Retroperitoneum

Retroperitoneum liposarcoma tumors occur somewhat more frequently in women. It's usually an adult tumor, with a peak incidence of between 40- 60 years old. There is no evidence that any race or geographic area is more at risk to develop liposarcomas.[2] || · Well-differentiated (most seen) · De-differentiated · Mixed differentiated · Poorly differentiated ||
 * **Epidemiolgy:** || [[image:uwlmedicaldosimetry2012/retroper1.jpg width="480" height="269" caption="[1]"]]
 * **Etiology:** || There is no well- established cause of Retroperitoneum liposarcoma (although trauma has been implied).[3] ||
 * **Signs & Symptoms:** || In 60-80% of cases, patients present with abdominal pain or a mass. 50% of patients have weight loss and loss of appetite. Patients who have sarcomas many times are asymptomatic, whereas those with germ cell tumors or lymphomas are more acutely ill. Paraneoplastic syndromes, precocious puberty in children, intermittent hypoglycemia and excessive catecholamine can all occur with different tumors. [4] ||
 * **Diagnostic Procedures:** || The following procedures can be done in order to evaluate physiologic status of the patient, extent of tumor involvement, and histologic characteristics [4]:
 * Physical examination
 * Complete blood cell count
 * Blood studies
 * Computed tomography (CT)
 * Magnetic resonance imaging (MRI) ||
 * **Histology:** || Due to the number of organs, vessels and tissues there are a number of tumors that can occur in the retroperitoneal area of the body. The most common is the retroperitoneal liposarcomas and can be broken down in to four group.[1]
 * **Lymph node drainage:** || Lymph nodes involvement depends on the location of the tumor with in the retroperitoneal cavity itself the specific cell type and depth of the tumor. ||
 * **Metastatic spread:** || These tumors have a low rate of metastasis outside of the original site. Reoccurrence is typically seen if during surgery the margin around the tumor was not adequate. ||
 * **Grading:** || ==== According to the guidelines of the ADASP, dedifferentiated liposarcoma is considered high grade[5] ====

French Federation of Cancer Centers System grading scheme for adult sarcomas[5]

 * Tumor differentiation score = 3 for dedifferentiated liposarcoma
 * Mitotic index
 * Score 1 0-9 mitoses per 10 hpf (0.1744 sq mm)
 * Score 2 10-19 mitoses per 10 hpf
 * Score 3 >19 mitoses per 10 hpf
 * Tumor cell necrosis
 * Score 0 No necrosis on any slide (one slide per 2 cm tumor diameter)
 * Score 1 <50% of tumor is necrotic on slides examined
 * Score 2 >50% of tumor is necrotic on slides examined
 * Final Grade (add the three scores above)
 * Grade 1 Sum of scores = 2 or 3
 * Grade 2 Sum of scores = 4 or 5
 * Grade 3 Sum of scores = 6 or more ||
 * **Staging:** || ==== Use TNM Staging[5] ====

The surgical pathology report should contain or address the following[5]:
2. Rajan TV. Liposarcoma. //Radiology//. Available at: []. Accessed June 8, 2012. 3. Schwartz RA, Elston DM, Trovato MJ, et al. //Medscape//. Apr. 20, 2012. Available at: [|http://emedicine.medscape.com/article/1102007-overview#showall]. Accessed June 8, 2012. 4. Lenhard RE, Osteen R, Gansler T. //The American Cancer Society’s Clinical Oncology//. Williston, VT: Blackwell Publishing, Inc; 2001. 5. Dedifferentiated Liposarcoma. Stanford School of Medicine. 2012. Available at: []. Accessed on: June 6, 2012. 6. The Role of Radiation Therapy for Ewing’s Sarcoma. CancerConnect. 2012. []. Accessed on: June 6, 2012. 7. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991 8. Washington CM, Leaver D. Principles and Practice of Radiation Therapy. St. Louis, MO: Mosby; 2010. ||
 * Location
 * Type of resection or biopsy
 * Histologic diagnosis
 * Managerial category III (Local recurrence common; Metastasis occurs)
 * Extent of tumor cell necrosis
 * Grade
 * Percent poorly differentiated area
 * Stage
 * Size
 * Depth (dermis, subcutis, below fascia, body cavity)
 * Margins
 * Involved
 * Not involved
 * If under 2 cm give all such distances and sites
 * If over 2 cm give minimum distance and site
 * Results of supplementary studies if performed
 * Relationship to other specimens from the same patient ||
 * **Radiation side effects:** || Although patients do not feel anything while they are receiving radiation treatment, the effects of radiation gradually build up over time[6]. Large doses of radiation can cause skin damage in the areas receiving radiation[6]. Large doses of radiation to can damage blood vessels and nerves[6]. Researchers from Emory University have described several late effects of radiation therapy in children including: atrophy, fibrosis, bone growth abnormalities, impairment of mobility, edema, and peripheral nerve injury[6]. The most worrisome side effect among long-term survivors is second cancers due to radiation[6]. ||
 * **Prognosis:** || Histology, invasiveness, and resectability are the prognostic factors.[1] Retroperitoneal tumors have a ten year recurance rate of fifty percent. Death is usually due to systemic failure. [8] ||
 * **Treatments:** || Surgery, chemotherapy, and radiation can play a role in the treatment of these tumors. Generally preoperative radiation to a dose of 45Gy and a post operative boost is recomended. Liver and kidneys are structures to avoid.[1] ||
 * **TD 5/5:** || TD 5/5 is a statistical guideline to consider, which states that there has been a five percent probability of complication in five years. These values are based on a 200cGy, 5 fraction a week treatment schedule.[7] The table includes the five most commonly evaluated structures for irradiation [[image:uwlmedicaldosimetry2012/wk 3 pancr.jpg caption="wk 3 pancr.jpg"]] ||
 * **References:** || 1. Chao KS, Perez CA, Brady LW. Radiation Oncology: Management Decisions. 2nd ed. Philadelphia, PA: Lippincott Willam & Wilkins; 2002.

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Due to the number of organs, vessels and tissues there are a number of tumors that can occur in the retroperitoneal area of the body. The most common is the retroperitoneal liposarcomas and can be broken down in to four groups · Well-differentiated (most seen) · De-differentiated · Mixed differentiated · Poorly differentiated