Soft Tissue Sarcoma
Soft tissue sarcoma is a disease in which cancer cells are found in the soft tissue of part of the body.
Sarcomas are cancers of the body tissues, as opposed to those of specific organs. They arise in bone, cartilage, muscle, fat, nerves, blood vessels and other connective tissue. Most sarcomas arise in the extremities. But they can arise within almost any organ in the body, because all organs contain most of these types of tissue.
Sarcomas are divided into those involving hard tissue, bone and cartilage, and those involving soft tissue, which includes all other tissues.
There are a number of major types of sarcoma based on the type of cell from which it arises. These are angiosarcoma (blood vessel); liposarcoma (fat); fibrosarcoma (connective tissue); rhabdomyosarcoma (muscle); leiomyosarcoma (smooth, involuntary muscle); neurofibrosarcoma (nerve covering); synovial sarcoma (membrane lining the joints); and lymphangiosarcoma (lymph vessel).
Liposarcoma represents about 15 percent of all cases. It is commonly found on the extremities and behind the abdominal cavity.
Liposarcomas generally occur in patients who are fifty to sixty years of age.
Fibrosarcoma is another common type of soft tissue sarcoma, representing about 15 percent of all cases. It is seen in patients who are 30 to 55 years of age and commonly arises in the leg.
Malignant fibrous histiocytoma is a highly malignant tumor that now occurs in increasing frequency, about 20 percent of all cases. It occurs later in life.
As with most cancers, the true cause is unknown.
Depending upon where the sarcoma is, the symptoms and signs can vary substantially. Often they are found incidental to clinical or x-ray exams that are performed for other reasons.
CAT and MRI scans can show sarcomas. The scans can locate the tumor and describe the surrounding structures. A chest x-ray can detect lung metastases.
As with all tumors, a biopsy is required to make an accurate diagnosis. Many of these tumors look alike, particularly tumors that are poorly differentiated. The pathologist may need to examine many sections of each tumor to make a diagnosis.
Treatment options include surgery, radiation therapy, and chemotherapy.
Surgery is the most common treatment for adult soft tissue sarcoma. Traditional surgery has been amputation or wide excision including a broad margin of apparently normal tissue. When muscles are involved, surgeons often remove the entire muscle group. If the tumor is near the shoulder or hip, the entire joint is removed.
Recently, many surgeons are practicing more conservative surgery, including limb-sparing techniques. Conservative surgery for soft tissue sarcomas means the removal of the tumor with a suitable margin of normal-appearing tissue.
Radiation therapy is used to reduce local recurrence, especially after surgery that spared the limb from amputation. As with other malignancies, postoperative radiation therapy does not prolong survival. Radiation may also be given prior to surgery to reduce the size of a large tumor.
Chemotherapy has been very effective in bone sarcomas and rhabdomyosarcomas, or muscle tumors. Chemotherapy has been much less effective in other soft tissue sarcomas. Adriamycin is the most commonly used agent for these tumors.
Chemotherapy in addition to surgery, or adjuvant chemotherapy, is not very effective. Preoperative, or neoadjuvant, chemotherapy can be used to shrink large tumors prior to surgery.
The specific choice of treatment depends on the stage of the cancer, and the age and general health of the individual. Prognosis is influenced also by the location of the tumor. A tumor near the body’s surface has a better prognosis than one deep inside an extremity or other part of the body.
Where is the tumor located?
What type is it?
What is its staging?
What are treatment options?
Would chemotherapy help?
Will surgery be necessary?