Abstract:
Sarcomas are rare gynaecological tumours, but because most have a bad prognosis, it is important to know when to suspect a sarcoma and to be able to diagnose it from the common uterine fibroleiomyomas. The most common variety of gynaecological sarcomas is the leiomyosarcoma, which constitute about half of gynaecological sarcomas. It is followed by the low malignancy endometrial stromal sarcoma (about 20%) and the undifferentiated sarcoma (about 15%). The remaining 15% represent a long list of even more rare tumours. The suspicion of sarcoma should be raised if uterine tumours grow after menopause in women not receiving estrogen treatment. The mean age is 50-55 years, but sarcomas are seen also in young women. Furthermore, the incidence in women in their 40es and 70es is not much less than in the 50es and 60es. Gynaecological Ultrasound investigation may rise suspicion of malignancy sarcoma based on patterns, especially when supplemented by doppler. CT scans can be used to diagnose distant metastases, but MRI is better to differentiate between malignant and benign tumours, and to evaluate resectability. PET-CT is useful when high malignant potential is known, e.g., when recurrence is suspected, but not useful in case of stromal sarcomas of low malignant potential. If biopsy is considered, multiple samples should be taken. Surgery with wide excision and clear margins is the cornerstone of treatment and should be done in tertiary centres. Bilateral oophorectomy is recommended in endometrial stromal sarcoma patients, and subsequent estrogen therapy should be avoided. Lymphadenectomy in most cases does not result in a better prognosis, unless metastases to lymph nodes are present and resectable. Morcellation is contraindicated in sarcoma surgery. If surgery cannot be radical, it is best avoided. Adjuvant chemotherapy is generally not recommended, and radiation should be reserved for special cases. Both chemotherapy and radiation can be considered in stage III and IV patients.
Audience Take Away Notes:
- When to expect a tumour is a sarcoma and not a fibroma
- How to investigate, if sarcoma is suspected
- Extent of surgery
