Symptoms and Treatment of Soft Tissue Sarcoma
Symptoms of soft tissue sarcoma include pain, swelling, tenderness, and inflammation of the skin or other tissues. Depending on the type of sarcoma, a patient may need a biopsy, surgery, chemotherapy, or radiation therapy. Surgical removal of tumors is usually the first step in treating this condition. In some cases, the disease can spread to other parts of the body. Fortunately, this is not always the case.
Symptoms
Symptoms of soft tissue sarcoma can vary greatly. While some people feel a lump or pain, others feel only a dull ache. Whether you have a lump or not, you should see a doctor for an evaluation.
During an exam, a doctor will look for a lump in your skin. Most of these masses are benign, but you should see a physician if you have a mass that seems to be growing. They may also press against nearby nerves or organs. If the mass is pressing on a nerve, you may experience tingling or numbness.
A soft tissue sarcoma is cancer that grows in the connective tissues of the body. These include cartilage, tendons, muscle, and blood vessels. It can grow almost anywhere but is most common in the arms and legs.
When sarcoma is diagnosed, the treatment options are determined based on the stage of the disease. The stage is a measure of how far cancer has spread. If it has already spread to the lungs, for example, you may have to undergo a CT scan of your chest. If it hasn’t yet spread to the lungs, your treatment might involve chemotherapy and radiation therapy.
Most soft tissue sarcomas are characterized by a large lump under the skin. The mass is typically larger than a golf ball. If the lump isn’t painful, you might think it’s a bruise or a fat growth called a lipoma. The size of the tumor can vary. Some tumors grow inside a person’s fat, while others form in muscles or bones.
Because soft tissue sarcoma can occur in many parts of the body, it’s important to identify any lumps. In some cases, the tumor can’t be identified until it’s too large to feel.
If you are diagnosed with soft tissue sarcoma, you may have to undergo a biopsy. This involves the removal of a small piece of tissue and testing it in a lab to see if the cells are cancerous. The results of the biopsy will usually be returned in about a week.
Prebiopsy cross-sectional imaging
Performing prebiopsy cross-sectional imaging of soft tissue sarcomas is crucial to ensure the safety of the patient and minimize the risk of an undesirable outcome. This procedure is often performed in the community or at a local general hospital. In order to be successful, radiologists must understand important preprocedural considerations.
First, the site of the lesion should be determined. This will help to determine the approach to take for the biopsy. For example, if the lesion is on the sternum, the proximity to critical structures will influence the biopsy route. It is also imperative to consider the type of tissue that will be targeted for sampling.
If the lesion is on the bone, it is often necessary to perform an image-guided biopsy. These techniques are painless and provide high diagnostic accuracy. In addition, they have low complication rates. This makes percutaneous image-guided musculoskeletal biopsies a viable option for the diagnosis of soft tissue tumors. However, planning for a percutaneous biopsy requires careful coordination with the referring orthopedic oncologist.
After an initial evaluation of the lesion, the pathologist should decide whether a repeat biopsy is necessary. This decision will depend on the clinical suspicion of malignancy, the size and location of the lesion, and the likelihood of recurrence.
During the prebiopsy cross-sectional imaging of the soft tissue sarcoma, the osseous landmarks on the MRI should be evaluated. This can serve as a road map for CT-guided biopsy. In some cases, a “hockey stick” probe may be useful to locate the biopsy site.
In most cases, the lesion is a mesenchymal mass. These tumors arise from primitive mesenchymal cells. There are more than 35 histologic subtypes of soft tissue sarcomas. The most common types include leiomyosarcoma, gastrointestinal stromal tumors, and synovial sarcoma. Nonrhabdomyosarcomas have a better prognosis.
A key consideration is the patient’s comfort and anxiety level. Typical sedation medications will help to mitigate these factors. Other key factors to consider include the tumor’s location, the type of lesion, and the extent of surrounding critical structures.
In many cases, the initial imaging of soft tissue sarcomas includes an ultrasound. This modality is usually the primary modality used in the community or at a local general medical facility.
Surgery
Surgical removal of soft tissue sarcomas is a common treatment. However, the exact surgical procedure depends on the location of the tumor and the patient’s overall health. Some surgeons may use chemotherapy prior to surgery. This may help shrink the tumor before the operation.
Radiation therapy is usually given after surgery to kill cancer cells. It is also used as an adjuvant treatment in deep-seated tumors. It may be administered before surgery in order to facilitate tumor resection.
Surgery for soft tissue sarcomas is generally performed with the intent of removing the tumor completely and preventing a recurrence. It may be necessary to remove some healthy tissues around the tumor. This is known as a wide margin.
A margin of 1 to 2 cm is generally considered acceptable for most soft tissue sarcomas. The Enneking classification system is a commonly used method to evaluate surgical margins for soft tissue sarcomas. This system has a lot of conceptual appeals, but it is not uniformly applied in clinical groupings. This makes it difficult to interpret results.
The Enneking classification has been used as a surgical margin guideline, but its reproducibility is a concern. This can affect the overall outcome of the surgery, including the local recurrence rate. It is also important to consider the speed at which the tumor grows. Infiltrative soft tissue sarcomas, for instance, may have negative surgical margins. This is because the surrounding connective tissues become shortened after formalin fixation.
Infiltration of the tumor into the bone and other critical structures is a poor prognostic indicator. It is important to evaluate the presence of bone invasion on an MRI or CT scan. If the tumor invades vital structures, amputation is necessary.
Radiotherapy can be used before or after surgery to shrink the tumor. This may help to achieve microscopically negative margins. It can also be used as an adjuvant treatment for superficial tumors.
Surgical treatment is usually effective in preventing the recurrence of the disease. The length of hospital stay and recovery from surgery depends on the type of operation.
Chemotherapy
Several chemotherapy drugs are available for soft tissue sarcoma. These include doxorubicin, ifosfamide, and eribulin. These are given intravenously, sometimes as an outpatient.
The cytotoxic drugs interact with cells that are highly proliferative. They also interfere with the normal tissues of the body. These drugs are administered in cycles every 3-5 weeks. These drugs are also known to induce DNA cross-links, which are thought to block the growth of tumor cells in the S phase.
The most effective and common chemotherapy for soft tissue sarcomas is doxorubicin. Doxorubicin is a powerful antitumor antibiotic that is also easy to administer. It is currently the standard of care for patients with advanced metastatic soft tissue sarcoma. It is usually used in combination with other agents.
Combined chemotherapy regimens significantly improve response rates and overall survival. However, these regimens are more toxic than single-agent doxorubicin. The CYVADIC regimen (doxorubicin, ifosfamide, cyclophosphamide, vincristine, and doxorubicin) is considered to be the most effective regimen for soft tissue sarcoma. It was approved for the treatment of bone sarcomas and soft tissue sarcomas in the U.S. It was used in the Intergroup Rhabdomyosarcoma Study from 1972 to 1991.
The EORTC Soft Tissue Sarcoma Group (EORTC STSG) has been conducting trials on this group of cancers. They have published a systematic review of the data on the use of chemotherapy for these diseases. They have compared results from randomized controlled trials and clinical practice.
In addition, the National Comprehensive Cancer Network has published more detailed North American guidelines. The NCCN guidelines are not in line with the criteria for drug approval in most countries. In the United States, the off-label use of certain anticancer drugs is a common practice.
The United States Sarcoma Collaborative is a multi-institutional collaborative that conducts studies on this disease. They have been conducting multiple sarcoma trials. The lead author of one of these studies is P. Schoffski, MD, MPH.
While chemotherapy is the most commonly used treatment for soft tissue sarcomas, it does not provide satisfactory outcomes. The 5-year overall survival for these patients is around 50%.
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