Soft Tissue Sarcoma

Soft tissue sarcomas are cancers which arise from the soft tissues of extremities. i.e. cancers which arise from skin, fat, fascia, muscles, blood vessles, nerves etc. There are more than 80 variants of soft tissue sarcomas. They are known from the tissue of their origin. I.e. sarcoma arising from skin is known as Dermato sarcoma, from fat is known as Liposarcoma, and from muscles is known as Liomyosarcoma etc.

Dermatosarcoma, Dermatofibrosarcoma, Dermatofibrosarcoma protruberans, Liposarcoma, fibrosarcoma, Rhabdomyosarecoma, Liomyosarcoma, Synovial sarcoma, Malignant fibrous histeocytoma, Pleomorphic sarcoma, Alveolar soft part sarcoma, Angiosarcoma, Epitheloid hemangioendothelioma, Hemangiopericytoma, Malignant peripheral nerve sheath tumor, Neurofibrosarcoma, Epitheloid sarcoma.

Exact cause of Soft tissue sarcomas is unknown. However, it has been linked to some genetic syndromes, some pre-existing tumors and long standing ulcers. In majority, the exact cause cannot be reached.

It is diagnosed with the help of Xray, MRI and a needle biopsy – histopathology and immunohistochemistry (IHC).

Once diagnosed, its staging is done. Staging means, to find out whether it has spread to any other part of body or not? For that, typically a CT scan of chest and Sonography of abdomen, pelvis, axilla are done. However, with advent and availability of PET CT scans, even that can be done.

Following are the stages of Soft tissue sarcomas in simple terms.

Stage 1: Low grade Soft tissue sarcomas (i.e. the cancer is not very aggressive)

Stage 2: High grade Soft tissue sarcomas (i.e. the cancer is very aggressive) but has not spread to any other part of the body

Stage 3: High grade Soft tissue sarcomas which has spread to nearby lymphnodes or lungs

Stage 4: Soft tissue sarcomas which has spread to distant organs like liver brain or other bones

The treatment of Soft tissue sarcomas consists of Surgery and radiotherapy. About 10% of patients also receive chemotherapy. Duration of the treatment is approximately 3 to 6 months.

About 3 decades ago, only surgery offered to the patient of Soft tissue sarcomas was amputation, i.e. removing the whole leg. In today’s era, a specialized type of “limb salvage surgery” is offered to the patient, i.e. the tumor is removed but the limb id saved. With this type of surgery, patient remains near normal and functional.

After surgery, patent receives Radiotherapy to sterilize the margins and kill any residual microscopic disease. In case, amputation is done, radiation is not required in majority.

In select histologies, chemotherapy is given according to the standard protocol.

It depends on the stage of presentation. After optimum treatment, following are the chances of cure from Soft tissue sarcomas

1	Stage 2	90%
2	Stage 2	65%
3	Stage 3	10 – 15%
4	Stage 4	< 2 %

Once the treatment is over, patient needs to follow up on regular bases irrespective of any problems for next 10 years. It is only then, that the patient is declared free of cancer!

1	For first 2 years	3 monthly
2	For next 3 years	6 monthly
3	For next 5 years	1 yearly