Soft Tissue Sarcoma can start in any part of the body, such as the bone or soft tissue. About 60% of soft tissue sarcomas begin in an arm or leg, 30% start in the torso or abdomen, and 10% occur in the head or neck. Both children and adults can develop a sarcoma, but it is rare in adults, accounting for about 1% of all adult cancers. However, sarcoma in general represents about 15% of all childhood cancers.

About soft-tissue sarcoma

Soft-tissue sarcomas (STS) are a group of cancers that begin in the tissues that support and connect the body, such as fat cells, muscle, nerves, tendons, the lining of joints, blood vessels, or lymph vessels. As a result, STS can occur almost anywhere in the body.

Sarcoma, Soft Tissue – Risk Factors

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer.

Most sarcomas do not have known causes. The following factors can raise a person’s risk of developing sarcoma:

  • Previous radiation therapy.People who have been treated with radiation therapy for a previous cancer have a slightly increased risk of later developing sarcoma.
  • People with certain inherited diseases have a higher risk of sarcoma. These diseases include neurofibromatosis type I, also known as von Recklinghausen’s disease; Gardner syndrome; Werner syndrome;tuberous sclerosis; nevoid basal cell carcinoma syndrome; Li-Fraumeni syndrome; and retinoblastoma.
  • Workplace exposure to vinyl chloride monomer, used in making some types of plastics, or dioxin may increase the risk of sarcoma. However, most sarcoma is not known to be associated with specific environmental hazards.

Sarcoma, Soft Tissue – Symptoms and Signs

More than half of sarcomas begin in an arm or leg. Most people simply notice a lump that has grown over a period of time (weeks to months). Although the lump is often not painful, in some cases it will hurt.When sarcomas grow in the back of the abdomen (the retroperitoneum), the symptoms they cause more often come from other problems. Sometimes the tumors cause pain. They may also cause blockage or bleeding of the stomach or bowels. They can grow large enough for the tumor to be felt in the abdomen. About 20% of sarcomas begin in the abdomen (stomach) area.

Sarcomas can also begin on the outside of the chest or abdomen (about 10%) or in the head or neck area (around 10%).

If you have any of the following problems, see a doctor right away:

  • A new lump or a lump that is growing (anywhere on your body)
  • Abdominal pain that is getting worse
  • Blood in your stool or vomit
  • Black, tarry stools(when bleeding happens in the stomach or bowels, the blood can turn black as it is digested, and it may make the stool very black and sticky)

These symptoms are more often caused by things other than sarcoma, but they still need to be checked out by a doctor.

Sarcoma, Soft Tissue – Diagnosis

A diagnosis of sarcoma is made by a combination of clinical examination by a doctor and imaging tests. It is confirmed by the results of a biopsy. In addition to a physical examination, some of the following tests may be used to diagnose sarcoma:

  • X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. Typically, if an x-ray suggests cancer, the doctor will order other imaging tests. X-ray is particularly useful for bone sarcomas.
  • Ultrasound.An ultrasound uses sound waves to create a picture of the internal organs.
  • Computed tomography (CT or CAT) scan.A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors.
  • Magnetic resonance imaging (MRI)).An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size.
  • Positron emission tomography (PET) scan.A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist.

There are different types of biopsies. For a needle biopsy, a doctor removes a small sample of tissue from the tumor with a needle-like instrument — usually a core needle biopsy and, less often, a thin needle biopsy. This may be performed with the help of ultrasound, CT scan, or MRI to precisely find the tumor. In an incisional biopsy, the surgeon cuts into the tumor and removes a sample of tissue.

Sarcoma, Soft Tissue: Treatment Options

SURGERY

The surgeon’s goal is to remove the tumor and enough normal tissue around it to leave behind a “clean margin,” which means there are no tumor cells left in the area where the tumor was removed. Small sarcomas can usually be effectively eliminated by surgery alone. Those larger than 5 cm are often treated with a combination of surgery and radiation therapy. Radiation therapy or chemotherapy may be used before surgery to shrink the tumor and make removal easier, or they may be used during and after surgery to kill any remaining cancer cells.

  • Limb conservation surgery: Removal of the tumor in an arm or leg without amputation, so the use and appearance of the limb is saved. Radiation therapyor chemotherapy may be given first to shrink the tumor. The tumor is then removed in a wide local excision. Tissue and bone that are removed may be replaced with a graft using tissue and bone taken from another part of the patient’s body, or with an implant such as artificial bone.

RADIATION THERAPY

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.Radiation therapy may be done before surgery to shrink the tumor so that it may be more easily removed. Or it may be done after surgery to remove any cancer cells left behind. Radiation treatment may make it possible to do less surgery, often preserving the arm or leg if the sarcoma is located in one of those places.Radiation therapy can also damage normal cells, but because it is focused around the tumor, side effects are usually limited to those areas.In the short term, radiation can cause injury to the skin that looks like a sunburn and is usually treated with creams that keep the skin soft and helps relieve pain. Most radiation therapy side effects go away soon after treatment ends.

CHEMOTHERAPY

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. It may be given alone or in combination with surgery and/or radiation therapy.

TARGETED THERAPY

Targeted therapy is a newer type of cancer treatment that uses drugs or other substances to identify and attack cancer cells while doing little damage to normal cells. These therapies attack the cancer cells’ inner workings − the programming that makes them different from normal, healthy cells. Each type of targeted therapy works differently, but all alter the way a cancer cell grows, divides, repairs itself, or interacts with other cells.

Key points

  • Sarcoma can start in any part of the body, such as the bone or soft tissue. About 60% of soft tissue sarcomas begin in an arm or leg, 30% start in the torso or abdomen, and 10% occur in the head or neck.
  • Small sarcomas can usually be effectively eliminated by surgery alone.
  • Most patients can be treated with surgery to remove the tumor without amputation called limb conservation surgery