Treatments and Therapies for Uterine Sarcoma

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Fred Hutch Cancer Center offers comprehensive care for uterine sarcoma. We offer advanced therapies and new options available only through clinical trials.

The most common, and usually the first, treatment is surgery. This may be all the treatment you need, or you might have radiation therapy, chemotherapy, targeted therapy or hormone therapy. Some patients have a combination of treatments. But not everyone needs all of these. We’ll tailor your treatment to you.

Uterine Sarcoma Care Tailored to You

You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.

Referrals are required for new patients. Please request your primary care provider or specialist fax all relevant medical information to the fax number listed below.

How We Treat Uterine Sarcoma at Fred Hutch

Your gynecologic oncologist at Fred Hutch will design a custom treatment plan based on your cancer stage, along with many other factors. Fred Hutch offers all standard therapies for uterine sarcoma, which include:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Targeted therapy
  • Hormone therapy

Uterine Sarcoma Surgery

As a patient at Fred Hutch, you’ll have surgery by a UW Medicine gynecologic oncologist. Your surgeon will be specially trained and board certified in gynecologic oncology. They will recommend the best procedure to match your needs.

Gynecologic oncology is a unique specialty because your physician is a surgical oncologist and a medical oncologist, all in one.

“Patients benefit from having a surgeon who can manage all aspects of their cancer care and understands all the new treatments,” said gynecologic oncologist Barbara Goff, MD. “By performing the right surgery, selecting the right chemotherapy, using genetic testing to select targeted therapies, and connecting patients with clinical trials, we are slowly improving patient survival.”

How Surgery Can Treat Uterine Sarcoma

The goal of surgery for uterine sarcoma is to remove all of the cancer or as much cancer as possible. Some people need only surgery followed by checkups to monitor their condition. Others have radiation therapy or other treatments after surgery.

Rarely, physicians advise against surgery to remove the cancer. Your physician may feel surgery is not the best treatment for you because of the size of the cancer, where it is or other health problems you have. In this case, you have other options: radiation therapy, chemotherapy, targeted therapy, hormone therapy or a combination.

Hysterectomy

Most people with uterine sarcoma have a total hysterectomy (surgery to remove the uterus, including the cervix). If cancer has spread to your cervix or the tissue around it (parametrium), your surgeon will also remove that tissue, the ligaments that connect your uterus to your sacrum, and the upper part of your vagina. This is called a radical hysterectomy.

With either surgery, the surgeon will probably remove your fallopian tubes and ovaries (bilateral salpingo-oophorectomy) at the same time. These are places where uterine sarcoma may spread.

Lymph-Node Removal

Your surgeon will also remove lymph nodes from your pelvic area and around the major artery (aorta) in your abdomen (pelvic and para-aortic nodes). We’ll check the lymph nodes to see if cancer has spread there.

Other Steps During Surgery

At the start of your surgery, your surgeon may wash your abdominal and pelvic cavities with salt water (peritoneal lavage). We send this fluid to a laboratory to check for cancer cells. The results can help your physician recommend a treatment plan for you. The surgeon may also remove abdominal fat (omentum) and small samples of the lining of your abdominal and pelvic cavities (peritoneum) for testing.

Laparoscopic and Robot-Assisted Surgery

Our surgeons can use minimally invasive techniques to do hysterectomies, lymph-node removals and the other parts of surgery you may need. The surgeon can operate through small “keyhole” incisions in the belly (laparoscopically). They may insert tools directly through small incisions by hand. Or they may use a robotic system, like the da Vinci Surgical System, to assist with the surgery. Minimally invasive methods reduce pain after surgery, infection, blood loss and recovery time.

Other Surgical Approaches

New medicines aren’t the only line of inquiry. Other advanced approaches are helping people with late-stage disease get better results. For example, some patients may be eligible for CRS-HIPEC. For this treatment, surgeons remove tumors they can see. Then they bathe the inside of the abdomen in warm liquid chemotherapy. Fred Hutch offers this treatment, which isn’t available at all cancer centers.

Open surgery through a larger incision (laparotomy) is still done, too. In some cases, it’s the best option. If you need open surgery, your surgeon will explain the reasons. 

Radiation Therapy for Uterine Sarcoma

Radiation therapy (also called radiotherapy) uses high-energy beams to damage the DNA inside cancer cells. After enough damage, the cells cannot multiply, and they die. 

How Radiation Therapy Can Treat Uterine Sarcoma

Your physician may recommend having radiation therapy after surgery. If you’re not having surgery, then radiation therapy will likely be part of your care.

There are two main types of radiation therapy: external-beam radiation therapy (EBRT) and internal radiation therapy.

  • EBRT means radiation comes from a source outside your body. A machine sends a beam of photons (such as X-rays or gamma rays) or subatomic particles (tiny particles that are smaller than atoms, such as electrons or protons) at your cancer.
  • Internal radiation therapy means a radioactive substance is put inside your body so it can emit radiation from within.

External-Beam Radiation Therapy

Typically, you’ll have EBRT five days a week (Monday to Friday) for five to six weeks. It’s not painful, and each treatment lasts only about five to seven minutes.

For some people with uterine sarcoma, intraoperative radiation therapy (IORT) may be an option. It’s a fast, effective way to give you radiation therapy during surgery. This may be helpful if:

  • Surgeons cannot completely remove tumors in your pelvic area or abdomen because they are attached to important organs or nerves
  • Invisible cancer cells might remain behind after a tumor was removed

Internal Radiation Therapy

Internal radiation therapy (brachytherapy) means putting radioactive “seeds,” or pellets, in the body. For uterine sarcoma, the seeds are sealed in a rod that is inserted into the vagina or uterus.

Based on your needs, your care team might recommend a high-dose radiation source that’s inserted for a short time and removed the same day. Or you might need a low-dose radiation source that’s inserted and left for two to three days.

Radiation Plus Chemotherapy

Clinical trials are currently underway at Fred Hutch to test the combination of radiation therapy plus chemotherapy to treat uterine sarcoma. Our gynecologic oncologists and radiation oncologists are involved in this research.

Chemotherapy for Uterine Sarcoma

Chemotherapy helps to destroy cancer cells wherever they may be in your body. Usually, it means you get anti-cancer medicine through an intravenous (IV) line. Then the medicine travels throughout your body through your bloodstream.

How Chemotherapy Can Treat Uterine Sarcoma

Some women have chemotherapy after their surgery for uterine sarcoma. Chemotherapy may also be one of your options if you don’t have surgery.

Usually, physicians use chemotherapy for uterine sarcoma only if:

  • The cancer has already metastasized (spread) outside of the uterus by the time of surgery.
  • The cancer has come back after earlier treatment.

But your physician may recommend chemotherapy for other reasons, including for early-stage uterine cancer if you have a type that tends to be aggressive (to grow and spread quickly).

Chemotherapy Schedule

Chemotherapy schedules differ, based in part on which drugs you receive. Most women have chemotherapy every three weeks. Some chemotherapy regimens require weekly treatments. Treatment typically continues for three to six months.

Targeted Therapy for Uterine Sarcoma

Targeted therapies are medicines to treat cancer. They work differently than standard chemotherapy. Instead of killing all fast-growing cells or keeping them from dividing, targeted therapies work more selectively against cancer cells.

What Targeted Therapies Do

Targeted therapies do one of three things:

  • They target a gene or protein that causes cancer growth.
  • They damage cancer cells directly.
  • They tell your immune system to attack certain cells. This is also called immunotherapy.

How Targeted Therapy Can Treat Uterine Sarcoma

Your care team at Fred Hutch may recommend targeted therapy if:

  • Uterine sarcoma has spread to other parts of your body (advanced or metastatic disease).
  • Uterine sarcoma has come back after treatment.

The option to get targeted therapy may depend on if your cancer cells have certain changes (mutations) in genes. Your Fred Hutch team can test your cancer cells for these mutations.

Hormone Therapy for Uterine Sarcoma

Like chemotherapy, hormone therapy is a systemic therapy. It moves around your body through the bloodstream to affect cancer cells wherever they are.

How Hormone Therapy Can Treat Uterine Sarcoma

Some cancer cells have hormone receptors. These are points where hormones can attach and make the cells grow. Reducing or stopping hormone production helps prevent the growth of these cancers, which are called hormone-receptor positive.

Hormone therapy is sometimes used for endometrial stromal sarcoma, mainly if:

  • The cancer has spread beyond the uterus.
  • The cancer has come back after earlier treatment.

Hormone therapy is not used for other types of uterine sarcoma because it’s not effective against them.

Types of Hormone Therapy

Your physician may suggest using one of these hormone therapies to slow the growth of your cancer:

  • Progestins: These are the main hormone therapies for endometrial stromal sarcoma. They are like the hormone progesterone that occurs naturally in your body.
  • Tamoxifen: This drug helps prevent any estrogens that are circulating in your body from making cancer cells grow.
  • Aromatase inhibitors: If your ovaries have been removed (or no longer function), your body fat still makes estrogen. These drugs can stop this estrogen from being made.
  • Gonadotropin-releasing hormone (GnRH) agonists: If you haven’t gone through menopause and you still have your ovaries, you might get injections of these drugs. They stop your ovaries from making estrogen.

Clinical trials are underway to test other hormone therapies for endometrial stromal sarcoma.

Why Choose Fred Hutch for Uterine Sarcoma Treatment

At Fred Hutch, we understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.

Team-Based Care from Specialists

We have gynecologic oncologists and pathologists who specialize in gynecologic cancer. We offer the most advanced diagnostic, treatment and recovery programs. Along with treating your cancer, we also offer a range of services to support you and your caregiver. This is part of how we take care of you — not just your disease. From registered dietitians to Spiritual Health clinicians to social workers, our experts know how to care for people with uterine sarcoma.

Treatment Tailored to You

We view treatment as a collaborative effort. Your Fred Hutch physicians will explain all your options. We’ll recommend a treatment plan to get you the best results based on the stage and size of your cancer, where it is and your overall health. We have access to the latest developments in treating cancer and offer patients the chance to get promising therapies through clinical trials done by physician-scientists from Fred Hutch and UW Medicine.

Follow-Up Care

When your treatment is complete, we’ll keep close watch on your health with periodic follow-up visits. You’ll see the same team members who treated your disease. It’s specially designed to provide follow-up care for women who are five years out from their primary treatment.

Uterine Sarcoma Treatment and Therapies FAQ

The best way to treat uterine sarcoma depends on many factors, like the size of the tumor, where it is and if it has spread. For many people, the main treatment is surgery. The idea is that the most effective treatment is to remove any tumor from the body, if possible. For some women, this may be the only treatment they need.

In some cases, surgery might not work well enough on its own. You might need other treatments, too, like radiation therapy, chemotherapy, targeted therapy or hormone therapy. And there are times when surgery may not be helpful, but other treatments may help control the disease. At Fred Hutch, we design your treatment plan around what will be most effective for you.

In general, people who have the same stage of uterine sarcoma often have the same or similar treatments. Common treatments by stage may include:

  • Stage I (1): Surgery to remove the tumor. Sometimes surgeons need to remove nearby organs or lymph nodes. Some people have radiation therapy or chemotherapy after surgery.
  • Stage II (2): Surgery to remove the tumor and sometimes nearby organs or lymph nodes. Some people have radiation therapy or chemotherapy after surgery.
  • Stage III (3): Surgery to remove the tumor and all other tissue where there’s evidence of cancer. Some people have radiation therapy or chemotherapy after surgery.
  • Stage IV (4): Treatment depends on your needs and preferences. There’s no standard plan for everyone with stage IV disease. Your care team may recommend a clinical trial testing a promising approach.

Based on the features of their disease, some people may have hormone therapy or targeted therapy for cancer that has spread beyond the uterus or come back after treatment.

Fred Hutch offers all standard treatment for uterine sarcoma. Our patients also have access to newer options or treatment combinations that you can only get through clinical trials.

Fred Hutch researchers are always looking for better ways to treat uterine sarcoma. We are constantly researching and developing clinical trials of new treatments and combinations of treatments for uterine sarcoma that is advanced or has come back, including chemotherapies, targeted therapies and immunotherapies.

Learn more about uterine sarcoma research.

Your care team at Fred Hutch is here to help you prevent or prepare for side effects and to relieve any side effects you have. The most important step you can take is to let your team know what you’re feeling. We’ve helped many patients and families through this process and know ways to ease your experience.

Often, there are medicines to help, like anti-nausea drugs. Based on the side effect, there may be a range of other helpful options too, like diet changes, physical therapy and emotional and practical support. Fred Hutch researchers continue to look for the best ways to keep side effects at bay.

Your team at Fred Hutch offers long-term follow-up care for as long as you choose after your treatment for uterine sarcoma. Our patients find it reassuring to see the same team members who treated them — experts in gynecologic cancers — for their follow-up visits. This includes physicians as well as advanced registered nurse practitioners.

Typically, people come for checkups, including pelvic exams, every three months for the first two years after treatment. Some patients choose to have all these follow-up visits at Fred Hutch. Some alternate between coming to Fred Hutch and seeing their local primary gynecologist.

After you reach the two-year mark without your disease coming back, you are less likely to have a recurrence. From that point, you can come in less often. We usually ask you to come in every six months for a checkup until you are five years out from your primary treatment. After five years, an annual checkup is all that we recommend.