Soft tissue sarcoma Overview

Question 1

Describe soft tissue sarcomas?

Answer 1

• Rare
• 7000 new cases /pa in US
• Proper evaluation crucial
  
  • unplanned excision may have neagtive effect on outcome
  • delay in dx can -> affect outcome
• Metastatsis
  
  • Lung common site
• Prognosis
  
  • poor =
    
    • High grade
    • Size >5cm
    • tumour location below deep fascia

Question 2

Describe some types of sost tissue sarcomas?

Answer 2

• > 50 types
• Routine tested
  
  • Synovial sarcoma
  • Liposarcoma
  • Rhabomyosarcoma
  • Fibrosarcoma
  • Leiomyosarcoma
  • angiosarcoma

Question 3

How do soft tissue sarcomas present?

Answer 3

• Painless enlarging Mass

O/E

• Palpable soft tissue mass
• above/below fascia has diagnostic importance
• size >5cm = poor prognostic sign

Question 4

What is seen on MRI?

Answer 4

• Mandatory to evaluate soft tissue
• MRI diagnostic for benign lesions=
  
  • lipomas
  • Neurilomoma ( schwanoma)
  • Intramuscular myxoma
• If diagnostic and mass is benign it can be removed without biopsy
• interdeterminate biopsy or suggestive of sarcoma= core needle biopsy/open biopsy
• soft tissue sarcomas can look like similar to haematomas so cautious when haematoma without trauma- do open biopsy if haematoma on core needle biopsy ;)

Question 5

Describe the tx of Soft tissue sarcomas?

Answer 5

• tx must be based on tissue dx unless images diagnostic

Operative

• Radiation therapy & wide surgical resection
  
  • standard care most pt
  • radtx= adjunct reduce local reoccurrance
  • 50-60 Gy standard dose
  • Give Pre/POst op
  • pre- assoc 30% wound complx
  • post op > radiation indiced morbidity & increased risk of radiation induced sarcoma
  • Chemo is contraversial for Soft tissue sarcomas
  • Surgical resection must confirm border free of disease other wise ** tumour bed re-excision as this is the most important tx related factor **

Question 6

What are the complications of surgical resection of soft tissue sarcomas?

Answer 6

• Reoccurrance
  
  • locally
  • low grade soft tissue sarcoma