Müllerian mixed tumor is a malignant tumor in women. It mostly occurs in the area of the uterus. Diseases of the fallopian tubes, the ovaries and the mesentery are also described in the specialist literature.
What is Müllerian mixed tumor?
The Müller mixed tumor refers to malignant mesodermal mixed tumors that are located in the area of the ovaries or in the area of the ovaries. The term Müller mixed tumor is obsolete. Today, these tumors are referred to as carcinosarcomas or simply as mixed tumors. See psyknowhow for Histiocytosis X Explained.
The name carcinosarcoma comes from the fact that the tumors contain both carcinoma components and sarcoma components. Carcinomas are neoplasms that originate in epithelial tissue. Sarcomas are of mesodermal origin. This means that they come from the cells of the so-called mesenchymal supporting tissue.
The Müllerian mixed tumors represent 25 to 60 percent of all sarcomas of the uterus. However, only about three percent of all malignant diseases of the female genital organs are sarcomas. Overall, the disease is very rare. By 2005, just 50 cases of the tumor had been described. Most women who develop a mixed Müllerian tumor are older than 65 years.
The tumors arise from the cells of the Müller duct. This is located in the lining of the uterus. However, it is unclear why the cells of the Müllerian duct degenerate. What is certain is that in Müllerian mixed tumors, the blood and lymphatic vessels are quickly affected. Thus, metastasis takes place in the very early stages. Lymph node metastases can already be found in stages I and II of this tumor in up to 35 percent of cases.
Symptoms, Ailments & Signs
The tumor often remains asymptomatic for a long time. When symptoms do occur, they are similar to those of benign fibroids. Affected women often notice abnormal bleeding from the uterus. A menstrual period can usually be ruled out at the age at which Müllerian mixed tumor occurs. In women who are still menstruating, the tumor can make itself felt through menstrual pain and increased menstrual bleeding. There may also be pain in the lower abdomen.
Rapid enlargement of the uterus is also an indication of a malignant process. The patients may notice that they gain weight within a short period of time despite their usual diet. You may even see swelling in the abdominal area. In advanced stages of the disease, abdominal and gastrointestinal symptoms are also caused by the displacement of abdominal organs or by metastasis to other organs.
Diagnosis & course of disease
If there is a suspicion of a tumor in the area of the genital organs, the doctor treating you first carries out an ultrasound examination (sonography). If this does not yet provide any information, computer tomography and magnetic resonance imaging can also be carried out.
If a tumor is discovered during these examinations, fractional curettage can be used to determine whether it is a Müllerian mixed tumor or not. In a fractional curettage, tissue is removed from the uterus using a sharp curette. To avoid cell mixing between cells of the cervix and the body of the uterus, the cervical canal is scraped before the curettage. The tissue obtained during the curettage is then examined histologically.
Since this disease is a form of cancer, it is usually not possible to give a general course. This depends very much on the severity and spread of the tumor. The life expectancy of the person affected may also be reduced due to the tumor. Those affected primarily suffer from relatively severe menstrual pain.
These also last longer than usual and are also accompanied by relatively heavy bleeding. Many women also suffer from depression or mood swings, which can lead to complications with their partner. Furthermore, those affected gain weight in a short time and also suffer from swelling in the face. If this tumor is not treated, it can spread to other regions of the body.
Discomfort in the lower abdomen or in the stomach can also occur. The treatment of this tumor is not associated with complications. This is removed with the help of an operation. The remaining components can then be removed with the help of radiation or chemotherapy. There may be side effects.
When should you go to the doctor?
Müllerian mixed tumor occurs exclusively in women. Since they belong to the risk group and the disease can be fatal, they should exercise increased vigilance in the event of physical or health changes. The sooner a doctor is consulted, the better the chances of recovery.
Women are well advised to take part in regular check-ups with a doctor. Abnormalities are noticed during these examinations, which leads to early detection and thus to rapid treatment of the tumor.
Irregularities and discrepancies in the monthly menstrual period of a sexually mature woman are signs of an existing disorder. They need to be evaluated and treated if they persist for a long time or increase in intensity. If there is increased bleeding or intermenstrual bleeding, a doctor’s visit is necessary. In case of cramps, abdominal pain or disturbances during sexual intercourse, a doctor should be consulted.
Swelling in the abdomen, a feeling of tightness or changes in the appearance of the skin should be presented to a doctor to clarify the cause. An unwanted increase in weight without changing the food intake is considered a warning signal from the organism. If there is a general feeling of being unwell, a decrease in physical performance or a feeling of illness, a doctor is needed. In the case of digestive disorders or irregularities when going to the toilet, it is necessary to clarify the symptoms.
Treatment & Therapy
The Müllerian mixed tumor is operated on immediately after the diagnosis. During the operation, the abdominal cavity is carefully examined. Then a so-called flush cytology is taken. The uterus, ovaries and fallopian tubes are then completely removed. The large mesh (omentum majus) and the lymph nodes in the abdomen are also removed. Radiation therapy and chemotherapy are only marginally effective in this type of tumor.
While radiotherapy does not improve survival, it appears to reduce local recurrence. Chemotherapy does not improve the chances of survival at all. If the tumor has metastasized or in the case of recurrences, it can only prolong survival time. Drugs such as carboplatin, doxorubicin, docetaxel, paclitaxel or gemcitabine are used in the chemotherapeutic treatment of Müllerian mixed tumors.
However, the prognosis for Müllerian mixed tumors is generally poor. It depends on several factors. On the one hand, the proportion of sarcomas in the tumor plays a role. On the other hand, the tumor stage and the location of the tumor are relevant. In stage I, the 5-year survival rate is less than 50 percent. In more advanced stages, the rate is only 25 to 30 percent. The prognosis also worsens with deep infiltration of the uterine muscles, with lymph node metastases in the pelvic area and with the growth of the tumor into surrounding blood vessels.
Outlook & Forecast
The prognosis for a Müllerian tumor is generally poor, but depends on several factors. The 5-year survival rate depends on the percentage of sarcoma tissue. It is the lower, the higher this proportion is. Overall, the decisive factor is whether the specialists are able to remove all of the tumor tissue as part of a surgical procedure. If only a few residual (remaining) tumor cells remain in the body after the operation, the prognosis is quite good.
However, the tumor stage also plays a role in the success of the surgical procedure and thus the prognosis. The 5-year survival rate for stage I Müllerian mixed tumors is between 40 and 50 percent. As the disease progresses, this drops to 25 to 30 percent. In addition, it is important for the prognosis how far or deep the tumor tissue has infiltrated the myometrium (middle layer of the uterine wall), the surrounding blood vessels and the cervix (cervix uteri). As the tumor grows into these structures, the prognosis worsens. In addition, metastases (settlements) in the lymph nodes in the pelvic area (so-called pelvic lymph nodes) have a negative effect on the prognosis. If left untreated, a mixed Müllerian tumor will always lead to death.
Since it is not yet known why the cells in the uterus degenerate, the tumor cannot be prevented either. Since the chances of survival decrease as the tumor progresses, early detection and rapid removal of the tumor is very important. Pre-cancerous stages can be detected at an early stage with early detection examinations. In Germany, annual medical check-ups are free for women over the age of 20. During the check-ups, a cell smear is taken from the uterus.
This so-called “Pap test” is used to quickly identify cell changes in the uterus. This should be done before the cervical cancer develops. This regulation for early cancer detection only applies to healthy women. In the event of symptoms, women should not wait until the next appointment for early detection, but go straight to a doctor.
Such alarm symptoms are, for example, spotting and bleeding outside of menstruation or after the menopause, pain in the abdomen or pain during sexual intercourse. Even if other diseases of the uterus, such as fibroids, are known, more frequent examinations should be carried out by the gynecologist.
The average time until tumor recurrence is less than two years for Müllerian mixed tumors. In the three years following the therapy, a check-up is therefore recommended every three months. The vagina is examined, taking into account the history of the disease. The small pelvis is also scanned, since every fourth recurring tumor manifests itself there.
If drugs have been prescribed, the potentially strong side effects and interactions must be discussed with doctors during these clinic visits. For the patient himself, it is recommended to engage in physical activity. Thanks to this, it is possible to reduce pain and improve mood. Moderate exercise also has a positive effect on the prognosis. This strengthens the performance of the cardiovascular system and the immune system.
Sporting activities can already be started at the end of the therapy and continued afterwards. Furthermore, a diet is recommended, which should be worked out together with a doctor or nutritionist. The change in diet should then be implemented according to the recommendation of the attending physicians.
This can alleviate the symptoms of chemotherapy, but also improve the prognosis. Because this aggressive tumor is associated with a poor prognosis, psychological care for those affected is recommended. This can be supported by psychologists or take place in a self-help group.
You can do that yourself
Patients who have been diagnosed with a mixed Müllerian tumor require immediate medical treatment. The medical therapy can be supported, among other things, by sporting measures. Regular exercise helps to reduce pain and improve mood even during the initial therapy.
Even after the treatment has been completed, moderate exercise improves the prognosis by strengthening the performance of the cardiovascular system and immune system. An adapted diet additionally supports the therapy. Cancer patients should create a suitable diet with the responsible doctor or a nutritionist and implement it consistently. This can reduce symptoms, especially during chemotherapy, and improve the overall prognosis. Accompanying this, a therapeutic consultation is always indicated. Since Müllerian mixed tumor is a malignant tumor, many suffer from anxiety and panic attacks. These need to be worked through in cooperation with a psychologist or as part of a self-help group.
In addition, regular visits to the hospital are necessary, especially in the case of unusual symptoms or side effects and interactions caused by the prescribed medication. Finally, tumor patients should take it easy and avoid physically or mentally strenuous activities, especially in the first few weeks of therapy.