Categories: Orthopaedics

Soft Tissue Sarcoma

Cancer arising in the Mesenchymal tissue (Connective Tissue), known as Sarcoma. And the sarcoma arising in the soft tissue called Soft Tissue Sarcoma (STS).

So, it can arise from the following tissue

  1. Muscles – Rhabdomyosarcoma
  2. Blood vessels – Angiosarcoma
  3. Nerves – Malignant peripheral nerve sheath tumour (MPNST)
  4. Fat – Liposarcoma
  5. Joint tissue – Synovial sarcoma, chondrosarcoma
  6. Ligament and tendon – Fibrosarcoma

Location: It can arise anywhere in the body. The most common location is the extremity in which the thigh is the most common site. The retroperitoneal area is the 2nd most common site.

Age: Age is no bar for sarcomas, some sarcoma can happen at a young age and even in children.

Warning Signs:

  1. A new lump
  2. Pain in an existing lump
  3. A sudden increase in the size of the pre-existing lump
  4. Lump of size more than 5 cm
  5. Difficulty in normal movement
  6. Fatigue
  7. Unintended weight loss

Risk Factors: Most of the patients don’t have any risk factors, while some risk factors are:

  1. Exposure to radiation
  2. Genetic syndrome-like NF1 etc.
  3. Chemical exposure
  4. Pre-existing swelling like lymphedema

Can Soft Tissue Sarcoma spread?

Yes. It can spread to the Lungs, Lymph nodes and vital organs.

Diagnosis

Correct diagnosis is the most important part of management. As there about 50 types of histologically different types of STS. The prognosis and management plan depends on the histology.

A biopsy will be done to diagnose correct histology. Biopsy should always be done by Sarcoma Specialist Surgeon. The wrong Biopsy may lead to the spread of cancer.

Evaluation at a cancer centre that treats a large number of sarcoma patients and has a specialized sarcoma management team improves chances of correct diagnosis and treatment and reduces chances of relapse.

Once the diagnosis is confirmed, staging workup will be done to rule out spread to other organs, in the form of CT chest, USG of draining lymph node or PET-CT.

Treatment

A sarcoma specialist will tell you different treatment options. These Options were advised depending on the various factors like stage, grade, and histology. Having appropriate knowledge about them will help you make the right decision.

  1. Surgery: It is the main treatment for Sarcoma. The type of surgery like Limb Salvage or Amputation will depend on the location and extent of the tumour.
  2. Chemotherapy: It is the cytotoxic drug given to kill cancer cells. Useful in a certain type of sarcoma. Can be given before or after the surgery depending upon the stage. Can be used as a supportive treatment for improvement of quality of life.
  3. Radiation Therapy: This mode of treatment given to reduce the chances of local relapse. This high energy X-ray Beam gave to kill cancer cells. Can be given before surgery to shrink the tumour. Or can be given after surgery to kill remaining cancer cells. It can be given as external beam radiation or as Brachytherapy.

Outcome of Sarcoma

The outcome of the treatment depends on several factors like stage of cancer, grade of tumour, size, location, adequacy of previous surgery, Biopsy scar and place whether treatment is taken by sarcoma specialist or not.

  • For Stage I, 5 yr survival is between 80% – 95%
  • For Stage II/III, 5 yr Survival is between 60% – 70%
  • For Stage IV, 5 yr Survival is usually < 40%

This article is authored by Dr. Lokesh Garg, Consultant – Orthopaedics (Musculoskeletal / Orthopaedic Oncology), Dharamshila Narayana Superspeciality Hospital, Delhi

Narayana Health

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