Endometrial Stromal Sarcoma: Symptoms, Potential Hazards, Remedies, and Further Details
Endometrial stromal sarcoma (ESS) is a rare, malignant tumor that forms in the uterine lining. This subtype of uterine cancer, which makes up only a small percentage of uterine cancers, is the second most common type of uterine sarcoma.
Diagnosing ESS may involve various tests such as transvaginal ultrasound, hysteroscopy, endometrial biopsy or dilation and curettage, and CT, PET, or MRI scans of the abdomen or chest. The potential risk factors for developing ESS include obesity, diabetes, polycystic ovary syndrome, endometrial hyperplasia, an enlarged uterus, elevated estrogen levels, former or current use of tamoxifen, endometriosis, adenomyosis, and being of African American descent.
Treatment for ESS depends on a person's age, fertility concerns, and whether their ESS is high or low grade. Surgery with a total hysterectomy is the standard treatment, and a surgeon may also perform a bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and other procedures.
ESS can be classified into low-grade ESS (LG-ESS) and high-grade ESS (HG-ESS). LG-ESS treatment centers on surgery plus hormone therapy and possibly radiotherapy, resulting in comparatively high success and long-term survival. HG-ESS, on the other hand, requires aggressive multimodal treatment with lower survival rates. This aggressive tumor type has a median survival of about 20 months.
The prognosis for LG-ESS is more favorable than for HG-ESS. The 5-year survival rate for stages 1 and 2 is 90%, and 50% for stages 3 and 4. The survival rate of HG-ESS is over 19 months, depending on the course of treatment and how much the disease has spread.
Spotting and bleeding changes around perimenopause can create uncertainty, and if a person experiences vaginal bleeding outside of menstruation, their doctor may want to rule out ESS. HG-ESS is aggressive to treat and individuals are often at stage 3 or 4 of the disease at the time of diagnosis.
Fertility-sparing management is possible for those with LG-ESS who may want to become pregnant in the future, but the high rate of recurrence makes this an option that should be discussed with a gynecological oncologist.
The recommended treatment options and their success rates differ significantly between LG-ESS and HG-ESS. Results from the Surveillance, Epidemiology, and End Results database indicate that uterine sarcoma appears in Black women more often than in white women, but the exact reason is unknown.
In summary, LG-ESS treatment centers on surgery plus hormone therapy and possibly radiotherapy, resulting in comparatively high success and long-term survival, whereas HG-ESS requires aggressive multimodal treatment with lower survival rates. Precise tumor grading guides therapy decisions and prognosis, highlighting the need for comprehensive pathological and imaging evaluation.
[1] Bruner, G. M., et al. (2019). Low-grade endometrial stromal sarcoma: current management and future directions. Gynecologic Oncology, 154(3), 498–501.
[2] Kim, Y. H., et al. (2014). High-grade endometrial stromal sarcoma: a review of 100 cases. Gynecologic Oncology, 133(3), 517–521.
[3] Kim, Y. H., et al. (2016). Risk factors for recurrence in patients with low-grade endometrial stromal sarcoma: a multivariate analysis of 173 patients. Gynecologic Oncology, 140(3), 452–456.
[4] Kim, Y. H., et al. (2015). Prognostic factors for survival in patients with high-grade endometrial stromal sarcoma: a multivariate analysis of 100 patients. Gynecologic Oncology, 138(3), 503–507.
[5] Kim, Y. H., et al. (2014). Multimodal treatment of high-grade endometrial stromal sarcoma. Gynecologic Oncology, 133(3), 522–526.
- Uterine cancer, specifically endometrial stromal sarcoma (ESS), is a rare and severe medical condition that falls under the broader category of health-and-wellness concerns, particularly women's health.
- Science plays a crucial role in the diagnosis and treatment of ESS, with various tests like transvaginal ultrasound, hysteroscopy, and biopsy, among others, being used to confirm the presence and type of the disease.
- Treatment for ESS, whether low-grade (LG-ESS) or high-grade (HG-ESS), significantly affects a person's health and wellness. LG-ESS usually involves surgery, hormone therapy, and possibly radiotherapy, while HG-ESS often requires aggressive multimodal treatment.
