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PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-.

Uterine Sarcoma Treatment (PDQ®)

Patient Version

Authors
PDQ Adult Treatment Editorial Board.

Published online: June 12, 2019.

This PDQ cancer information summary has current information about the
treatment of uterine sarcoma. It is meant to inform and help patients,
families, and caregivers. It does not give formal guidelines or
recommendations for making decisions about health care.
Editorial Boards write the PDQ cancer information summaries and keep
them up to date. These Boards are made up of experts in cancer treatment
and other specialties related to cancer. The summaries are reviewed
regularly and changes are made when there is new information. The date
on each summary ("Date Last Modified") is the date of the most recent
change. The information in this patient summary was taken from the
health professional version, which is reviewed regularly and updated as
needed, by the PDQ Adult Treatment Editorial Board.

General Information About Uterine Sarcoma

Key Points for This Section

 Uterine sarcoma is a disease in which malignant (cancer) cells form

in the muscles of the uterus or other tissues that support the uterus.
 Past treatment with radiation therapy to the pelvis can increase the
risk of uterine sarcoma.
 Signs of uterine sarcoma include abnormal bleeding.
 Tests that examine the uterus are used to detect (find) and diagnose
uterine sarcoma.
 Certain factors affect prognosis (chance of recovery) and treatment
options.
Uterine sarcoma is a disease in which malignant (cancer) cells
form in the muscles of the uterus or other tissues that support
the uterus.
The uterus is part of the female reproductive system. The uterus is the
hollow, pear-shaped organ in the pelvis, where a fetus grows. The cervix is
at the lower, narrow end of the uterus, and leads to the vagina.

Anatomy of the female reproductive system. The organs in the female

reproductive system include the uterus, ovaries, fallopian tubes, cervix,
and vagina. The uterus has a muscular outer layer called the myometrium
and an inner lining called the endometrium.
Uterine sarcoma is a very rare kind of cancer that forms in the uterine
muscles or in tissues that support the uterus. (Information about other
types of sarcomas can be found in the PDQ summary on Adult Soft Tissue
Sarcoma Treatment.) Uterine sarcoma is different from cancer of
the endometrium, a disease in which cancer cells start growing inside the
lining of the uterus. (See the PDQ summary on Endometrial Cancer
Treatment for information).

Past treatment with radiation therapy to the pelvis can increase

the risk of uterine sarcoma.
Anything that increases your risk of getting a disease is called a risk factor.
Having a risk factor does not mean that you will get cancer; not having
risk factors doesn’t mean that you will not get cancer. Talk with your
doctor if you think you may be at risk. Risk factors for uterine sarcoma
include the following:
 Past treatment with radiation therapy to the pelvis.
 Treatment with tamoxifen for breast cancer. If you are taking
this drug, have a pelvic exam every year and report
any vaginal bleeding (other than menstrual bleeding) as soon as
possible.

Signs of uterine sarcoma include abnormal bleeding.

Abnormal bleeding from the vagina and other signs and symptoms may be
caused by uterine sarcoma or by other conditions. Check with your doctor
if you have any of the following:
 Bleeding that is not part of menstrual periods.
 Bleeding after menopause.
 A mass in the vagina.
 Pain or a feeling of fullness in the abdomen.
 Frequent urination.

Tests that examine the uterus are used to detect (find) and
diagnose uterine sarcoma.
The following tests and procedures may be used:
 Physical exam and history: An exam of the body to check general
signs of health, including checking for signs of disease, such as
lumps or anything else that seems unusual. A history of the patient’s
health habits and past illnesses and treatments will also be taken.
 Pelvic exam: An exam of the vagina, cervix, uterus, fallopian
tubes, ovaries, and rectum. A speculum is inserted into the vagina
and the doctor or nurse looks at the vagina and cervix for signs of
disease. A Pap test of the cervix is usually done. The doctor or nurse
also inserts one or two lubricated, gloved fingers of one hand into
the vagina and places the other hand over the lower abdomen to feel
the size, shape, and position of the uterus and ovaries. The doctor or
nurse also inserts a lubricated, gloved finger into the rectum to feel
for lumps or abnormal areas.

Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved

fingers of one hand into the vagina and presses on the lower
abdomen with the other hand. This is done to feel the size, shape,
 and position of the uterus and ovaries. The vagina, cervix, fallopian
tubes, and rectum are also checked.
 Pap test: A procedure to collect cells from the surface of the cervix
and vagina. A piece of cotton, a brush, or a small wooden stick is
used to gently scrape cells from the cervix and vagina. The cells are
viewed under a microscope to find out if they are abnormal. This
procedure is also called a Pap smear. Because uterine sarcoma
begins inside the uterus, this cancer may not show up on the Pap
test.

Pap test. A speculum is inserted into the vagina to widen it. Then, a
brush is inserted into the vagina to collect cells from the cervix. The
cells are checked under a microscope for signs of disease.
 Transvaginal ultrasound exam: A procedure used to examine the
vagina, uterus, fallopian tubes, and bladder. An ultrasound
transducer (probe) is inserted into the vagina and used to bounce
high-energy sound waves (ultrasound) off internal tissues or organs
and make echoes. The echoes form a picture of body tissues called
a sonogram. The doctor can identify tumors by looking at the
sonogram.

Transvaginal ultrasound. An ultrasound probe connected to a

computer is inserted into the vagina and is gently moved to show
different organs. The probe bounces sound waves off internal organs
and tissues to make echoes that form a sonogram (computer picture).
 Dilatation and curettage: A procedure to remove samples of tissue
from the inner lining of the uterus. The cervix is dilated and
 a curette (spoon-shaped instrument) is inserted into the uterus to
remove tissue. The tissue samples are checked under a microscope
for signs of disease. This procedure is also called a D&C.

Dilatation and curettage (D and C). A speculum is inserted into the

vagina to widen it in order to look at the cervix (first panel). A
dilator is used to widen the cervix (middle panel). A curette is put
through the cervix into the uterus to scrape out abnormal tissue (last
panel).
 Endometrial biopsy: The removal of tissue from the endometrium
(inner lining of the uterus) by inserting a thin, flexible tube through
the cervix and into the uterus. The tube is used to gently scrape a
small amount of tissue from the endometrium and then remove the
tissue samples. A pathologist views the tissue under a microscope to
look for cancer cells.

Certain factors affect prognosis (chance of recovery) and

treatment options.
The prognosis (chance of recovery) and treatment options depend on the
following:
 The stage of the cancer.
 The type and size of the tumor.
 The patient's general health.
 Whether the cancer has just been diagnosed or has recurred (come
back).
Stages of Uterine Sarcoma

Key Points for This Section

 After uterine sarcoma has been diagnosed, tests are done to find out
if cancer cells have spread within the uterus or to other parts of the
body.
 Uterine sarcoma may be diagnosed, staged, and treated in the same
surgery.
 There are three ways that cancer spreads in the body.
 Cancer may spread from where it began to other parts of the body.
 The following stages are used for uterine sarcoma:
o Stage I
o Stage II
o Stage III
o Stage IV

After uterine sarcoma has been diagnosed, tests are done to

find out if cancer cells have spread within the uterus or to
other parts of the body.
The process used to find out if cancer has spread within the uterus or to
other parts of the body is called staging. The information gathered from
the staging process determines the stage of the disease. It is important to
know the stage in order to plan treatment. The following procedures may
be used in the staging process:
 Blood chemistry studies: A procedure in which a blood sample is
checked to measure the amounts of certain substances released into
the blood by organs and tissues in the body. An unusual (higher or
lower than normal) amount of a substance can be a sign of disease.
 CA 125 assay: A test that measures the level of CA 125 in the
blood. CA 125 is a substance released by cells into the bloodstream.
An increased CA 125 level is sometimes a sign of cancer or
other condition.
 Chest x-ray: An x-ray of the organs and bones inside the chest. An
x-ray is a type of energy beam that can go through the body and onto
film, making a picture of areas inside the body.
 Transvaginal ultrasound exam: A procedure used to examine
the vagina, uterus, fallopian tubes, and bladder. An ultrasound
transducer (probe) is inserted into the vagina and used to bounce
high-energy sound waves (ultrasound) off internal tissues or organs
and make echoes. The echoes form a picture of body tissues called
a sonogram. The doctor can identify tumors by looking at the
sonogram.

Transvaginal ultrasound. An ultrasound probe connected to a

computer is inserted into the vagina and is gently moved to show
 different organs. The probe bounces sound waves off internal organs
and tissues to make echoes that form a sonogram (computer picture).
 CT scan (CAT scan): A procedure that makes a series of detailed
pictures of areas inside the body, such as the abdomen and pelvis,
taken from different angles. The pictures are made by a computer
linked to an x-ray machine. A dye may be injected into a vein or
swallowed to help the organs or tissues to show up more clearly.
This procedure is also called computed tomography, computerized
tomography, or computerized axial tomography.
 Cystoscopy: A procedure to look inside the bladder and urethra to
check for abnormal areas. A cystoscope is inserted through the
urethra into the bladder. A cystoscope is a thin, tube-like instrument
with a light and a lens for viewing. It may also have a tool to remove
tissue samples, which are checked under a microscope for signs of
cancer.
 Cystoscopy. A cystoscope (a thin, tube-like instrument with a light
and a lens for viewing) is inserted through the urethra into the
bladder. Fluid is used to fill the bladder. The doctor looks at an
image of the inner wall of the bladder on a computer monitor.

Uterine sarcoma may be diagnosed, staged, and treated in the

same surgery.
Surgery is used to diagnose, stage, and treat uterine sarcoma. During this
surgery, the doctor removes as much of the cancer as possible. The
following procedures may be used to diagnose, stage, and treat uterine
sarcoma:
 Laparotomy: A surgical procedure in which an incision (cut) is made
in the wall of the abdomen to check the inside of the abdomen for
 signs of disease. The size of the incision depends on the reason the
laparotomy is being done. Sometimes organs are removed or tissue
samples are taken and checked under a microscope for signs of
disease.
 Abdominal and pelvic washings: A procedure in which
a saline solution is placed into the abdominal and pelvic
body cavities. After a short time, the fluid is removed and viewed
under a microscope to check for cancer cells.
 Total abdominal hysterectomy: A surgical procedure to remove the
uterus and cervix through a large incision (cut) in the abdomen.

Hysterectomy. The uterus is surgically removed with or without

other organs or tissues. In a total hysterectomy, the uterus and cervix
 are removed. In a total hysterectomy with salpingo-oophorectomy,
(a) the uterus plus one (unilateral) ovary and fallopian tube are
removed; or (b) the uterus plus both (bilateral) ovaries and fallopian
tubes are removed. In a radical hysterectomy, the uterus, cervix, both
ovaries, both fallopian tubes, and nearby tissue are removed. These
procedures are done using a low transverse incision or a vertical
incision.
 Bilateral salpingo-oophorectomy: Surgery to remove
both ovaries and both fallopian tubes.
 Lymphadenectomy: A surgical procedure in which lymph nodes are
removed and checked under a microscope for signs of cancer. For
a regional lymphadenectomy, some of the lymph nodes in the tumor
area are removed. For a radical lymphadenectomy, most or all of the
lymph nodes in the tumor area are removed. This procedure is also
called lymph node dissection.
Treatment in addition to surgery may be given, as described in
the Treatment Option Overview section of this summary.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:
 Tissue. The cancer spreads from where it began by growing into
nearby areas.
 Lymph system. The cancer spreads from where it began by getting
into the lymph system. The cancer travels through the lymph
vessels to other parts of the body.
 Blood. The cancer spreads from where it began by getting into the
blood. The cancer travels through the blood vessels to other parts of
the body.

Cancer may spread from where it began to other parts of the

body.
When cancer spreads to another part of the body, it is called metastasis.
Cancer cells break away from where they began (the primary tumor) and
travel through the lymph system or blood.
  Lymph system. The cancer gets into the lymph system, travels
through the lymph vessels, and forms a tumor (metastatic tumor) in
another part of the body.
 Blood. The cancer gets into the blood, travels through the blood
vessels, and forms a tumor (metastatic tumor) in another part of the
body.
The metastatic tumor is the same type of cancer as the primary tumor. For
example, if uterine sarcoma spreads to the lung, the cancer cells in the lung
are actually uterine sarcoma cells. The disease is metastatic uterine
sarcoma, not lung cancer.

metastasis: how cancer spreads

Many cancer deaths are caused when cancer moves from the original
tumor and spreads to other tissues and organs. This is called metastatic
cancer. This animation shows how cancer cells travel from the place in the
body where they first formed to other parts of the body.
YouTube

The following stages are used for uterine sarcoma:

Stage I

In stage I, cancer is found in the uterus only. Stage I is divided into stages

IA and IB, based on how far the cancer has spread.
 Stage IA: Cancer is in the endometrium only or less than halfway
through the myometrium (muscle layer of the uterus).
 Stage IB: Cancer has spread halfway or more into the myometrium.

Stage II

In stage II, cancer has spread into connective tissue of the cervix, but has

not spread outside the uterus.

Stage III

In stage III, cancer has spread beyond the uterus and cervix, but has not

spread beyond the pelvis. Stage III is divided into stages IIIA, IIIB, and
IIIC, based on how far the cancer has spread within the pelvis.
  Stage IIIA: Cancer has spread to the outer layer of the uterus and/or
to the fallopian tubes, ovaries, and ligaments of the uterus.
 Stage IIIB: Cancer has spread to the vagina or to
the parametrium (connective tissue and fat around the uterus).
 Stage IIIC: Cancer has spread to lymph nodes in the pelvis and/or
around the aorta (largest artery in the body, which
carries blood away from the heart).

Stage IV

In stage IV, cancer has spread beyond the pelvis. Stage IV is divided into

stages IVA and IVB, based on how far the cancer has spread.
 Stage IVA: Cancer has spread to the bladder and/or bowel wall.
 Stage IVB: Cancer has spread to other parts of the body beyond
the pelvis, including the abdomen and/or lymph nodes in the groin.

Recurrent Uterine Sarcoma

Recurrent uterine sarcoma is cancer that has recurred (come back) after it
has been treated. The cancer may come back in the uterus, the pelvis, or in
other parts of the body.

Treatment Option Overview

Key Points for This Section

 There are different types of treatment for patients with uterine

sarcoma.
 Four types of standard treatment are used:
o Surgery
o Radiation therapy
o Chemotherapy
o Hormone therapy
 New types of treatment are being tested in clinical trials.
 Treatment for uterine sarcoma may cause side effects.
  Patients may want to think about taking part in a clinical trial.
 Patients can enter clinical trials before, during, or after starting their
cancer treatment.
 Follow-up tests may be needed.

There are different types of treatment for patients with uterine

sarcoma.
Different types of treatments are available for patients with uterine
sarcoma. Some treatments are standard (the currently used treatment), and
some are being tested in clinical trials. A treatment clinical trial is
a research study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When clinical
trials show that a new treatment is better than the standard treatment, the
new treatment may become the standard treatment. Patients may want to
think about taking part in a clinical trial. Some clinical trials are open only
to patients who have not started treatment.

Four types of standard treatment are used:

Surgery

Surgery is the most common treatment for uterine sarcoma, as described in

the Stages of Uterine Sarcoma section of this summary.
After the doctor removes all the cancer that can be seen at the time of the
surgery, some patients may be given chemotherapy or radiation
therapy after surgery to kill any cancer cells that are left. Treatment given
after the surgery, to lower the risk that the cancer will come back, is
called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high energy x-rays or

other types of radiation to kill cancer cells or keep them from growing.
There are two types of radiation therapy:
 External radiation therapy uses a machine outside the body to send
radiation toward the cancer.
  Internal radiation therapy uses a radioactive substance sealed in
needles, seeds, wires, or catheters that are placed directly into or
near the cancer.
The way the radiation therapy is given depends on the type and stage of
the cancer being treated. External and internal radiation therapy are used to
treat uterine sarcoma, and may also be used as palliative therapy to
relieve symptoms and improve quality of life.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of

cancer cells, either by killing the cells or by stopping them from dividing.
When chemotherapy is taken by mouth or injected into a vein or muscle,
the drugs enter the bloodstream and can reach cancer cells throughout the
body (systemic chemotherapy). When chemotherapy is placed directly into
the cerebrospinal fluid, an organ, or a body cavity such as the abdomen,
the drugs mainly affect cancer cells in those areas (regional
chemotherapy). The way the chemotherapy is given depends on the type
and stage of the cancer being treated.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks

their action and stops cancer cells from growing. Hormones are substances
produced by glands in the body and circulated in the bloodstream. Some
hormones can cause certain cancers to grow. If tests show the cancer cells
have places where hormones can attach (receptors), drugs, surgery, or
radiation therapy is used to reduce the production of hormones or block
them from working.

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI website.

Treatment for uterine sarcoma may cause side effects.

For information about side effects caused by treatment for cancer, see
our Side Effects page.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment
choice. Clinical trials are part of the cancer research process. Clinical trials
are done to find out if new cancer treatments are safe and effective or
better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical
trials. Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer
will be treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and help
move research forward.

Patients can enter clinical trials before, during, or after starting

their cancer treatment.
Some clinical trials only include patients who have not yet received
treatment. Other trials test treatments for patients whose cancer has not
gotten better. There are also clinical trials that test new ways to stop cancer
from recurring (coming back) or reduce the side effects of cancer
treatment.
Clinical trials are taking place in many parts of the country. Information
about clinical trials supported by NCI can be found on NCI’s clinical trials
search webpage. Clinical trials supported by other organizations can be
found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out
the stage of the cancer may be repeated. Some tests will be repeated in
order to see how well the treatment is working. Decisions about whether to
continue, change, or stop treatment may be based on the results of these
tests.
Some of the tests will continue to be done from time to time after
treatment has ended. The results of these tests can show if
your condition has changed or if the cancer has recurred (come back).
These tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

For information about the treatments listed below, see the Treatment
Option Overview section.

Stage I Uterine Sarcoma

Treatment of stage I uterine sarcoma may include the following:
 Surgery (total abdominal hysterectomy, bilateral salpingo-
oophorectomy, and lymphadenectomy).
 Surgery followed by radiation therapy to the pelvis.
 Surgery followed by chemotherapy.
Use our clinical trial search to find NCI-supported cancer clinical trials
that are accepting patients. You can search for trials based on the type of
cancer, the age of the patient, and where the trials are being done. General
information about clinical trials is also available.

Stage II Uterine Sarcoma

Treatment of stage II uterine sarcoma may include the following:
 Surgery (total abdominal hysterectomy, bilateral salpingo-
oophorectomy, and lymphadenectomy).
 Surgery followed by radiation therapy to the pelvis.
 Surgery followed by chemotherapy.
Use our clinical trial search to find NCI-supported cancer clinical trials
that are accepting patients. You can search for trials based on the type of
cancer, the age of the patient, and where the trials are being done. General
information about clinical trials is also available.

Stage III Uterine Sarcoma

Treatment of stage III uterine sarcoma may include the following:
 Surgery (total abdominal hysterectomy, bilateral salpingo-
oophorectomy, and lymphadenectomy).
 A clinical trial of surgery followed by radiation therapy to the pelvis.
 A clinical trial of surgery followed by chemotherapy.
Use our clinical trial search to find NCI-supported cancer clinical trials
that are accepting patients. You can search for trials based on the type of
cancer, the age of the patient, and where the trials are being done. General
information about clinical trials is also available.

Stage IV Uterine Sarcoma

There is no standard treatment for patients with stage IV uterine sarcoma.
Treatment may include a clinical trial using chemotherapy.
Use our clinical trial search to find NCI-supported cancer clinical trials
that are accepting patients. You can search for trials based on the type of
cancer, the age of the patient, and where the trials are being done. General
information about clinical trials is also available.

Treatment Options for Recurrent Uterine Sarcoma

For information about the treatments listed below, see the Treatment
Option Overview section.
There is no standard treatment for recurrent uterine sarcoma. Treatment
may include a clinical trial using chemotherapy.
For patients with recurrent carcinosarcoma (a certain type of tumor),
treatment may include the following:
 Radiation therapy as palliative therapy to relieve symptoms (such as
pain, nausea, or bowel problems) and improve the quality of life.
 Hormone therapy.
 A clinical trial of a new treatment.
Use our clinical trial search to find NCI-supported cancer clinical trials
that are accepting patients. You can search for trials based on the type of
cancer, the age of the patient, and where the trials are being done. General
information about clinical trials is also available.

To Learn More About Uterine Sarcoma

For more information from the National Cancer Institute about uterine
sarcoma, see the Uterine Cancer Home Page.
For general cancer information and other resources from the National
Cancer Institute, see the following:
  About Cancer
 Staging
 Chemotherapy and You: Support for People With Cancer
 Radiation Therapy and You: Support for People With Cancer
 Coping with Cancer
 Questions to Ask Your Doctor about Cancer
 For Survivors and Caregivers

About This PDQ Summary

About PDQ
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's)
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Purpose of This Summary

This PDQ cancer information summary has current information about the
treatment of uterine sarcoma. It is meant to inform and help patients,
families, and caregivers. It does not give formal guidelines or
recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep
them up to date. These Boards are made up of experts in cancer treatment
and other specialties related to cancer. The summaries are reviewed
regularly and changes are made when there is new information. The date
on each summary ("Updated") is the date of the most recent change.
The information in this patient summary was taken from the health
professional version, which is reviewed regularly and updated as needed,
by the PDQ Adult Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether
one treatment is better than another. Trials are based on past studies and
what has been learned in the laboratory. Each trial answers certain
scientific questions in order to find new and better ways to help cancer
patients. During treatment clinical trials, information is collected about the
effects of a new treatment and how well it works. If a clinical trial shows
that a new treatment is better than one currently being used, the new
treatment may become "standard." Patients may want to think about taking
part in a clinical trial. Some clinical trials are open only to patients who
have not started treatment.
Clinical trials can be found online at NCI's website. For more information,
call the Cancer Information Service (CIS), NCI's contact center, at 1-800-
4-CANCER (1-800-422-6237).

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The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Uterine Sarcoma
Treatment. Bethesda, MD: National Cancer Institute. Updated
<MM/DD/YYYY>. Available
at: https://www.cancer.gov/types/uterine/patient/uterine-sarcoma-
treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389379]
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