Gynaecological sarcomas.”