Introduction
Although we have had significant medical milestones this past year, such as the progression of the COVID-19 vaccination programmes and the increase in awareness of heart problems in professional sports players, we should also remember that this month is Gynaecological Cancer Awareness Month (September). In this week’s blog, we will focus specifically on gynaecological sarcomas.
Owing to the rarity of gynaecological sarcomas, the data to support diagnosis and management remain obscure.1 Prognosis is poor, and although surgery and adjuvant therapy can be used in combination to mitigate the sarcomas and prolong survival, further development of identification techniques and targeted therapy is needed to allow healthcare professionals to provide patients with the optimal treatment strategy.2
What Are Sarcomas?
Sarcomas are rare cancers that develop in various regions of the body. While carcinomas originate in epithelial cells and tend to affect the surfaces and membranes of organs and the body, sarcomas develop in the mesenchymal cells.2 These are stem cells that are found in bone marrow and are used to make up organs such as muscles, bones, cartilage, tissues, and also vital organs such as the brain.3,4
What Are Gynaecological Sarcomas?
Gynaecological sarcomas occur in the female reproductive system: the uterus (womb), ovaries, vagina, vulva, and fallopian tubes. Gynaecological sarcomas account for approximately 4% of all gynaecological malignancies and 13% of all sarcomas.5,6 Although rare, they can affect women of any age.7,8,9
Most gynaecological sarcomas (83%) occur in the uterus (womb) and can also occur in the ovaries (8%), vagina (5%), and other organs related to the female reproductive system (2%).8 The most common histological subtype includes uterine leiomyosarcoma (63%), endometrial stromal sarcoma (21%), and high-grade/undifferentiated uterine sarcoma (16%).
Diagnosing Gynaecological Sarcomas
For uterine sarcomas, their symptoms are quite broad, as they include uterine bleeding (56%), abdominal distention (52%), and pelvic pain/pressure (22%), which overlap with other less severe uterine conditions.5
MRI imaging, ultrasound, abnormal lactate dehydrogenase levels, and pre-operative needle biopsies are all reliable in increasing suspicion of uterine sarcomas and differential diagnosis between benign uterine conditions but fall short of being considered definitive diagnostic tools.5,7
These diagnostic challenges and vague symptom characteristics mean that pre-operative diagnosis of uterine sarcomas is quite uncommon.5 Further research into developing novel biomarkers or improving diagnostic efficacy of biopsy will allow for earlier and accurate diagnosis of gynaecological sarcomas, enabling healthcare professionals to provide earlier treatment, which could result in prolonging patient survival.
Owing to the relative infrequency of ovarian, cervical, vulval, and vaginal sarcomas, there are limited data regarding how they are managed. Therefore, there is an unmet need as there are no specific diagnostic guidelines to follow.5
Treatments for Gynaecological Sarcomas
Individuals with gynaecological sarcomas are managed by a team of specialists from a wide range of healthcare professions.9 This multidisciplinary team will allow for the effective support of individuals and their caregivers, and ensure that optimal treatment is provided.
The standard of care of treating gynaecological sarcomas is surgery.9 However, for patients at a late-stage disease, treatment is palliative.10 For other patients, surgery includes total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph-node dissection, and cytology of peritoneal washings.5
Adjuvant treatment is also available for patients following surgery and is individualised based on the stage at diagnosis and the health of the patient. Adjuvant therapies (dependent on the type of sarcoma) include radiotherapy and chemotherapy, which help with killing off any remaining cancer cells following surgery.8,9,10 As various gynaecological sarcomas are stimulated by female growth hormones, such as oestrogen and progesterone, hormone treatment can be given, which will help in reducing the risk of recurrence and inhibit tumour growth for individuals at a later stage of the disease.9
Conclusion
As this month is Gynaecological Cancer Awareness Month, increasing attention of gynaecological sarcomas will hopefully provide organisations with the support they need to further study and develop better treatments for patients. This will not only sufficiently manage the sarcoma but also help maintain the quality of life of gynaecological sarcoma patients and allow them to spend more time with family and friends.
At TVF, our medical and client services team have significant expertise in rare diseases and are able to quickly understand new therapy areas, ensuring diagnostic tools or care pathways reach the patients when they need it most. This puts us in prime position to aid in the investigation, development, branding, and marketing of potential diagnostics and therapeutics in the field of oncology. If you would like to find out more about TVF’s business offerings, get in touch!
By William Shieu
