
Leiomyosarcoma is a tumor derived from mutated smooth muscle cells.  Smooth muscle is found in the skin, in the "goose bumps" raising  muscles [pilor erectus], in the lining of blood vessels,  in the gastrointestinal tract, and in the muscle layer of the uterus.  I suspect that most LMS arises from the lining of blood vessels, except for some GI LMS, cutaneous LMS, and SOME uterine LMS.  I think that is why true cutaneous LMS does not metastasize, as the subcutaneous type does.  

I think Uterine LMS arises in three ways, all of which are possible, and probably all occur.

Firstly I think some uterine LMS arises from the lining of uterine blood vessels, not from the uterine muscle layer [myometrium].  

Secondly I think that some of the uterine LMS arises from leiomyomata [leiomyomas] [uterine fibroids] that have undergone further mutation.   That some LMS often occurs inside or adjacent to fibroids is very suspicious.

Thirdly I think that LMS occurs also de novo from the myometrium... from the smooth muscle tissue layer in the uterus.  

There is no question that LMS can occur in the absence of fibroids, though it can be mistaken for one.

There is no question that leiomyomata have been harvested that show foci of LMS growing within them, as well.

All uterine cancers are related to estrogen levels.  Estrogen tends to make uterine tissue proliferate.  Proliferating tissue is more likely to have errors/mutations passed on.  

LMS occurs about once every 30,000 fibroids.
However, for symptomatic fibroids--bleeding or painful ones-- the percentage of cancers found increases to ? about 2%.

So I would, myself, consider hysterectomy in the following cases, especially in peri- or postmenopausal women.  In premenopausal women, careful consideration may need to be given to other factors.


1. Any fibroid in a woman whose family has a history of any kinds of cancer, but especially leiomyomatosis, LMS, or renal cell, or one of the inherited cancer promoting syndromes.
2. There is any FAST growth in a fibroid.  {LMS is not the ONLY uterine
cancer.}
3. There is a foul smell vaginally, and no sexually transmitted disease.
4. There is bleeding that is not normal.
5. There is pain.
6. There is cramping.
7. There is a feeling of heaviness in the pelvis. 
8. There are associated bladder or colon symptoms.
9. Degenerate or dishomogeneous fibroids.

Be aware, however, that many LMS tumors are without symptoms, and are a surprise finding on a pathology report.

doctordee

  
<b>Uterine Leiomyomata [leiomyomas, fibroids]

Uterine leiomyomas</b>, or fibroids, develop in the majority of American women and become symptomatic in one-third of these women. They are the most frequent indication for hysterectomy in the United States. Although the initiator or initiators of fibroids are unknown, several predisposing factors have been identified, including age (late reproductive years), African-American ethnicity, nulliparity, and obesity. Nonrandom cytogenetic abnormalities have been found in about 40% of tumors examined. Estrogen and progesterone are recognized as promoters of tumor growth, and the potential role of environmental estrogens has only recently been explored. 

PMID: 12826476 
For more information about fibroids:
&&url
(719) 633-3454
1 (877) 553-NUFF

&&url


<b>Estrogen Disruptors</b>

<b>"Endocrine-disrupting chemicals</b> can undermine neurological and behavioral development and subsequent potential of individuals exposed. ..  Some of the components and by-products of many manufactured organic compounds that interfere with the endocrine system are persistent and undergo biomagnification in the food web, which makes them of greater concern as endocrine disruptors. ... New technology has revealed that some man-made chemicals are ... [present] at concentrations which are biologically active. "

&&url

National Institute for Environmental Sciences.  Read:  Uterine Fibroid Growth Study
&&url

World Wildlife Federation   Read:  Toxic Chemicals; Endocrine Disruptors
&&url


<b>Tamoxifen and Uterine Dysplasia and Cancers</b>

Tamoxifen is an estrogen blocker used to block estrogen receptors in breast breast cancer patients.  While Tamoxifen prevents stimulation of breast tissue by estrogen, it STIMULATES uterine estrogen receptors.   Tamoxifen causes uterine dysplasia [abnormal growth of uterine tissue] and uterine cancers.  Tamoxifen use is associated with the development of uterine leiomyosarcoma.

Search PubMed for  &&url

Search Pubmed for  &&url


<b>Diet and Uterine Myomas</b> [Leiomyomas, Fibroids]                    

"Women with uterine myomas reported more frequent consumption of beef, other red meat, and ham and less frequent   consumption of green vegetables, fruit, and fish. ...Myoma is associated with beef and ham consumption, whereas high intake of green vegetables seems to have a protective effect."

&&url PMID: 10472866 


<b>Incidence of LMS in Women with Symptomatic Fibroids</b>

The incidence in the GENERAL population of uterine fibroids that become cancerous is VERY low. However one study of a symptomatic population [symptoms being pain, bleeding, etc.] states that the presence of leiomyosarcoma in the hysterectomy specimens increased steadily from the fourth to seventh decades of age (0.2%, 0.9%, 1.4%, and 1.7%, respectively).  The ages of these women ranged from 36 to 62 years.  So a symptomatic woman in her 50's is in the 1.4% to 1.7% range. Note that a woman in her 50's is in her 6th decade.

&&url PMID: 2327466
 
This link has statistics on Uterine LMS occurrence rates in relationship to generic fibroids.
Scroll to the bottom for combined uterine sarcoma statistics.

&&url


<b>Enlarged Uteri and Preoperative Diagnosis</b>

One hundred and eighty two patients with symptomatic fibroids were sorted into 2 groups: those with uteri weighing more than 500g, and those with uteri weighing less. Of the patients with menorrhagia [abnormal bleeding], 21-30% did not undergo a preoperative biopsy. Biopsy failed to detect 2.75% of malignancies. All patients diagnosed postop with malignancy had complained of abnormal bleeding. 
With complaints other than bleeding, a preoperative biopsy may be omitted. But "any menstrual complaints warrant an investigation of the endometrium even though the incidence of endometrial carcinoma in these larger uteri is only 1.1%."

&&url PMID: 12611090 
 

<b>The management of uterine leiomyomas.</b>

"English-language articles from MEDLINE, PubMed, and the Cochrane Database were reviewed from 1992 to 2002".  "The level of evidence has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. "

"BENEFITS, HARMS, AND COSTS: The majority of fibroids are asymptomatic and will not require intervention or further investigations. For the symptomatic fibroid, hysterectomy offers a definitive solution. However, it is not the preferred solution for women who wish to preserve their uterus. The predicted benefits of alternative therapies must be carefully weighed against the possible risks of these therapies. In the properly selected woman with symptomatic fibroids, the result from the selected treatment should be an improvement in the quality of life. The cost of the therapy to the health-care system and to women with fibroids must be interpreted in the context of the cost of untreated disease conditions and the cost of ongoing or repeat treatment modalities."

" RECOMMENDATIONS: 1. Medical management should be tailored to the needs of the woman presenting with uterine fibroids and geared to alleviating the symptoms. Cost and side effects of medical therapies may limit their long-term use. (III-C) 2. In women who do not wish to preserve fertility and who have been counselled regarding the alternatives and risks, hysterectomy may be offered as the definitive treatment for symptomatic uterine fibroids and is associated with a high level of satisfaction. (II-A) 3. Myomectomy is an option for women who wish to preserve their uterus, but women should be counselled regarding the risk of requiring further intervention. (II-B) 4. Hysteroscopic myomectomy should be considered as first-line conservative surgical therapy for the management of symptomatic intracavitary fibroids. (I-B) 5. It is important to monitor ongoing fluid balance carefully during hysteroscopic removal of fibroids. (I-B) 6. Laparoscopic myolysis may present an alternative to myomectomy or hysterectomy for selected women with symptomatic intramural or subserous fibroids who wish to preserve their uterus but do not desire future fertility. (II-B) 7. Uterine artery occlusion may be offered as an alternative to selected women with symptomatic uterine fibroids who wish to preserve their uterus. (I-C) 8. Women choosing uterine artery occlusion for the treatment of fibroids should be counselled regarding possible risks, and that long-term data regarding efficacy, fecundity, pregnancy outcomes, and patient satisfaction are lacking. (III-C) 9. Removal of fibroids that distort the uterine cavity may be indicated in infertile women, where no other factors have been identified, and in women about to undergo in vitro fertilization treatment. (III-C) 10. Concern of possible complications related to fibroids in pregnancy is not an indication for myomectomy, except in women who have experienced a previous pregnancy with complications related to these fibroids. (III-C) 11. Women who have fibroids detected in pregnancy may require additional fetal surveillance when the placenta is implanted over or in close proximity to hen the placenta is implanted over or in close proximity to a fibroid. (III-C) 12. In women who present with acute hemorrhage related to uterine fibroids, conservative management consisting of estrogens, hysteroscopy, or dilatation and curettage may be considered, but hysterectomy may become necessary in some cases. (III-C) 13. Hormone replacement therapy may cause myoma growth in postmenopausal women, but it does not appear to cause clinical symptoms. Postmenopausal bleeding and pain in women with fibroids should be investigated in the same way as in women without fibroids. (II-B) 14. There is currently no evidence to substantiate performing a hysterectomy for an asymptomatic leiomyoma for the sole purpose of alleviating the concern that it may be malignant. ..."

&&url PMID: 12738981
 

<b>Estrogen Levels and Development of Uterine Sarcomas</b>

Uterine sarcomas studied here were leiomyosarcoma, mixed mullerian tumor, endometrial stromal sarcoma.
" We analyzed data from a population-based, multi-center, case-control study to determine whether the occurrence of histologic types of uterine sarcoma is related to exogenous hormone use and/or to two correlates of endogenous estrogens: excess weight and cigarette smoking."

"Use of oral contraceptives was positively associated with the risk of leiomyosarcoma ...primarily among women who last used these medications 15 or more years prior to diagnosis. Use of noncontraceptive estrogens was directly associated with the risk of mixed mullerian tumors, but only among recent and long-term users of these medications. Women in the highest quantile of body mass index ... one year prior to diagnosis were at increased risk of each type of uterine sarcoma .... Women who had ever smoked cigarettes were at reduced risk of leiomyosarcoma ... but the relationship was not more pronounced among heavy smokers; no association with smoking was observed with mixed mullerian tumors. CONCLUSIONS: Several of these findings parallel those from studies of endometrial carcinoma and may indicate a role for unopposed estrogen in the etiology of histologic types of uterine sarcoma." 

[Smoking induces liver enzymes.  These enzymes also metabolize estrogen.  Estrogen levels in a group of women smokers will be less than estrogen levels in a group of women nonsmokers.  Obese women make more estrogen in their fat tissue.
Increased estrogen levels are implicated in all uterine cancers, because the estrogen stimulates tissues to grow.]

&&url PMID: 8616764 


<b>Endometrial Cancer after Antipsychotics Exposure</b>

"Most endometrial cancers are related to hormonal imbalance, and antipsychotics are a common cause of hyperprolactinemia."
We investigated the possible relation between the use of antipsychotics and the risk of endometrial cancer. ... Use of antipsychotics, diabetes mellitus and obesity were identified as independent variables with risk ..Conclusions: Use of antipsychotics is a risk factor for endometrial cancer, and hyperprolactinemia associated with antipsychotics may impart the risk of endometrial cancer in premenopausal women."

&&url PMID: 12566908 


<b>Some NON-causes of ULMS</b>

If you are worried about the incidence of cancer with DDT, do the pubmed search:

Search Pubmed  &&url 


I can tell you categorically that the induced labor drugs do not cause cancer.  The yeast infection drugs like mycostatin and canesten are not implicated in the creation of cancer.  Changing gynecologists does not cause cancer. The oral contraceptive pill actually reduces the rates of ovarian and uterine cancers.    You can do pubmed searches on that, too.

 
<b>Ovarian and uterine cancers in vitro fertilization patients</b>

"Cancer cases in this large, well-defined cohort of IVF patients show a broad range of patient and tumor characteristics. We found an increased incidence of uterine sarcoma in women with a history of infertility. Increased ascertainment of preexisting cancers in the course of infertility investigations and management is to be expected."

&&url PMID: 11426963 

compiled by doctordee
December 2004
