Leiomyosarcoma natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]

Leiomyosarcoma of uterus is an agressive soft tissue tumor which is diagnosed accidentally when they remove fibroid tumor and histology analysis reveal the aggressive nature of tumor. Most common sites that leiomyosarcoma invades are the lungs, liver, abdomen, pelvis, and lymph nodes, bone and brain metastases are less common sites of involvement. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary, in those that tumor spread beyond uterus and pelvic, prognosis is very poor. Prognosis depends mainly on the age of the patient, race, FIGO stage, mitotic index and hormonal receptor expression in the tumor.

• Most leiomyosarcoma are diagnosed incidentally during hysterectomy of suspected fibroid tumors.^[1][2][3]
• A leiomyosarcoma, especially in the early stages, may not be associated with any obvious symptoms other than irregular vaginal bleeding or feeling pressure in abdomen or pelvic.
• The majority of patients with leiomyosarcoma remain asymptomatic for decades.
• General symptoms associated with cancer may occur including fatigue, fever, weight loss, malaise, and nausea and vomiting.
• The prognosis of patients with uterine sarcomas has not changed in recent decades because of rare nature of disease and late diagnosis.
• Patients with leiomyosarcoma have overall 5‐year survival rate of between 17.5% and 54.7% in various studies.

Leiomyosarcomas are aggressive tumors that potentially cause complications due to metastasis to other organs, some of the complications of uterine leiomyosarcoma are include the following:^{[4][5][6][6][7][8][9]}

• Anxiety and stress because of uterine cancer
• Lockjaw and numbness in lips
• Dysphagia due to esophageal leiomyosarcoma metastasis
• Anemia due to metastasis to duodenum or cancer itself.
• Metastasis to lung and pulmonary symptoms due to that.
• Side effects of chemotherapy and radiation therapy such as sexual dysfunction.

The prognosis of leiomyosarcoma is poor and it depends upon different factors including site of tumor, size, and type, as well as the extent of tumor spread. Some patients with low grade tumors or with tumors that have not spread beyond stage I have better prognosis. In general, high-grade tumors that have spread widely throughout the body have less favorable survival rates. Some of these progostic factors that affect survival rates of patients with leiomyosarcoma include:^[10]

• FIGO stage at the time of the initial diagnosis (survival after initial diagnosis has been reported to be 50% in stage 1 and stage 2 disease)
• Age at the time of diagnosis
• Mitotic count
• Tumor size (tumors greater than 5cm has worse prognosis)
• Adjuvant therapies such as chemotherapy and radiation

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