Magnified view of cancer cells.

Sar­co­mas — a rare form of cancer

Sar­co­mas are a very rare form of can­cer in the field of tumor dis­eases. They can appear any­where in the body. In gyne­col­o­gy, sar­co­mas are even rar­er, as they form a sub­fam­i­ly of soft tis­sue sar­co­mas as part of the female gen­i­tal tract. Since they ini­tial­ly cause lit­tle pain, sar­co­mas are often dis­missed as harm­less swellings. The rar­i­ty is due to the fact that the treat­ing doc­tor has sig­nif­i­cant­ly less lit­er­a­ture and guide­lines to fall back on than is the case with com­mon types of can­cer such as breast or lung cancer.

A sar­co­ma is a malig­nant tumor that devel­ops in soft tis­sue (mus­cle, fat and con­nec­tive tis­sue). The num­ber of new sar­co­ma cas­es in Ger­many is esti­mat­ed at around 5,000 per year. These most com­mon­ly occur on the extrem­i­ties (arms and legs). How­ev­er, sar­co­mas can also devel­op in the female gen­i­tal organs such as the womb (uterus), ovaries (ovaries), vagi­na (vagi­na) or vul­va. In this case, doc­tors usu­al­ly refer to this as gyne­co­log­i­cal sar­co­mas. Com­pared to clas­sic gyne­co­log­i­cal can­cers such as ovar­i­an or cer­vi­cal can­cer, gyne­co­log­i­cal sar­co­mas make up only a small pro­por­tion of gyne­co­log­i­cal malig­nant dis­eases. It is esti­mat­ed that only a max­i­mum of 2% of all gyne­co­log­i­cal can­cers are gyne­co­log­i­cal sarcomas.

Soft tis­sue sar­co­mas can occur at any age. How­ev­er, they occur more fre­quent­ly in child­hood and ado­les­cence as well as in adult­hood between the ages of 45 and 55. Gyne­co­log­i­cal sar­co­mas such as B. a leiomyosar­co­ma of the uterus or a sar­co­ma of the ovary, almost nev­er occur in child­hood, but are a dis­ease of adult women.

Not every gyne­co­log­ic sar­co­ma is the same

There are dif­fer­ent sub-forms, which dif­fer in their his­to­log­ic com­po­si­tion. The most com­mon gyne­co­log­i­cal sar­co­ma, at over 50%, is leiomyosar­co­ma of the uterus, the sec­ond most com­mon is endome­tri­al stro­mal sar­co­ma, which also occurs in the uterus. There are also many rare gyne­co­log­i­cal forms of sar­co­ma, such as liposar­co­ma or angiosar­co­ma. Although it is more of a dis­ease that occurs at an old­er age, women of any age can be affect­ed by this disease.

Diag­no­sis: How can a sar­co­ma be diagnosed?

Most sar­co­mas are diag­nosed very late, as they often only cause symp­toms when the tumor is in an advanced stage. For exam­ple, a sar­co­ma can cause pul­monary metas­tases, which then restrict lung func­tion, i.e. cause short­ness of breath. A symp­tom can also be that pain does not improve over time, but man­i­fests itself over many weeks and even wors­ens, such as: B. in a sar­co­ma of the uterus. In rare cas­es, atyp­i­cal bleed­ing dur­ing or after men­stru­a­tion can also be a first symp­tom. If the sar­co­ma is locat­ed in the area of the ovary, the patient usu­al­ly only feels symp­toms at a very advanced stage. It is often pain or an increase in abdom­i­nal cir­cum­fer­ence that ulti­mate­ly prompts the patient to see a doc­tor, who then diag­noses a sar­co­ma. A real ear­ly detec­tion or pre­ven­tive exam­i­na­tion is there­fore not pos­si­ble with sar­co­mas, not even with a smear in the area of ​​the uterus.

Ther­a­py: How are sar­co­mas treated?

The treat­ment of gyne­co­log­i­cal sar­co­mas is inter­dis­ci­pli­nary (includ­ing radi­ol­o­gy, pathol­o­gy, gynae­col­o­gy, gen­er­al surgery). It main­ly depends on the tumor stage, the tis­sue type and the health and phys­i­cal sta­tus of the patient. In an ear­ly tumor stage, surgery alone can be the only and suf­fi­cient treat­ment. In the case of cer­tain risk fac­tors such as dis­tant metas­tases or tumor residues at the sur­gi­cal mar­gins, chemother­a­py or radi­a­tion can be part of the so-called mul­ti­modal ther­a­py strat­e­gy. In the case of advanced tumor stages with dis­tant spread or in the event of recur­rence, med­ica­tion – usu­al­ly chemother­a­py or a tar­get­ed ther­a­py strat­e­gy – is also used. The col­lec­tive term “tar­get­ed ther­a­py strate­gies” sum­ma­rizes nov­el treat­ment approach­es which, as the name sug­gests — in con­trast to the broad effect (“cell divi­sion poi­son”) of clas­sic chemother­a­py — are used in a tar­get­ed man­ner against a sin­gle, spe­cif­ic struc­ture. This can be an anti­body or so-called “small mol­e­cules” that are so small that they can pen­e­trate the sar­co­ma cell and affect cell metab­o­lism there.

What does the prog­no­sis of my dis­ease depend on?

Unfor­tu­nate­ly, a sar­co­ma is an aggres­sive form of tumor with a rather poor prog­no­sis. Although many more women with gyne­co­log­i­cal sar­co­mas are sur­viv­ing today than 30 years ago thanks to sig­nif­i­cant­ly improved sur­gi­cal tech­niques, lit­tle progress has been made in recent decades. The rar­i­ty of the dis­ease pos­es a major prob­lem for the fur­ther devel­op­ment of ther­a­py and thus the improve­ment of the prog­no­sis. If you look at the exam­ple of breast can­cer, the most com­mon can­cer in women, you can see that the prog­no­sis has improved mas­sive­ly in recent decades. This made count­less stud­ies pos­si­ble, in which sev­er­al hun­dred thou­sand patients took part. As a result of this very inten­sive research activ­i­ty, numer­ous new insights were gained. The field of sar­co­mas is only just beginning.

In prin­ci­ple, how­ev­er, a cure is also pos­si­ble for malig­nant tumors. The exact deter­mi­na­tion of the sar­co­ma sub­type is impor­tant for the treat­ment. This depends on the tumor bio­log­i­cal fac­tors, which are described in par­tic­u­lar by the tumor stage. An ear­ly-stage tumor has a very high chance of recov­ery, while a lat­er-stage tumor with dis­tant metas­tases is already present,
the chances of recov­ery are usu­al­ly only small. The chances increase sig­nif­i­cant­ly if the sar­co­ma can be com­plete­ly removed by surgery (with a bor­der of healthy sur­round­ing tis­sue, sur­geons then speak of a tumor com­part­ment). How­ev­er, such an oper­a­tion is not always pos­si­ble. Even a suc­cess­ful oper­a­tion does not nec­es­sar­i­ly guar­an­tee a cure. In any case, sar­co­mas should be treat­ed in spe­cial­ized sar­co­ma centers.

The prog­no­sis is influ­enced by many dif­fer­ent fac­tors. On the one hand, there are tumor-typ­i­cal fac­tors, such as B. the tumor size, the degree of dif­fer­en­ti­a­tion of the cells and the tis­sue type, but on the oth­er hand gen­er­al fac­tors also play a role, such as the phys­i­cal con­di­tion of the patient, her age and the func­tion­al sta­tus of her organs (blood count, kid­ney val­ues, kid­ney func­tion, etc.).

After­care

After com­ple­tion of the ther­a­py, an indi­vid­ual med­ical after­care plan should be dis­cussed in coop­er­a­tion with the attend­ing physi­cian. This is valid for the next five years, in accor­dance with the guide­lines for gyne­co­log­i­cal oncol­o­gy. Fol­low-up appoint­ments are ini­tial­ly held about every three months. Lat­er the exam­i­na­tion
inter­vals become longer. As a rule, the after­care appoint­ments can be made on an out­pa­tient basis with a spe­cial­ist or in spe­cial­ized clin­ics such as the Char­ité Women’s Clin­ic. The doc­tor in charge will con­stant­ly check whether the con­se­quences of the ther­a­py are lead­ing to impair­ments and whether new can­cer cells have formed so that they can be treat­ed quick­ly if nec­es­sary. Here, too, the fol­low­ing applies: If a recur­rence dis­cov­ered ear­ly can be com­plete­ly removed, the prog­no­sis is good.

If you have any ques­tions about sar­co­mas, you can also con­tact the can­cer infor­ma­tion ser­vice per­son­al­ly: on the free tele­phone num­ber 0800 — 420 30 40 or by e‑mail to krebsinformationsdienst@dkfz.de.

Sources:

Gesund.bund.de — Sarkome
Ver­lässliche Infor­ma­tio­nen für Ihre Gesundheit

Deutsche Sarkom­s­tiftung — sarkome.de
Infor­ma­tions- und Aus­tausch-Plat­tform für Patien­ten, Ange­hörige, Medi­zin­er, Forsch­er und andere Vertreter des Gesundheitssystems

Char­ité — Uni­ver­sitätsmedi­zin Berlin — https://frauenklinik.charite.de/
Sarkomer­fahrene Medi­zin­er und Sarkom-Zentrum

Leave a Reply