Low-grade endometrial stromal sarcoma (LGESS) is a rare cancer originating in the uterus. It develops from stromal cells, part of the connective tissue in the endometrium, the inner lining of the uterus. As a malignant tumor, LGESS has the potential to grow and spread.
Understanding Low-Grade Endometrial Stromal Sarcoma
LGESS originates from the stromal cells, the supportive tissue within the uterine lining, unlike more common uterine cancers that arise from glandular cells. The “low-grade” designation means the cancer cells grow slowly and resemble normal endometrial stromal cells under a microscope, making LGESS less aggressive than high-grade sarcomas.
Despite slow growth, LGESS can invade the myometrium (muscular wall of the uterus) and may extend into blood vessels or lymphatic channels. It can also spread to nearby pelvic organs like the ovaries or fallopian tubes. Uterine sarcomas, including LGESS, are rare compared to other uterine cancers like endometrial carcinoma, accounting for approximately 0.2% to 1% of all uterine cancers.
Recognizing the Signs and Diagnosis
LGESS often presents with symptoms requiring medical evaluation. Abnormal vaginal bleeding is a common indicator, manifesting as bleeding between menstrual periods, unusually heavy periods, or postmenopausal bleeding. Pelvic pain or a feeling of pressure in the pelvic area may also occur. A noticeable uterine mass might also be detected.
Diagnosis begins with a thorough pelvic examination, followed by imaging tests to visualize the uterus and surrounding structures. An ultrasound provides initial images, while an MRI scan offers more detailed views of the tumor’s extent and potential spread. Definitive diagnosis relies on a biopsy, where a tissue sample is taken from the uterine lining. This tissue is obtained through procedures like dilation and curettage (D&C) or hysteroscopy, allowing for direct visualization and sampling. A pathologist then examines the tissue under a microscope to confirm LGESS cells and assess their characteristics.
Treatment Approaches
The primary treatment for LGESS is surgical removal of the tumor. A hysterectomy (removal of the uterus) is generally the mainstay of treatment. The ovaries and fallopian tubes are also often removed during surgery, particularly because LGESS can be hormone-sensitive. The extent of surgery depends on whether the cancer has spread beyond the uterus.
Hormonal therapy often plays a significant role as an additional treatment after surgery, especially for recurrent or advanced disease. Since LGESS cells frequently express estrogen and progesterone receptors, therapies like progestins (synthetic forms of progesterone) or aromatase inhibitors (which reduce estrogen production) can effectively control tumor growth. Radiation therapy and chemotherapy are considered, but their roles are more limited compared to surgery and hormonal therapy for LGESS. These treatments might be used in specific situations, such as extensive spread or when other therapies are unsuitable.
Prognosis and Follow-Up
The prognosis for LGESS is generally favorable due to its slow-growing nature. However, the cancer has a recognized potential to recur, sometimes many years after initial treatment. This possibility of late recurrence underscores the importance of ongoing monitoring and follow-up care.
Long-term follow-up typically involves regular check-ups with a healthcare provider to monitor for any signs of recurrence. This may include periodic imaging tests, such as chest X-rays, as LGESS can sometimes spread to the lungs. Symptom monitoring is also continuous, as new or returning symptoms could indicate a recurrence. Adherence to these appointments helps in the early detection and management of any potential reappearance of the disease.