LMS, ULMS or just LMS
Uterine LMS is a rare malignant (cancerous) tumor. It arises from the endometrial lining or smooth muscles lining the walls of the uterus (myometrium), (Pic. 1).
Leiomyosarcoma, in general, is classified as a soft tissue sarcoma, whilst sarcomas are malignant tumors 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.
As the first treatment approach to the uterine leiomyosarcoma, the hysterectomy – surgical removal of uterus (also with ovaries and fallopian tubes in most cases) is proposed. By hysterectomy, the tumor in the uterus is removed. Furthermore, hormone therapy, chemotherapy and radiotherapy may be other ways to encourage the surgical treatment or to treat the metastases spread into the major organs in the body.
Symptoms of ULMS may vary depending on the tumor 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 tumors – uterine fibroid. Thus many uterine sarcomas may reach an advanced stage before the diagnosis is made.
Hysterectomy – complications after the surgery
Surgery and uterus removal itself may be itself the cause of following complications during healing the wound.
It has been observed that the ULMS metastasize to all the major organs, especially to lungs and liver. Metastases to these organs or to the heart my require surgery to prevent acute complications. Also chemotherapy, using drugs which circulates in bloodstream to reach and destroy cancer cells, may be used in try to treat or reduce the metastases.
Chemotherapy and radiotherapy
Anti-cancer drugs used alone or in combination with radiation therapy were also used to treat individuals with leiomyosarcoma following surgery. Using these therapies and drugs may cause uncomfortable states of nausea, fatigue, hair loss and other complications connected with chemotherapy and radiotherapy.
The woman with ULMS has to undergo the surgery of uterus removal called hysterectomy, to get rid of the tumor. Usually, the ovaries and the fallopian tubes are removed as well depending upon the stage of the cancer or the size of the tumor. As the uterus has to be removed, the woman is not able to get pregnant and carry the child later on. However, as the ULMS usually occurs at the women with the age of 40 to 60 years, or after menopause, they usually already have children or do not plan any more children.
Surgery is the primary therapy for patients first diagnosed with ULMS. In 70 – 75 % of patients the cancer has not spread out of the uterus. However, uterine leiomyosarcomas are cancerous tumor and may spread locally and to other areas of the body, especially lungs and liver. The 5-year survival rate is only 50% with patients whose tumor is confined to the uterus. Women with ULMS that spreads beyond the uterus have an extremely poor prognosis.
Even though the appearance is rare, this tumor tends to be aggressive. Despite complete surgical removal of the uterus (with ovaries and fallopian tubes as well) which is the best available treatment, more than two thirds of patients will develop a recurrence within 8 to 16 months of the initial diagnosis and treatment. Recurrent uterine LMS is difficult to manage.
As the surgical removal of the uterus (with ovaries and fallopian tubes as well) is necessary, the woman is not able to get pregnant and carry a child anymore. However, methods and techniques of assisted reproductive technology are the possible solution for the couples desiring for the baby.