What is soft tissue sarcoma?
Sarcomas (Greek for “fleshy tumors”) are derived from mesenchymal tissue, the tissue forming the structure of the body. Cancers known as carcinomas, on the other hand, arise from the lining tissues, for example in the lung, colon, breast, or prostate.
Bone sarcomas develop in the bones, while soft tissue sarcomas develop in the soft tissues of the body. Sarcomas are the most common solid tumors of childhood, and more information about childhood sarcomas can be found at the Cleveland Clinic Childrens’ Hospital Pediatric Hematology/Oncology web site.
Among adults, soft tissue sarcomas represent less than 1 percent of all cancers. Even this relatively small grouping includes a number of distinct cancers, such as leiomyosarcoma, synovial sarcoma, malignant peripheral nerve sheath tumor, angiosarcoma, fibrosarcoma, pleomorphic sarcoma (sometimes called malignant fibrous histiocytoma, or MFH), gastrointestinal stromal tumor (GIST) and others.
Soft tissue sarcomas can arise anywhere in the body, but most commonly develop in the legs, arms, chest, or the area behind the abdomen, an area known as the retroperitoneum.
What are the symptoms of soft tissue sarcomas?
Because they are often located deep in the tissues of the arms and legs, chest or abdomen, soft tissue sarcomas often grow to be quite large before causing symptoms. Most commonly, soft tissue sarcomas present as masses or bumps, which may be painful. Tumors in the abdomen may produce nausea or a sensation of fullness as well as pain.
How are soft tissue sarcomas diagnosed?
No routine screening tests for sarcomas are recommended. We should all be aware of our bodies, however, and tell our doctors about new lumps or other symptoms that cannot be explained or that don’t go away in a few weeks.
Once a sarcoma is suspected, it is best if a patient is evaluated further by a sarcoma specialist. Tests to be done to evaluate a patient with a suspected soft tissue sarcoma include regular X-rays, CT scans of the involved area, and MRI scans of the affected region.
CT scans of the chest are often done because soft tissue sarcomas tend to spread to the lungs. The only way to make a final diagnosis of soft tissue sarcoma, however, is by a biopsy. In this procedure, a small portion of the tumor is removed and examined under the microscope to see if sarcoma cells can be seen. Often, the way in which the biopsy is performed affects the final surgery that is done to treat the tumor, so it is best if the biopsy is done by a surgeon with experience in treating sarcomas.
Staging is a process whereby the extent of involvement of a tumor in the body is determined. Staging involves the scans mentioned above. Tumors that have spread to distant organs are the most advanced. Tumors that have not spread to other organs are characterized by their size, depth and how they look under the microscope. On the basis of these features, the chance of the sarcoma coming back after treatment can be determined.
What are the treatment options?
The primary treatment of soft tissue sarcomas is surgical removal of the tumor. Because sarcomas are uncommon tumors, the surgery is best done by a sarcoma specialist who treats a lot of these tumors and who is part of a team of doctors familiar with sarcomas. If the tumor has spread to distant organs, removal of the primary tumor may be deferred or not done at all. Usually, however, the primary tumor is removed surgically.
Sometimes, radiation, chemotherapy, or both are given before surgery in order to shrink the tumor and make the surgeon’s job easier. If they were not given before surgery, radiation treatments are sometimes given after surgery to reduce the chances of the sarcoma coming back in its original spot.
Radiation may not be necessary after surgery, depending on the characteristics of the tumor and the amount of normal tissue surrounding the tumor that was removed. Chemotherapy is sometimes given after surgery for tumors that are large, deep in the body, and of high grade (aggressive-appearing under the microscope).
The value of chemotherapy after surgery is controversial and the side effects of the treatment are severe, so that the decision about whether or not to take this treatment is a difficult one that must be discussed by the patient and their doctors.
Patients whose tumors have spread to other organs, especially the lungs, are usually treated with chemotherapy. Sometimes, tumors in the lungs can be removed surgically.