uterine LMS, ULMS or just LMS
Uterine LMS is a rare malignant (cancerous) tumour. It arises from the endometrial lining or smooth muscles lining the walls of the uterus (myometrium).
Leiomyosarcoma, in general, is classified as a soft tissue sarcoma, whilst sarcomas are malignant tumours arising from the connective tissues – which connect, support, and surround the structures and organs in the body. Soft tissue includes fat, muscle, never, tissue surrounding the joints and blood and lymph vessels. The exact cause of leiomyosarcoma, including uterine leiomyosarcoma, is unknown.
Uterine leiomyosarcoma is one of the most common type of leiomyosarcoma, however, the diagnoses of ULMS itself is rare. ULMS occur primarily in women from 40 to 60 years of age.
The symptoms of the ULMS might be abnormal vaginal bleeding, irregular menstruation bleeding and / or heavy pelvic or abdominal pain. These symptoms however, might also belong to uterine fibroids (leiomyomas; non-cancerous growth within the muscular wall of the uterus) as they could be also present in the uterus. On pelvic examination, the uterus may be enlarged. Other symptoms, such as weight loss, fatigue, weakness, lethargy and fever, are generally associated with any type of cancer.
The only procedure how to treat leiomyosarcoma is hysterectomy – the removal of the uterus with the possibility to remove also the ovaries, fallopian tubes and cervix, if they are also affected. The range and type of hysterectomy depends on the cancer stage – which parts of woman reproductive system are affected.
Anti-cancer drugs used alone or in combination with radiation therapy were also used to treat individuals with leiomyosarcoma following surgery. The benefits of this adjuvant therapy treatment were however limited.
As the uterine leiomyosarcoma might be diagnosed as non-cancerous uterine fibroids because of the similar symptoms and their possible presence in the uterus at the same time it is hard to recognize the leiomyosarcoma and thus the leiomyosarcoma is often diagnosed during or after the operation.
As the uterus has to be removed, the woman is not able to get pregnant and carry the child later on. Assisted reproductive technologies are necessary to conceive and bring the baby to the world.
Associated diseases
Complications
Risk factors
The woman with ULMS has to undergo the surgery of uterus removal called hysterectomy, to get rid of the tumour. Usually, the ovaries and the fallopian tubes are removed as well depending upon the stage of the cancer or the size of the tumour. As the uterus has to be removed, the woman is not able to get pregnant and carry the child later on. It is not the big problem though as the ULMS usually occurs at the women with the age of 40 to 60 years, or after menopause, which already have children or do not plan any more children. However, oocyte cryopreservation technique (laboratory technique used to long-.term storage of female of the female gametes) is possible; the cryopreserved oocytes of such patient can be later artificially fertilized with partner’s sperm and the resulting embryo is then transferred into the gestational carrier’s uterus.
The best prevention in the case of USLM is the regular examinations at the doctor. Some sampling and testing are available for recognizing uterine fibroids and leiomyosarcoma. To find the cause of abnormal uterine bleeding, a sample of tissue may be removed from the lining of the uterus and looked at under a microscope. Thus in case of uterine leiomyosarcoma, the cancer may be diagnosed in the early stage.
Symptoms of ULMS may vary depending on the tumour location, size and its progression. Many women don’t have any apparent symptoms. Anyway, the most frequent presenting symptoms are abnormal vaginal bleeding, postmenopausal bleeding and pelvic or abdominal pains. At the doctor examination, the uterus is often found enlarged and in some cases, the uterine prolapse through the cervix to the vagina is also present.
Additional symptoms may occur such as vaginal discharge or change in bladder or bowel habits. Other symptoms such as weight loss, fatigue, weakness, lethargy and fever are generally associated with any type of cancer.
However, the signs and symptoms of uterine sarcoma are different. Sometimes the ULMS may be diagnosed because of the symptoms. Unfortunately, the diagnosis is mostly made during or after the surgery for what is thought to be benign tumours – uterine fibroid. Thus many uterine sarcomas may reach an advanced stage before the diagnosis is made.
Acupuncture with heat and stimulation and oral vitamin supplementation seemed beneficial in some studies and cases. Also, the big problem for people and cancer patients is malnutrition and complications from malnutrition. Thus, there are the recommendations about food and spices which may serve as the prevention or even helping in cancer treatment. Among these food and spices, there could be found: garlic, broccoli, green vegetable, nuts, lemon, raspberries, chilli peppers, jalapeños, grains or beans. Having at least 2/3 of the plate with vegetables and grains seems as beneficial also as the prevention.
There were also positive result with meditations and relaxations. As the stress produces the hormones that sabotage the self-healing and the body chemistry reacts to the thoughts and emotion state of body, finding the way to release the mental and emotional stress has the positive influence as the prevention and also additional self-healing technique.
At the first approach, the surgical way by hysterectomy is proposed and seen as the best solution. Furthermore, there are also pharmacotherapeutic methods to encourage the surgical treatment.
Pharmacotherapy
Hormone therapy
Hormone therapy uses hormones or hormone-blocking drugs to treat the cancer or tumour growth. At the ULMS, progestins, which act as the hormone progesterone, or gonadotropin-releasing hormone (GNRH) which switches of the estrogens production are mostly used.
Chemotherapy
Chemotherapy uses the drugs to treat the cancer. These drugs circulate in bloodstream through the body to reach and destroy cancer cells. Chemotherapy may be used to treat metastases as the cancer might spread beyond the uterus and as the additional treatment to the surgical procedure.
Surgical therapy
Hysterectomy
Surgical approach is the first in the case of the recognized diagnose of ULMS. Hysterectomy is the surgical removal of the uterus with leiomyosarcoma. Besides the uterus, the fallopian tubes, ovaries and cervix or also upper part of vagina may be removed.
Other therapy
Radiotherapy
Radiation therapy using high energy radiation such as x-rays is used to kill the cancer cells directly. As the hysterectomy is made in the case of the ULMS, radiotherapy might be used in case of metastases or that the cancer recurring appears.
Immunotherapy
Cancer immunotherapy attempts to stimulate the immune system to destroy tumours. A variety of strategies are in use or are undergoing research and testing.
If all treatments used by conventional medicine fail, the approaches of artificial reproductive techniques are used.
If the ovaries show the normal development and normal function, there is possibility of egg retrieval and following in vitro fertilization (IVF). IVF and ART generally start with stimulating the ovaries to increase egg production. Most fertility medications are agents that stimulate the development of follicles in the ovary. Examples are gonadotropins and gonadotropin-releasing hormone. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body.
Oocyte cryopreservation technique is also possible. It is is laboratory technique used to long-term storage of female gametes in liquid nitrogen for later use in assisted reproduction procedures. As the cancer treatment has negative influence on patient’s fertility, to preserve the fertility of female cancer patients, the oocyte freezing is a reasonable option. These oocytes can mature under laboratory conditions and can be also stored for later use. Cancer treatment can be also related with some anatomical abnormalities. As an example of anatomical abnormality as a result of cancer therapy can serve the removal of uterus, called hysterectomy, done to treat the uterine or cervical carcinoma. In such case the patient that has undergone hysterectomy may retain the capability to produce healthy oocytes, but for obvious reasons can’t bear a child. Cryopreserved oocytes of such patient can be later artificially fertilized with partner’s sperm and the resulting embryo is then transferred into the gestational carrier’s uterus in a synchronized menstrual cycle.
Infertile couples may also resort to egg donation or embryo donation when the female partner cannot have genetic children because her own eggs cannot generate a viable pregnancy.
However if the uterus is absent, there is always necessary to place the fertilized egg into surrogate mother, if the law of the country allows to do so. Surrogacy via a gestational carrier is also an option when a patient's medical condition prevents a safe pregnancy, when a patient has ovaries but no uterus due to congenital absence or previous surgical removal, and where a patient has no ovaries and is also unable to carry a pregnancy to full term.
Process by which a woman donates eggs for purposes of assisted reproduction or biomedical research.
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
The procedure in which a man (sperm donor) provides his sperm for fertility treatment.
A process in which an egg is fertilised by sperm outside the body: in vitro. Own or donated gametes may be used.
