Uterine Sarcoma · Surgery (Distinct from Fibroid)

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Type + preoperatively suspected?
   Preoperatively suspected sarcoma? Incidental after fibroid surgery? Advanced?
   • Preoperatively suspected uterine sarcoma (rapid growth, postmenopausal enlargement, suspicious imaging, raised LDH) → Suspected sarcoma → total hysterectomy (no morcellation)
   • Incidental finding (pathology after fibroid surgery) → Incidental diagnosis → multidisciplinary + supplementary
   • Advanced/metastatic → Advanced → debulking + systemic
2. [End] Suspected sarcoma → total hysterectomy (no morcellation)
   Suspected uterine sarcoma → total hysterectomy (± bilateral salpingo-oophorectomy by type/menopausal status); en bloc removal, unprotected morcellation strictly prohibited (to prevent peritoneal dissemination); adjuvant therapy individualized for leiomyosarcoma/undifferentiated sarcoma.
3. [End] Incidental diagnosis → multidisciplinary + supplementary
   Sarcoma diagnosed incidentally after fibroid surgery → multidisciplinary assessment, supplementary imaging staging (check for metastasis); decide supplementary surgery (bilateral adnexa) and adjuvant therapy by type; prior morcellation raises recurrence risk.
4. [End] Advanced → debulking + systemic
   Advanced/metastatic → debulking (when feasible) + systemic therapy (chemotherapy/hormonal by subtype; low-grade endometrial stromal sarcoma ESS is hormone-sensitive); palliative.

Source guidelines & references

• Uterine sarcoma management (NCCN/ESGO; no morcellation; subtype-based adjuvant)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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