Patients suspect of harbouring a soft tissue sarcoma of the uterus or other internal gynecological organs by clinical examination and/or radiological studies should promptly be referred to a specialized sarcoma center. This should be done without previous biopsy.
Prognosis of patients with localized gynecological sarcomas is as with other abdominal sarcomas greatly dependent on the correct initial treatment.
At the specialized sarcoma center, the patient will be evaluated by a multidisciplinary team which will determine the need for biopsi and the treatment plan.
Total hysterectomy and bilateral salpingo-oophorectomi is the standard treatment for localized sarcomas of the uterus not infiltrating through the serosal surfaces.
An extended resection is indicated for all tumors extending beyond the uterus serosa and multiorgan resection must be carried out for tumors densely adhered to or infiltrating neighbouring organs. Since especially endometrial stromal sarcomas, but also other gynecological sarcomas are hormone sensitive, bilateral ooporectomy is always indicated.
Utmost care must be taken to achieve negative tumor margins over all surfaces and including in the vagina. The limited pelvic space renders resection of large gynecological sarcomas especially challenging. Laparoscopic resections for uterine sarcomas should not be attempted.
- Curative treatment where the avoidance of spreading of tumor cells is considered.