Department of Senological, Gynecological, Plastic and Reconstructive Surgery - Paris Professor Fabrice Lecuru - Institut Curie
  • Cancer de l'ovaire - Ce qu'il faut savoir

    What there is to know

    Uterine sarcomas are relatively rare tumors of the uterus since they represent only 1 to 3% of uterine cancers.
    They correspond to a proliferation of tumor cells within the uterine muscle or the endometrium leading to different histological types depending on the type of overexpressed cells.
    The natural history of sarcomas is poorly understood due to the low incidence of this type of cancer in the general population.

    HISTOLOGICAL TYPES
    There are several histological types of uterine sarcomas:
    - Leiomyosarcomas (the most common, developed at the expense of the uterine muscle)
    - High or low grade endometrial stromal sarcomas (ESS)
    - And undifferentiated uterine sarcomas (USS)

    THE SYMPTOMS
    There is no specific symptom of this pathology. Gynecological bleeding between periods or after menopause are the most frequently observed clinical signs. Uterine sarcomas can also cause pelvic pain or abdominal heaviness as well as bladder stimulation and constipation in some cases. These signs result from the presence of a mass in the pelvis and can therefore also be found in cases of benign or malignant pelvic tumour.

    WHEN TO CONSULT THE DIAGNOSIS?
    There is no screening for uterine sarcomas.

    The diagnosis can be evoked clinically.
    The most characteristic situation is the rapid increase in size of a known uterine fibroid after menopause. Pain and bleeding may be associated.
    The same signs can be observed before menopause, but are much less alarming because fibroids cause these same symptoms in a common way.

    Sarcomas can also be evoked by pelvic ultrasound or MRI. The examination is generally indicated by the follow-up or the pre-operative assessment of banal fibroids. It is therefore important for the radiologist to be able to spot “discreet” signs that can raise the alarm. It is also important that the gynecologist or the surgeon take into account this alert, which must modify his operating technique. It is best to seek advice or choose treatment in a center specialized in the treatment of sarcomas (the list of specialized centers is given on the site www.netsarc.sarcomabcb.org. The Institut Curie, labeled center European expert is one of them: Dr S Bonvalot, www.curie.fr).
    The diagnosis can sometimes be made by an endometrial biopsy (which is a sample taken in a gynecological consultation) in the event of endometrial stromal sarcoma. The sample is taken in the event of abnormal bleeding.

    PRE-THERAPEUTIC ASSESSMENT
    The gynecological sarcoma assessment includes a preoperative pelvic MRI to characterize the mass. This examination lasts approximately 45 minutes and makes it possible to analyze the uterus in order to identify whether it is a reassuring-looking fibroid or whether, on the contrary, it has atypical characteristics which should lead to the diagnosis of sarcoma. The MRI will also ensure that the mass is limited to the uterus and does not reach the other pelvic organs.

    The assessment of the extension of this disease is carried out by a thoraco-abdomino-pelvic scanner which will make it possible to visualize any abdominal or pulmonary lesions possibly secondary to this cancer. A PET scanner is also offered in the majority of cases. There is no specific biological marker for this type of cancer.

    It is important that the imaging examinations and the file are presented and discussed in a specialized RCP (the list of specialized centers is given on the site www.netsarc.sarcomabcb.org; Institut Curie, labeled European expert center in fact part: Dr S Bonvalot, www.curie.fr).

    Furthermore, in the context of the discovery or suspicion of a cancerous pathology requiring surgical treatment, an anesthesia consultation, a nutritional assessment, an oncogeriatric consultation depending on the patient's age may be essential for proper care.