What is an Endometrial Stromal Sarcoma?

A cancer that originates in the myometrial cells of the lining of the uterus is referred to as an endometrial stromal sarcoma. Considered one of the more rare forms of cancer, the early detection of an endometrial stromal sarcoma is essential to a good prognosis. Treatment options for this condition are dependent on the individual and the extent, or staging, of her cancer.

There is no known cause for the development of cell mutation in the uterine tissue. It has been asserted that estrogen levels may contribute to the development of abnormal myometrial cells. The advanced mutation of abnormal myometrial cells, found within the muscles of the lining of the uterus, can become invasive of the surface epithelial cells resulting in the development of endometrial carcinoma.

Women who began menstruating at a very early age or experienced delayed-onset menopause may be at an increased risk of developing uterine sarcoma. Those who have experienced ovulation irregularities or have never become pregnant may also be at a higher risk for developing endometrial stromal sarcoma. Additional risk factors include diabetes, a family history of breast or ovarian cancer, and obesity.

Endometrial stromal sarcoma is a condition that tends to manifest most frequently in post-menopausal women. The most common symptom associated with this condition is irregular vaginal bleeding. Women who are symptomatic may also experience pelvic discomfort, unintentional weight loss, and irregular menstruation.

A diagnosis of endometrial stromal sarcoma is generally confirmed through a number of tests. Initially, uterine abnormalities may be detected during a pelvic examination and Pap test. In cases where an abnormality is suspected, a transvaginal ultrasound may be conducted to evaluate the condition of the lining of the uterus, or endometrium. If an abnormality is confirmed, an endometrial biopsy may be ordered, which involves the collection of sample cells from within the uterine lining that are sent for laboratory analysis.

A confirmation of endometrial cancer necessitates a referral of the individual to a gynecological oncologist for further testing. Additional tests associated with diagnosis confirmation include the administration of blood tests and a computerized tomography (CT) scan. Results from the additional tests are utilized to determine the extent, or staging, of the cancer and whether or not it has spread, or metastasized, to other parts of the body.

Endometrial cancers that are assigned a stage one label are those that have not spread beyond the uterus. Stages two and three are those cancers which have spread beyond the confines of the uterus to the immediate surrounding organs, including the cervix and lymph nodes in the pelvic area respectively. An endometrial cancer which has spread beyond the pelvic region to other parts of the body is considered the most serious and is labeled a stage four.

Surgery is frequently utilized as an initial step toward treating an endometrial stromal sarcoma. Depending on the staging of the cancer, it is frequently recommended that either the uterus is removed, known as a hysterectomy, or the entire reproductive system is removed, referred to as a hysterectomy with bilateral salpingo-oophorectomy. During surgery, the surrounding lymph nodes and tissues are also removed. Post-surgery treatment is generally dependent on the individual and the extent of her cancer.

In most cases, women with endometrial cancer undergo a combination of radiation and chemotherapy. Radiation therapy employs either the internal or external application of highly concentrated X-ray energy to target and eradicate cancer cells. Side effects associated with radiation therapy include irritation and redness at the administration site and fatigue. Chemotherapy utilizes drugs, administered orally or intravenously, to eliminate cancerous cells. The administration of chemotherapy can cause various side effects that may include nausea, fever, and an impaired immunity to infection.

Women with advanced endometrial stromal sarcoma may also be treated with hormone therapy, which may inhibit the cancer's ability to grow. Hormone therapy generally involves the administration of high doses of synthetic progestin, a form of progesterone. Additional hormone therapy options for premenopausal women involve the administration of synthetic peptide drugs, called gonadotropin-releasing hormone agonists, which work to reduce estrogen levels.