Soft+Tissue+Sarcoma

Age: Mostly found in older patients Radiation exposure: radiation treatment for a previous condition can increase the chance of developing a soft tissue sarcoma Chemical exposure: Exposure to certain types of chemicals such as vinyl chloride and dioxin increase the risk of soft tissue sarcomas || Other types include:1 Rhabdomyosarcoma is the most common type of pediatric STS.1 Over 100 types of soft tissue sarcoma described by the World Health Organization. 1 || Gx: grade cannot be assessed G1: well differentiated G2: moderately differentiated G3: poorly differentiated G4: undifferentiated || Tx: Tumor cannot be assessed T0: No evidence of primary tumor T1: Tumor is 5 cm in size or less – T1a if tumor is superficial and T1b if tumor is deep T2: Tumor is greater than 5 cm – T2a if tumor is superficial and T2b if tumor is deep
 * **Epidemiolgy:** || Soft tissue sarcomas may occur at any age but are more common in adults, the average age of patients diagnosed with soft tissue sarcomas is 57. There are certain types of soft tissue sarcomas that are more common in children.5 ||
 * **Etiology:** || There are not many known risk factors for soft tissue sarcomas, there are three main ones that are discussed:5
 * **Signs & Symptoms:** || In its beginning stages, soft tissue sarcomas do not commonly produce any signs or symptoms. As the tumor grows swelling may occur or a lump may be noticeable this can be accompanied by pain is the lump presses on any nerves or muscles. If the tumor is located in the abdomen or digestive tract a blockage in the stomach or intestines can occur as well as gastrointestinal bleeding.5 ||
 * **Diagnostic Procedures:** || Evaluation based on physiologic status, extent of tumor involvement, and histological characteristics1
 * Complete blood cell count and blood studies
 * Plain radiographs of the involved site
 * Computed tomography (CT) with contrast or a Magnetic Resonance imaging to evaluate neurovascular compromise and possible mass fixation to bone
 * Chest radiograph
 * Ct scan of chest ( most common metastatic site: lung)
 * PET scan ( metastasis)
 * Bone scan
 * Arteriography
 * Lymphangiogram
 * Ultrasound ||
 * **Histology:** || Most common Soft Tissue Sarcoma is Malignant Fibrous Histiocytoma (MFH) (28%).1
 * leiomyosarcoma (12%)
 * <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">liposarcoma (15%)
 * <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">synovial sarcoma (10%)
 * <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">malignant peripheral nerve sheath tumors.
 * **Lymph node drainage:** || <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Lymphatic extension is not common. 2 ||
 * **Metastatic spread:** || * The lung is the most common site of metastatic disease.
 * Lymph node metastases are uncommon, but are an ominous sign when they occur.
 * Invasion proceeds to adjacent muscle, skin, nerves, and bone.
 * Tumors of the trunk, head, and neck may invade adjacent structures earlier.
 * Skin involvement is seen in approximately 10% of patients.
 * Hematogenous metastases are the most common pattern of metastatic disease and occur more frequently as the tumor enlarges.3 ||
 * **Grading:** || AJCC grading system used for soft tissue sarcoma.3
 * **Staging:** || AJCC TNM Staging system.3
 * Tumor **

Nx: Regional Lymph nodes cannot be assessed N0: No regional lymph node metastasis N1: Regional lymph node metastasis
 * Nodal involvement **

M0: No distant metastasis M1: Distant metastasis
 * Distant Metastasis **

Stage IA – T1a, N0, M0, G1/Gx or T1b, N0, M0, G1/Gx Stage IB – T2a, N0, Mo, G1/Gx or T2b, N0, M0, G1/Gx Stage IIA – T1a, N0, M0, G2/G3 or T1b, N0, M0, G2/G3 Stage IIB – T2a, N0, M0, G2 or T2b, N0, M0, G2 Stage III – T2a/T2b, N0, M0, G3 or Any T, N1, M0, Any G  Stage IV – Any T, Any N, M1, Any G ||
 * Staging **
 * **Radiation side effects:** || Complications and side effects of radiation are difficult to determine due to the large variability among sarcoma patients with respect to anatomic site, tumor size, tumor grade, and pre-existing conditions. 4 Commonly reported functional impairments are pain, loss of range of motion, muscle weakness, edema, and muscle fibrosis. 4 Wound complications can also occur, but do at a low rate. 4 ||
 * **Prognosis:** || **Prognostic Factors** 4

Mortality Distant Metastasis Local Recurrence
 * Grade
 * Size
 * Recurrent
 * Lower extremity site
 * Leimysarcoma
 * Grade
 * Size
 * Depth
 * Recurrent
 * Liposarcoma
 * Age older than 50
 * Recurrent
 * Fibrosarcoma
 * Grade
 * Depth ||
 * **Treatments:** || Surgical resection has been the main treatment modality for soft tissue sarcomas of all sites. 4 Radiation alone should be reserved for patients with unresectable lesions because of anatomical location, medical inoperability, or surgery refusal. 4 Radiation can also be used preoperatively, postoperatively, and intraoperatively (with external beam or brachytherapy). 4 ||
 * **TD 5/5:** || [[image:Normal tissue tolerance to therapeutic irradiation.jpeg width="800" height="664"]] ||
 * **References:** || # <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Chao KS, Perez CA, Brady LW. Radiation Oncology Management Decisions. 3rd edition. Philadelphia, PA: Lippincott Williams & Wilkins. 2011; 704-705.
 * 1) <span style="color: #0000ff; font-family: Arial,Helvetica,sans-serif;">Bartenhagen L, Koth J. Principles and Practice of Radiation Therap. 3rd Edition. St. Louis, Missouri: Mosby.2011:599.
 * 2) <span style="color: #ff0000; font-family: Arial,Helvetica,sans-serif;">Chao KS, Perez CA, Brady LW. //Radiation Oncology Management Decisions//. 3rd edition. Philadelphia, PA: Lippincott Williams & Wilkins. 2011; 704-705.
 * 3) <span style="background-color: #ffffff; color: #800080; font-family: Arial,Helvetica,sans-serif;">Hoppe RT, Phillips TL, Mack III M. Leibel and Phillips Textbook of Radiation Oncology. 3rd ed. Philadelphia Pa: Elsevier Saunders; 2010.
 * 4) Mayo Clinic, Soft tissue sarcoma, available at []. Accessed 7-9-2012 ||

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