Uterine carcinosarcoma

The name reflects two tissue patterns seen together: carcinoma, from gland or lining cells, and a component resembling sarcoma, from supporting tissue. For many years it was treated as a type of sarcoma. Research has since shown that the carcinoma is the dominant, original part, so it is now grouped with high-grade womb carcinomas.

Macmillan places carcinosarcoma in its list of type 2 endometrial cancers, alongside serous and clear cell types and grade 3 endometrioid cancers, and Cancer Research UK says type 2 cancers are generally faster growing and more likely to spread. The condition is uncommon, so many hospitals refer to a gynaecological oncology centre for planning.

It is mainly diagnosed after the menopause. Risk factors are similar to those of other womb cancers, including higher oestrogen exposure, obesity, and, in some cases, previous pelvic radiotherapy or long use of tamoxifen. None of these is certain to lead to it, and many people with carcinosarcoma have no clear risk factor.

Unlike type 1 womb cancers, type 2 cancers are not linked to excess oestrogen according to Cancer Research UK, so risk factors are less well defined.

The NHS lists bleeding or spotting after menopause, heavy or unusual periods, bleeding between periods and altered discharge, with pelvic or lower back pain, a lump or swelling in the pelvis, and bowel or bladder change as other signs. An urgent suspected cancer referral is usual.

Investigations include a pelvic ultrasound, a womb lining biopsy (often via hysteroscopy), MRI of the pelvis and CT of the chest and abdomen to look for spread. Pathology confirms the two components and may add molecular testing.

Cancer Research UK describes surgery to remove the womb and cervix, often with both tubes and ovaries, as the main treatment for womb cancer, with the extent depending on spread. Lymph nodes may be assessed. For high-risk disease, the same pages describe chemotherapy given with radiotherapy, afterwards, or by itself, particularly for stage 3 or 4 or type 2 cancers.

Drugs used for womb cancer include paclitaxel and carboplatin, and immunotherapy is an option for recurrent disease. Treatment choice is agreed by a gynaecological oncology multidisciplinary team, with attention to your fitness, stage and preferences.

Because it is high grade and prone to spread, carcinosarcoma has a less favourable outlook than low-grade endometrioid cancer, and recurrence is a real possibility. Stage at diagnosis is the strongest guide. Your oncologist can give personal information, and palliative care teams work alongside active treatment to help with symptoms.

Follow-up combines clinical review and imaging when indicated. Recovery from major surgery takes weeks to months, and the team can advise on menopausal symptoms, lymphoedema if nodes were removed, emotional effects and practical support.