Treatments for uterine sarcoma

The following are treatment options for uterine sarcoma, a type of uterine cancer, by stage. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

The following are treatment options for stages 1 and 2, also called early-stage uterine sarcoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is the main treatment for early-stage uterine sarcoma. Surgery is used to both remove the cancer and determine what stage the cancer is (called surgical staging). The type of surgery and amount of tissue that needs to be removed depends on several factors about you and the cancer, including your age, where cancer is in the uterus and how it was diagnosed.

Most people with early-stage uterine sarcoma will have a total hysterectomy (removal of the uterus and cervix) and a bilateral salpingo-oophorectomy (removal of the 2 fallopian tubes and ovaries). If cancer was diagnosed after a biopsy or myomectomy (surgery to remove uterine fibroids), removal of all the above tissues is usually done in a single surgery. If cancer was diagnosed after a hysterectomy, you may have a second surgery to remove more tissue so that, between the two surgeries, the surgeon will have removed all tissues necessary.

The surgeon may also remove lymph nodes in the pelvis (called pelvic lymph nodes) and around the aorta (called para-aortic lymph nodes) if you have certain types of uterine sarcoma, including:

• high-grade endometrial stromal sarcoma (HG-ESS)
• undifferentiated uterine sarcoma

In cases of early-stage uterine sarcoma that has grown into tissues outside the uterus (stage 2A or stage 2B), tumour debulking is also typically done to try to remove as much of the cancer in surrounding tissues as possible.

Doctors may offer young and premenopausal people with stage 1 leiomyosarcoma the option of surgery that doesn’t remove the ovaries to prevent the onset of menopause (called treatment-induced menopause) . There is an increased risk of cancer coming back (recurrence) if you don’t have your ovaries removed, but not having your ovaries removed means you’ll avoid the side effects of menopause, such as loss of bone density.

In some cases of low-grade, early-stage endometrial stromal sarcoma that hasn’t spread outside of the endometrium, uterine-sparing surgery may be offered. As with surgery that doesn't remove the ovaries, there’s an increased risk of cancer coming back with uterine-sparing surgery. Typically, people who have this surgery will also have a hysterectomy and bilateral salpingo-oophorectomy after they have finished trying to conceive. Surgery for early-stage uterine sarcoma may be followed by another type of treatment, such as radiation therapy or chemotherapy. This is called adjuvant therapy.

Find out more about surgery for uterine cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation therapy may be offered as adjuvant therapy for some types of early-stage uterine sarcoma when the cancer cells have spread to tissues outside of the uterus (stage 2A or stage 2B).

In some cases, if it’s unclear whether the tumour can be completely removed through surgery, radiation therapy may be used first (called neoadjuvant therapy) to try to shrink the tumour, making it easier to remove.

Radiation therapy may also be offered if you can’t have surgery to treat early-stage uterine sarcoma.

External radiation therapy, brachytherapy or a combination may be given for early-stage uterine sarcoma. These may also be given with systemic therapy such as chemotherapy.

Find out more about radiation therapy for uterine cancer.

Chemotherapy uses drugs to destroy cancer cells. Chemotherapy is sometimes offered for early-stage uterine sarcoma.

You may be given chemotherapy after surgery as adjuvant therapy for some types of early-stage uterine sarcoma, including:

• HG-ESS
• uterine adenosarcoma
• leiomyosarcoma
• undifferentiated uterine sarcoma

Chemotherapy can be given on its own or together with radiation therapy. When chemotherapy and radiation therapy are given in the same time period, it’s called chemoradiation.

The most common chemotherapy drug combination used for early-stage uterine sarcoma is cisplatin and doxorubicin. If you aren’t given a chemotherapy drug combination, you may have doxorubicin or carboplatin instead.

Find out more about chemotherapy for uterine cancer.

Hormone therapy adds, blocks or removes hormones to slow or stop the growth of cancer cells that need hormones to grow. Hormone therapy may be offered as adjuvant therapy for early-stage uterine adenosarcoma and endometrial stromal sarcoma (ESS) that are hormone receptor–positive.

Hormone receptor–positive uterine sarcomas have receptors for either estrogen (called estrogen receptor–positive) or progesterone (called progesterone receptor–positive), or both.

If you can’t have surgery for early-stage uterine sarcoma, you may also be offered hormone therapy.

Hormone therapy drugs offered for early-stage uterine sarcoma include:

• medroxyprogesterone (Provera)
• megestrol

If you are post-menopausal, you may also be offered:

• anastrozole (Arimidex)
• exemestane (Aromasin)
• letrozole (Femara)

If you are premenopausal and didn’t have your ovaries removed during surgery, you may be offered goserelin (Zoladex) or leuprolide (Lupron, Lupron Depot, Eligard) as well.

Find out more about hormone therapy for uterine cancer.

The following are treatments for stages 3 and 4, also called advanced-stage, uterine sarcoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is the main treatment for advanced-stage uterine sarcoma. Surgery is used to both remove the cancer and determine what stage the cancer is (called surgical staging). The type of surgery and amount of tissue that needs to be removed depends on several factors about you and the cancer, including your age, where cancer is in the uterus and how it was diagnosed.

Surgery for advanced-stage uterine sarcoma is followed by another type of treatment, such as radiation therapy or chemotherapy. This is called adjuvant therapy.

Stage 3 uterine sarcoma is usually treated with a hysterectomy (removal of the uterus) and a bilateral salpingo-oophorectomy (removal of the 2 fallopian tubes and ovaries). Depending on how far the cancer has spread, the surgeon will either do a total hysterectomy or radical hysterectomy.

A total hysterectomy is surgery to remove the uterus and the cervix. A radical hysterectomy removes more tissues than a total hysterectomy. In addition to the uterus and cervix, a radical hysterectomy may remove:

• the upper vagina
• tissues surrounding the uterus

Tumour debulking is typically done at the same time as the hysterectomy and bilateral salpingo-oophorectomy to try to remove as much of the cancer in surrounding tissues as possible.

The surgeon may also remove lymph nodes in the pelvis (called pelvic lymph nodes) and around the aorta (called para-aortic lymph nodes).

If cancer was diagnosed after a biopsy or myomectomy (surgery to remove uterine fibroids), removal of all of the above tissues is usually done in a single surgery. If cancer was diagnosed after a hysterectomy, you may have a second surgery to remove more tissue so that, between the two surgeries, the surgeon will have removed all tissues necessary.

Stage 4 uterine sarcoma is sometimes treated with surgery. In cases where the cancer hasn’t spread outside of the pelvis, surgical debulking and a pelvic exenteration may be done.

In cases where the cancer has spread from its original location to distant organs or lymph nodes (called distant metastasis), but only to a few sites, surgery may be used to try to remove the cancer (called surgical resection). This typically is done in more than one surgery. Your healthcare team will refer you to a surgeon who specializes in surgery of the organs where the metastasis is found. For example, if metastatic uterine sarcoma is found in the lungs, you’ll see a thoracic surgeon to remove the cancer there.

In cases where cancer has spread too far to be removed by debulking or the metastasis is too widespread, a hysterectomy may still be done to help relieve symptoms of the cancer.

Find out more about surgery for uterine cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered radiation therapy as adjuvant therapy after surgery for advanced-stage uterine sarcoma.

In some cases, when the tumour is too big or has spread too far to be removed with surgery, radiation therapy may be used first (called neoadjuvant therapy) to try to shrink the tumour and make it possible for doctors to remove it.

If you can’t have surgery, you may also be offered external radiation therapy as palliative therapy to manage symptoms of uterine sarcoma.

Brachytherapy, external radiation therapy or a combination may be used for advanced-stage uterine sarcoma. Radiation therapy can be given on its own or with systemic therapy.

Find out more about radiation therapy for uterine cancer.

Chemotherapy uses drugs to destroy cancer cells. You may be offered chemotherapy after surgery (called adjuvant chemotherapy) for advanced-stage uterine sarcoma. In cases of stage 4 cancer that can’t be removed with surgery (metastatic uterine sarcoma), chemotherapy may be offered to help control the symptoms of metastatic cancer.

Chemotherapy drug combinations that are used to treat advanced-stage uterine sarcoma include:

• docetaxel and gemcitabine
• doxorubicin and dacarbazine
• doxorubicin, ifosfamide and mesna
• doxorubicin and cisplatin
• gemcitabine and dacarbazine
• doxorubicin and trabectedin

Single chemotherapy drugs that may also be used for advanced-stage uterine sarcoma include:

• doxorubicin
• ifosfamide
• gemcitabine
• dacrabazine
• epirubicin

If you have advanced stage leiomyosarcoma, you may also be offered a combination of doxorubicin and trabectedin, or trabectedin on its own.

Chemotherapy may be given by itself or with radiation therapy. When chemotherapy and radiation therapy are given in the same time period, it’s called chemoradiation.

Find out more about chemotherapy for uterine cancer.

Hormone therapy adds, blocks or removes hormones to slow or stop the growth of cancer cells that need hormones to grow. Hormone therapy may be offered as adjuvant therapy for advanced-stage uterine adenosarcoma and endometrial stromal sarcoma (ESS) that are hormone receptor–positive.

Hormone receptor–positive uterine sarcomas have receptors for either estrogen (called estrogen receptor–positive) or progesterone (called progesterone receptor–positive), or both.

If you can’t have surgery for advanced-stage uterine sarcoma, you may also be offered hormone therapy.

Hormone therapy drugs that are given for advanced-stage uterine sarcoma include:

• medroxyprogesterone (Provera)
• megestrol

If you are post-menopausal, you may also be offered:

• anastrozole (Arimidex)
• exemestane (Aromasin)
• letrozole (Femara)

Find out more about hormone therapy for uterine cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Some people may be offered targeted therapy as a treatment for advanced-stage uterine sarcoma.

Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are drugs that inhibit neurotrophic tyrosine receptor kinase (NTRK). They may be given as palliative therapy for advanced-uterine sarcoma that has an NTRK gene mutation and can’t be treated with surgery.

Pazopanib (Votrient) is a drug that inhibits new blood vessels from forming (called an angiogenesis inhibitor) by blocking several kinase proteins. Pazopanib may be given as palliative therapy for advanced-stage uterine sarcoma that didn’t respond to, or continued to grow after, treatment with chemotherapy.

Find out more about targeted therapy for uterine cancer.

Recurrent uterine sarcoma means that the cancer has come back after it has been treated. The treatments you’ll have for recurrent uterine sarcoma are based on where it comes back, the amount of the cancer and which kinds of treatment you’ve had before.

Local recurrence means the cancer has come back in the same area as the original tumour or in tissues, organs or lymph nodes close to it.

Distant recurrence means the cancer has come back in other parts of the body. Distant recurrence may also be called metastatic cancer. When distant recurrence only occurs in a few sites and there is no evidence of cancer anywhere else in the body, it’s called isolated metastasis. When distant recurrence occurs in many places throughout the body, it’s called disseminated metastasis.

You may be offered the following treatments for recurrent uterine sarcoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

You may be offered surgery for recurrent uterine sarcoma, depending on how much cancer there is and where it has spread. In cases of local recurrence, surgery may be used to try to remove the cancer (called surgical resection) and debulk the tumour. A pelvic exenteration may also be used to remove organs and tissues not removed during previous surgeries for uterine sarcoma, such as:

• fallopian tubes
• ovaries
• lymph nodes in the pelvis (called pelvic lymph nodes) and around the aorta (called para-aortic lymph nodes)
• parts of the peritoneum
• the bladder
• the rectum
• the vagina
• the vulva

A pelvic exenteration surgery is a type of salvage therapy done if the cancer hasn’t responded to treatment with other therapies.

In cases of distant recurrence to only a few sites (also called isolated metastasis), when there is no evidence of disseminated metastasis, the surgeon may also try to remove tumours outside of the pelvis. This typically is done in more than one surgery. You’ll be referred to another surgeon who specializes in surgery in the location where the isolated metastasis is found. You’re most likely to have surgical resection for distant recurrence in the lungs.

Surgery for recurrent uterine sarcoma is followed by another type of treatment, such as radiation therapy or chemotherapy. This is called adjuvant therapy.

Find out more about surgery for uterine cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation therapy is sometimes given for recurrent uterine sarcoma. The type of radiation therapy you have depends on where the cancer came back and the type of radiation therapy you previously had for uterine sarcoma.

For a local recurrence, if you didn’t previously have radiation therapy, you may be offered external radiation therapy as adjuvant therapy. This may be combined with brachytherapy. Sometimes, you’ll also have external radiation therapy as neoadjuvant therapy before surgery.

When you can’t have surgery, you may have radiation as the primary treatment if you didn’t previously have radiation therapy. Some people who can’t have surgery and previously had radiation therapy for uterine sarcoma will be offered external radiation, brachytherapy, or a combination, for recurrent uterine sarcoma.

For a distant recurrence, in cases of isolated metastasis that can be surgically removed, external radiation therapy may be used either before or after surgery.

When isolated metastasis can’t be surgically removed, external radiation therapy may be given to control the growth of the cancer and make it possible for doctors to remove it. If the cancer responds to these therapies and the surgeon can remove it, you may also have external radiation therapy after surgery.

In cases of disseminated metastasis, radiation therapy may be given as palliative therapy to manage symptoms caused by recurrent uterine cancer.

Find out more about radiation therapy for uterine cancer.

Chemotherapy uses drugs to destroy cancer cells. You may be offered chemotherapy for recurrent uterine sarcoma.

When recurrent cancer can be treated with surgery, chemotherapy is usually given as adjuvant therapy after surgery. Sometimes, you may also have chemotherapy as neoadjuvant therapy before surgery to kill any cancer cells that have broken away from the primary tumour.

In some cases of isolated metastasis, when the tumour is too big or has spread too far to be surgically removed, chemotherapy may be used to control the growth of the cancer and make it possible for doctors to remove it.

If recurrent cancer can’t be treated with surgery, you may be offered chemotherapy to relieve the symptoms of metastatic cancer.

You may have chemotherapy by itself or with radiation therapy. When chemotherapy and radiation therapy are given in the same time period, it’s called chemoradiation. Whether you have chemotherapy alone or together with radiation therapy depends on where the cancer came back and whether you had radiation therapy for uterine sarcoma before.

Chemotherapy drug combinations that are used to treat recurrent uterine sarcoma include:

• docetaxel and gemcitabine
• doxorubicin and dacarbazine
• doxorubicin, ifosfamide and mesna
• doxorubicin and cisplatin
• gemcitabine and dacarbazine
• doxorubicin and trabectedin

Single chemotherapy drugs that may also be used for recurrent uterine sarcoma include:

• doxorubicin
• ifosfamide
• gemcitabine
• dacrabazine
• epirubicin

If you have recurrent leiomyosarcoma, you may also be offered a combination of doxorubicin and trabectedin, or trabectedin on its own.

Find out more about chemotherapy for uterine cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Some people are given targeted therapy as palliative therapy for recurrent uterine sarcoma.

You may have targeted therapy by itself or together with radiation therapy.

Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are drugs that inhibit neurotrophic tyrosine receptor kinase (NTRK). They may be given as palliative therapy for recurrent uterine sarcoma that has an NTRK gene mutation and can’t be treated with surgery.

Pazopanib (Votrient) is a drug that inhibits new blood vessels from forming (called an angiogenesis inhibitor) by blocking several kinase proteins. Pazopanib may be given as palliative therapy for recurrent uterine sarcoma that didn’t respond to, or continued to grow after, treatment with chemotherapy.

Find out more about targeted therapy for uterine cancer.

Hormone therapy adds, blocks or removes hormones to slow or stop the growth of cancer cells that need hormones to grow. Hormone therapy may be offered for recurrent uterine sarcoma that is hormone receptor–positive.

Hormone receptor–positive uterine cancer has receptors for either estrogen (called estrogen receptor–positive) or progesterone (called progesterone receptor–positive), or both.

You may have hormone therapy as adjuvant therapy after surgery for locally recurrent uterine sarcoma or isolated metastasis that can be treated with surgery. If you can’t have surgery, you may be offered hormone therapy to relieve symptoms of recurrent and metastatic uterine sarcoma.

Hormone therapy may be given by itself or with radiation therapy.

Hormone therapy drugs that are given for recurrent uterine sarcoma include:

• medroxyprogesterone (Provera)
• megestrol

If you are post-menopausal, you may also be offered:

• anastrozole (Arimidex)
• exemestane (Aromasin)
• letrozole (Femara)

Find out more about hormone therapy for uterine cancer.

Talk to your doctor about clinical trials open to people with uterine sarcoma in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.