Presentation and management of carcinosarcoma of the uterus

Carcinosarcoma of the uterus is an uncommon tumor composed of epithelial and mesenchymal components. The incidence is higher in blacks and increases with age. It most commonly presents with postmenopausal bleeding or as a prolapsing, polypoid uterine mass. When clinically limited to the uterus, this tumor will be surgically upstaged in 20% to 30% of cases, usually because of its propensity for nodal metastasis. Treatment of choice consists of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and complete surgical staging. Surgical findings determine further therapy. Retrospective studies have shown a decrease in local recurrence after pelvic irradiation, which also is beneficial in the control of localized recurrences or advanced disease. Chemotherapy has been limited to advanced or recurrent disease, although its role in the adjuvant setting is currently under investigation. The most active single agents are ifosfamide and cisplatin.