What is GYN Carcinosarcoma (GCS) or MMMT?

  • Another Term for GYN Carcinosarcoma is malignant mixed Müllerian tumor or MMMT. GYN carcinosarcoma is a malignant neoplasm found in the uterus, the ovaries, the fallopian tubes and other parts of the body that contains both carcinomatous (epithelial tissue) and sarcomatous (connective tissue) components.
  • It is divided into two types: homologous (which is made of tissues found in the uterus such as endometrial, fibrous and/or smooth muscle tissues) and a heterologous type (made up of tissues not found in the uterus, such as cartilage, skeletal muscle and/or bone).
  • The term carcinosarcoma was formerly used to describe lesions with homologous tumors, and “malignant mixed Müllerian tumor” or “mixed mesodermal tumor” was used to describe heterologous tumors.
  • While “carcinosarcoma” is now considered standard, “malignant mixed Müllerian tumor” has a lengthy history within gynecological literature and is expected to continue to be used.
  • GCS is rare. Fewer than 1,000 cases of GCS are diagnosed each year. The rarity of this neoplasm resulting in small sample size has precluded large trials for evaluation of various treatment protocols.
  • GCS is found predominantly in postmenopausal women with an average age of 66 years.
  • Risk factors for the development of GCS are similar to those of endometrial carcinoma and include nulliparity, advanced age, obesity, exposure to exogenous estrogens, and long-term use of tamoxifen. Tamoxifen is associated with a 2–7x greater risk of developing endometrial malignancies. Specifically, carcinosarcomas have been reported to occur 7–20 (median of 9 years) years after the initiation of this regime. On the contrary, oral contraceptives are reported to provide a protective effect against these tumors.
  • GCS is aggressive; it spreads and grows rapidly and that it may be highly resistant to chemo/radiation if allowed to divide and progress.
  • GCS is usually found in later stages (beyond Stage 2) and is usually not discovered until it has spread beyond the first affected organ.

How is Uterine/Ovarian Carcinosarcoma Treated?

  • New breakthroughs in immunotherapy and personalized cancer treatments are being discovered every day. Because GCS is so rare, it is not on the radar screen for these new therapies. But this is where the cures will be found. The current therapies — surgery, radiation and chemo — have not yielded any improvement in survival in over 40 years.
  • To date, no national consensus guidelines have been established for the management of GCS. A full understanding of the pathobiogenesis of this tumor is necessary to predict the “gold standard” treatment. But as previously stated, GCS is so rare that it is not studied as a unique entity and is treated as an ovarian or uterine cancer with poor results.
  • Current therapeutic approaches may differ depending on the primary lesion (sarcoma or carcinoma?). Chemotherapy effectiveness in sarcomas differs greatly from that in endometrial carcinomas.
  • The current primary treatment option remains surgery; however, high rates of relapse and metastases postoperatively necessitate effective adjuvant therapies such as chemotherapy.
  • Regardless, in higher-staged tumors, neither radiotherapy nor chemotherapy provides any significant overall survival benefit and there remains to date no consensus to guide therapeutic strategies for the various stages of disease.
  • I found this flow chart summarizes the current recommendations for the treatment of uterine carcinosarcomas.

uterine-carcinosarcoma-treatment

A Few Other Thoughts to Share

  • You must find a GYN Oncologist who has significant experience with GCS.
  • As complex as the science is, you must be able to work with your treatment team and understand all your options.
  • Obtain copies of your medical records — everything: pathology reports, scans, etc., and seek help to interpret the test results.
  • Seek a second or third opinion. Find a team in which you have confidence.
  • Know what your insurance covers.