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==Overview==
==Overview==
A sarcoma (from the Greek 'sarx' meaning "flesh") is a [[cancer]] of the [[connective tissue|connective or supportive tissue]] ([[bone]], [[cartilage]], [[fat]], [[muscle]], [[blood vessel]]s) and [[soft tissue]].  This is in contrast to [[Carcinoma|carcinomas]], which are of [[Epithelium|epithelial]] origin ([[breast]], [[Colon (anatomy)|colon]], [[pancreas]], and others).   
A sarcoma (from the Greek 'sarx' meaning "[[flesh]]") is a [[cancer]] of the [[connective tissue|connective or supportive tissue]] ([[bone]], [[cartilage]], [[fat]], [[muscle]], [[blood vessel]]s) and [[soft tissue]].  This is in contrast to [[Carcinoma|carcinomas]], which are of [[Epithelium|epithelial]] origin ([[breast]], [[Colon (anatomy)|colon]], [[pancreas]], and others).   


==Classification==
==Classification==
Sarcomas are given a number of different names, based on the type of tissue from which they arise.  For example, [[osteosarcoma]] arises from [[bone]], [[chondrosarcoma]] arises from [[cartilage]], and [[leiomyosarcoma]] arises from [[smooth muscle]].  Sarcomas strike people in all age ranges, but they are very rare, accounting for only 1% of all cases of [[cancer]].<ref>Borden EC, Baker LH, Bell RS, Bramwell V, Demetri GD, Eisenberg BL, Fletcher CD, Fletcher JA, Ladanyi M, Meltzer P, O'Sullivan B, Parkinson DR, Pisters PW, Saxman S, Singer S, Sundaram M, van Oosterom AT, Verweij J, Waalen J, Weiss SW, Brennan MF. Soft tissue sarcomas of adults: state of the translational science.Clin Cancer Res. 2003 Jun;9(6):1941-56. Review. PMID 12796356</ref>  Soft tissue sarcomas, such as [[leiomyosarcoma]], [[chondrosarcoma]], and [[gastrointestinal stromal tumor]] (GIST), are more common in adults than in children.  GIST is the most common form of sarcoma, with approximately 3000-3500 cases per year in the United States.<ref>Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 2005;100:162-8. PMID 15654796 </ref> This should be compared with breast cancer, with approximately 200,000 cases per year in North America.<ref>Smigal C, Jemal A, Ward E, Cokkinides V, Smith R, Howe HL, Thun M. Trends in breast cancer by race and ethnicity: update 2006. CA Cancer J Clin 2006;56:168-83. PMID 16737949 </ref> Bone sarcomas, such as [[osteosarcoma]] and [[Ewing's sarcoma]], are more common in children than in adults.  These tumors most commonly strike adolescents and young adults between the ages of 12 and 25. In addition to being named based on the tissue of origin, sarcomas are also assigned a grade, such as low grade or high grade.  Low grade sarcomas are usually treated surgically, although sometimes [[radiation therapy]] or [[chemotherapy]] are used.  High grade sarcomas are more frequently treated with [[chemotherapy]].  Since these tumors are more likely to undergo [[metastasis]] (spreading to distant sites), these tumors are treated more aggressively.  Childhood sarcomas are almost always treated with a combination of [[surgery]] and [[chemotherapy]], and radiation is frequently used as well.  The recognition that childhood sarcomas are sensitive to chemotherapy has dramatically improved the survival of patients.  For example, in the era before chemotherapy, long term survival for patients with localized osteosarcoma was only approximately 20%, but now has risen to 60-70%.<ref>Longhi A, Errani C, De Paolis M, Mercuri M, Bacci G. Primary bone osteosarcoma in the pediatric age: state of the art.  Cancer Treat Rev. 2006;32:423-36. PMID 16860938 </ref>
* Sarcomas are given a number of different names, based on the type of [[Tissue (biology)|tissue]] from which they arise.  For example, [[osteosarcoma]] arises from [[bone]], [[chondrosarcoma]] arises from [[cartilage]], and [[leiomyosarcoma]] arises from [[smooth muscle]].   
* Sarcomas strike people in all age ranges, but they are very rare, accounting for only 1% of all cases of [[cancer]].<ref>Borden EC, Baker LH, Bell RS, Bramwell V, Demetri GD, Eisenberg BL, Fletcher CD, Fletcher JA, Ladanyi M, Meltzer P, O'Sullivan B, Parkinson DR, Pisters PW, Saxman S, Singer S, Sundaram M, van Oosterom AT, Verweij J, Waalen J, Weiss SW, Brennan MF. Soft tissue sarcomas of adults: state of the translational science.Clin Cancer Res. 2003 Jun;9(6):1941-56. Review. PMID 12796356</ref>   
* Soft tissue sarcomas, such as [[leiomyosarcoma]], [[chondrosarcoma]], and [[gastrointestinal stromal tumor|gastrointestinal stromal tumor (GIST)]], are more common in [[Adult|adults]] than in children.   
* [[Gastrointestinal stromal tumor|GIST]] is the most common form of sarcoma, with approximately 3000 - 3500 cases per year in the United States.<ref>Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 2005;100:162-8. PMID 15654796 </ref>
* [[Osteosarcoma|Bone sarcomas]], such as [[osteosarcoma]] and [[Ewing's sarcoma]], are more common in children than in [[Adult|adults]].  These tumors most commonly strike adolescents and young adults between the ages of 12 and 25.  
* In addition to being named based on the [[Tissue (biology)|tissue]] of origin, sarcomas are also assigned a grade, such as low grade or high grade.   
* Low grade sarcomas are usually treated [[Surgery|surgically]], although sometimes [[radiation therapy]] or [[chemotherapy]] are used.   
* High grade sarcomas are more frequently treated with [[chemotherapy]].  Since these [[Tumor|tumors]] are more likely to undergo [[metastasis]] (spreading to distant sites), these [[Tumor|tumors]] are treated more aggressively.   
* Childhood sarcomas are almost always treated with a combination of [[surgery]] and [[chemotherapy]], and [[radiation]] is frequently used as well.   
* The recognition that childhood sarcomas are sensitive to [[chemotherapy]] has dramatically improved the survival of [[Patient|patients]].  For example, in the era before [[chemotherapy]], long term survival for [[Patient|patients]] with localized [[osteosarcoma]] was only approximately 20%, but now, it has risen to 60 - 70%.<ref>Longhi A, Errani C, De Paolis M, Mercuri M, Bacci G. Primary bone osteosarcoma in the pediatric age: state of the art.  Cancer Treat Rev. 2006;32:423-36. PMID 16860938 </ref>
 
===Tables ===
===Tables ===


{| class="wikitable"
{| class="wikitable"
|+ Table 1: Major Types of Soft-Tissue Sarcomas in Adults
|+ Table 1: Major Types of Soft-Tissue Sarcomas in Adults
|- valign=top
|- valign="top"
! <u>Tissue of Origin</u>
! <u>Tissue of Origin</u>
! <u>Type of Cancer</u>
! <u>Type of Cancer</u>
! <u>Usual Location in the Body</u>
! <u>Usual Location in the Body</u>
|- valign=top
|- valign="top"
| '''Fibrous tissue'''
| '''Fibrous tissue'''
| [[Fibrosarcoma]]
| [[Fibrosarcoma]]
| Arms, legs, trunk
| [[Arm|Arms]], [[Leg|legs]], [[trunk]]
|- valign="TOP"
|- valign="TOP"
|
|
| [[Malignant fibrous histiocytoma|Malignant fibrous<br>hystiocytoma]] || Legs
| [[Malignant fibrous histiocytoma|Malignant fibrous<br>hystiocytoma]] || [[Leg|Legs]]
|- valign="TOP"
|- valign="TOP"
|
|
| [[Dermatofibrosarcoma]] || Trunk
| [[Dermatofibrosarcoma]] || [[Trunk]]
|- valign=top
|- valign="top"
| '''Fat'''
| '''Fat'''
| [[Liposarcoma]]
| [[Liposarcoma]]
| Arms, legs, trunk
| [[Arm|Arms]], [[Leg|legs]], [[trunk]]
|- valign=top
|- valign="top"
| '''Muscle'''<br><dd>Striated muscle<dd>Smooth muscle
| '''Muscle'''<br><dd>[[Striated muscle]]<dd>[[Smooth muscle]]
| <br>[[Rhabdomyosarcoma]]<br />[[Leiomyosarcoma]]
| <br>[[Rhabdomyosarcoma]]<br />[[Leiomyosarcoma]]
| valign=bottom | <br>Arms, legs<br />Uterus, digestive tract
| valign="bottom" | <br>[[Arm|Arms]], [[Leg|legs]]<br />[[uterus]], [[Gastrointestinal tract|digestive tract]]
|- valign=top
|- valign="top"
| '''Blood vessels'''
| '''Blood vessels'''
| [[Hemangiosarcoma]]
| [[Hemangiosarcoma]]
| Arms, legs, trunk
| [[Arm|Arms]], [[Leg|legs]], [[trunk]]
|- valign="TOP"
|- valign="TOP"
| || [[Kaposi's sarcoma]] || Legs, trunk
| || [[Kaposi's sarcoma]] || [[Leg|Legs]], [[trunk]]
|- valign=top
|- valign="top"
| '''Lymph vessels'''
| '''Lymph vessels'''
| [[Lymphangiosarcoma]]
| [[Lymphangiosarcoma]]
| Arms
| [[Arm|Arms]]
|- valign=top
|- valign="top"
| '''Synovial tissue'''<br>(linings of joint cavities, tendon sheaths)
| '''Synovial tissue'''<br>(linings of [[joint]] cavities, [[Tendon sheath|tendon sheaths]])
| [[Synovial sarcoma]]
| [[Synovial sarcoma]]
| Legs
| [[Leg|Legs]]
|- valign=top
|- valign="top"
| '''Peripheral nerves'''
| '''Peripheral nerves'''
| [[Malignant peripheral nerve sheath tumour]]/[[Neurofibrosarcoma]]
| [[Malignant]] [[Peripheral nervous system|peripheral nerve]] sheath [[tumor]]/[[Neurofibrosarcoma]]
| Arms, legs, trunk
| [[Arm|Arms]], [[Leg|legs]], [[trunk]]
|- valign=top
|- valign="top"
| '''Cartilage and bone-forming tissue'''
| '''Cartilage and bone-forming tissue'''
| [[Extraskeletal chondrosarcoma]]
| Extraskeletal [[chondrosarcoma]]
| Legs
| [[Leg|Legs]]
|- valign="TOP"
|- valign="TOP"
|
|
| [[Extraskeletal osteosarcoma]] || Legs, trunk (not involving the bone)
| [[Extraskeletal osteosarcoma]] || [[Leg|Legs]], [[trunk]] (not involving the [[bone]])
|}
|}
{| class="wikitable"
{| class="wikitable"
|+ Table 2: Major Types of Soft-Tissue Sarcomas in Children
|+ Table 2: Major Types of Soft-Tissue Sarcomas in Children
|- valign=top
|- valign="top"
! <u>Tissue of Origin</u>
! <u>Tissue of Origin</u>
! <u>Type of Cancer</u>
! <u>Type of Cancer</u>
! <u>Usual Location in the Body</u>
! <u>Usual Location in the Body</u>
! <u>Most common ages</u>
! <u>Most common ages</u>
|- valign=top
|- valign="top"
| '''Muscle'''
| '''Muscle'''
|
|
|  
|  
|
|
|- valign=top
|- valign="top"
| <dd>Striated<br><dd>muscle
| <dd>[[Striated muscle|Striated<br>]]<dd>[[Striated muscle|muscle]]
| Rhabdomyosarcoma
| [[Rhabdomyosarcoma]]
|
|
|
|
|- valign=top
|- valign="top"
|
|
| <dd>Embryonal
| <dd>[[Germ cell tumor|Embryonal]]
| Head and neck, genitourinary tract
| [[Head]] and [[neck]], [[genitourinary tract]]
| Infant–4
| Infant–4
|- valign=top
|- valign="top"
|
|
| <dd>[[Alveolar soft part sarcoma]]
| <dd>[[Alveolar soft part sarcoma]]
| Arms, legs, head, and neck
| [[Arm|Arms]], [[Leg|legs]], [[head]], and [[neck]]
| Infant–19
| Infant–19
|- valign=top
|- valign="top"
| <dd>Smooth<br><dd>muscle
| <dd>[[Smooth muscle|Smooth<br>]]<dd>[[Smooth muscle|muscle]]
| Leiomyosarcoma
| [[Leiomyosarcoma]]
| Trunk
| [[Trunk]]
| 15–19
| 15–19
|- valign=top
|- valign="top"
| '''Fibrous tissue'''
| '''Fibrous tissue'''
| Fibrosarcoma
| [[Fibrosarcoma]]
| Arms and legs
| [[Arm|Arms]] and [[Leg|legs]]
| 15–19
| 15–19
|- valign=top
|- valign="top"
|
|
|  Malignant fibrous<br>histiocytoma
|  [[Malignant fibrous histiocytoma|Malignant fibrous<br>histiocytoma]]
| Legs
| [[Leg|Legs]]
| 15–19
| 15–19
|- valign=top
|- valign="top"
|
|
|  Dermatofibrosarcoma
|  [[Dermatofibrosarcoma]]
| Trunk
| [[Trunk]]
| 15–19
| 15–19
|- valign=top
|- valign="top"
| '''Fat'''
| '''Fat'''
| Liposarcoma
| [[Liposarcoma]]
| Arms and Legs
| [[Arm|Arms]] and [[Leg|Legs]]
| 15–19
| 15–19
|- valign=top
|- valign="top"
| '''Blood vessels'''
| '''Blood vessels'''
| Infantile hemangio-<br><dd>pericytoma
| Infantile hemangio-<br><dd>pericytoma
| Arms, legs, trunk, head, and neck
| [[Arm|Arms]], [[Leg|legs]], [[trunk]], [[head]], and [[neck]]
| Infant–4
| Infant–4
|- valign=top
|- valign="top"
| '''Synovial tissue'''<br>(linings of joint cavities, tendon sheaths)
| '''Synovial tissue'''<br>(linings of [[joint]] cavities, [[Tendon sheath|tendon sheaths]])
| Synovial sarcoma
| [[Synovial sarcoma]]
| Legs, arms, and trunk
| [[Leg|Legs]], [[Arm|arms]], and [[trunk]]
| 15–19
| 15–19
|- valign=top
|- valign="top"
| '''Peripheral nerves'''
| '''Peripheral nerves'''
| Malignant peripheral nerve sheath tumors (also called neurofibrosarcomas, malignant schwannomas, and neurogenic sarcomas)
| [[Malignant peripheral nerve sheath tumor]] (also called [[Neurofibrosarcoma|neurofibrosarcomas]], [[malignant]] [[Schwannoma|schwannomas]], and [[neurogenic]] sarcomas)
| Arms, legs, and trunk
| [[Arm|Arms]], [[Leg|legs]], and [[trunk]]
| 15–19
| 15–19
|- valign=top
|- valign="top"
| '''Muscular nerves'''
| '''Muscular nerves'''
| [[Alveolar soft part sarcoma]]
| [[Alveolar soft part sarcoma]]
| Arms and legs
| [[Arm|Arms]] and [[Leg|legs]]
| Infant–19
| Infant–19
|- valign=top
|- valign="top"
| '''Cartilage and bone-forming tissue'''
| '''Cartilage and bone-forming tissue'''
| [[Extraskeletal myxoid chondrosarcoma]]
| Extraskeletal myxoid [[chondrosarcoma]]
| Legs
| [[Leg|Legs]]
| 10–14
| 10–14
|-
|-
|
|
| Extraskeletal mesenchymal
| Extraskeletal [[mesenchymal]]
| Legs
| [[Leg|Legs]]
| 10–14
| 10–14
|}
|}
Line 146: Line 156:
== Types of sarcoma ==
== Types of sarcoma ==
([[ICD-O]] codes are provided where available.)
([[ICD-O]] codes are provided where available.)
* Askin's Tumor (8803/3)
* Askin's [[tumor]] (8803/3)
* [[Chondrosarcoma]] (9220/3-9240/3)
* [[Chondrosarcoma]] (9220/3-9240/3)
* [[Ewing's]] (9260/3) - [[Primitive neuroectodermal tumor|PNET]] (9473/3)
* [[Ewing's]] (9260/3) - [[Primitive neuroectodermal tumor|PNET]] (9473/3)
Line 160: Line 170:
**[[Desmoplastic small round cell tumor]] (8806/3)
**[[Desmoplastic small round cell tumor]] (8806/3)
**[[Epithelioid Sarcoma]] (8804/3)
**[[Epithelioid Sarcoma]] (8804/3)
**Extraskeletal chondrosarcoma (9220/3)
**Extraskeletal [[chondrosarcoma]] (9220/3)
**Extraskeletal osteosarcoma (9180/3)
**Extraskeletal [[osteosarcoma]] (9180/3)
**[[Fibrosarcoma]] (8810/3)
**[[Fibrosarcoma]] (8810/3)
**[[Hemangiopericytoma]] (9150)
**[[Hemangiopericytoma]] (9150)
Line 169: Line 179:
**[[Liposarcoma]] (8850/3-8858/3)
**[[Liposarcoma]] (8850/3-8858/3)
**[[Lymphangiosarcoma]] (9170-9175)
**[[Lymphangiosarcoma]] (9170-9175)
**[[Lymphoma|Lymphosarcoma]]
**[[Lymphosarcoma]]
**[[Malignant fibrous histiocytoma]] (8830/3)
**[[Malignant fibrous histiocytoma]] (8830/3)
**[[Neurofibrosarcoma]] (9540/3)
**[[Neurofibrosarcoma]] (9540/3)
**[[Rhabdomyosarcoma]] (8900-8920)
**[[Rhabdomyosarcoma]] (8900-8920)
**[[Synovial sarcoma]] (9040/3-9043/3)
**[[Synovial sarcoma]] (9040/3-9043/3)
==Causes==
==Differential Diagnosis==
==Differential Diagnosis==
Soft tissue sarcoma needs to differentiate from soft tissue benige tumors such as:
[[Soft tissue]] sarcoma needs to differentiated from [[soft tissue]] [[Benign tumor|benign tumors]] such as:


*[[Adenoma]]
*[[Adenoma]]
Line 188: Line 196:


* [[Cyclophosphamide]]
* [[Cyclophosphamide]]
==Epidemiology==
==Epidemiology and Demographics==
===Incidence===
===Incidence===
* The estimated number of new cases of soft tissue sarcoma in the United States is approximately 12,000.<ref name=ACS>American Cancer Society: Cancer Facts and Figures 2014. Atlanta, Ga: American Cancer Society, 2014. [http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf Available online] . Last accessed May 21, 2014.</ref>
* The estimated number of new cases of [[soft tissue]] sarcoma in the United States is approximately 12,000.<ref name="ACS">American Cancer Society: Cancer Facts and Figures 2014. Atlanta, Ga: American Cancer Society, 2014. [http://www.cancer.org/acs/groups/content/@research/documents/webcontent/acspc-042151.pdf Available online] . Last accessed May 21, 2014.</ref>


* The estimated incidence of soft tissue sarcoma worldwide is 1.8 to 5 per 100,000 per year.<ref name="pmid19858086">{{cite journal| author=Wibmer C, Leithner A, Zielonke N, Sperl M, Windhager R| title=Increasing incidence rates of soft tissue sarcomas? A population-based epidemiologic study and literature review. | journal=Ann Oncol | year= 2010 | volume= 21 | issue= 5 | pages= 1106-11 | pmid=19858086 | doi=10.1093/annonc/mdp415 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19858086  }} </ref>
* The estimated [[incidence]] of [[soft tissue]] sarcoma worldwide is 1.8 to 5 per 100,000 per year.<ref name="pmid19858086">{{cite journal| author=Wibmer C, Leithner A, Zielonke N, Sperl M, Windhager R| title=Increasing incidence rates of soft tissue sarcomas? A population-based epidemiologic study and literature review. | journal=Ann Oncol | year= 2010 | volume= 21 | issue= 5 | pages= 1106-11 | pmid=19858086 | doi=10.1093/annonc/mdp415 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19858086  }} </ref>


===Age===
===Age===
Soft tissue sarcomas are more commonly found in older patients (>50 years old) although in children and adolescents under age 20, certain histologies are common (rhabdomyosarcoma).
[[Soft tissue]] sarcomas are more commonly found in older [[Patient|patients]] (>50 years old) although in children and [[Adolescence|adolescents]] under age 20, certain [[Histology|histological]] sub-types are more common ([[rhabdomyosarcoma]]).


===Percent Distribution of Soft Tissue Sarcoma by Histology===
===Percent Distribution of Soft Tissue Sarcoma by Histology===
* Fibrosarcoma: 6.9%
* [[Fibrosarcoma]]: 6.9%
* Infantile fibrosarcoma: 0.2%
* [[Infant|Infantile]] [[fibrosarcoma]]: 0.2%
* Fibrous histiocytoma, malignant: 9.2%
* [[Fibrous histiocytoma]], [[malignant]]: 9.2%
* Dermatofibrosarcoma: 3.6%
* [[Dermatofibrosarcoma]]: 3.6%
* Liposarcoma: 17.1%
* [[Liposarcoma]]: 17.1%
* Leiomyosarcoma: 13.2%
* [[Leiomyosarcoma]]: 13.2%
* Rhabdomyosarcoma: 3.1%
* [[Rhabdomyosarcoma]]: 3.1%
* Embryonal rhabdomyosarcoma: 1.3%
* [[Rhabdomyosarcoma|Embryonal rhabdomyosarcoma]]: 1.3%
* Hemangiosarcoma: 3.7%
* [[Hemangiosarcoma]]: 3.7%
* Hemangiopericytoma, malignant: 0.5%
* [[Hemangiopericytoma]], [[malignant]]: 0.5%
* Kaposi sarcoma: 0.8%
* [[Kaposi's sarcoma]]: 0.8%
* Malignant peripheral nerve sheath tumor: 1.6%
* [[Malignant peripheral nerve sheath tumor]]: 1.6%
* Malignant neurilemmoma: 0.2%
* [[Malignant]] [[neurilemmoma]]: 0.2%
* Neuroblastoma: 0.6%
* [[Neuroblastoma]]: 0.6%
* Synovial sarcoma: 4.8%
* [[Synovial sarcoma]]: 4.8%


==Risk Factor==
==Risk Factors==
*Radiation exposure: Clinical stidies suggest that patients with other kind of cancers such as lymphoma and breast cancer may develop sarcomas from radiation therapy. The sarcoma often happens in the area of the body that had been treated with radiation.
*[[Radiation therapy|Radiation]] exposure: [[Clinical trial|Clinical studies]] suggest that [[Patient|patients]] with other kind of [[cancers]] such as [[lymphoma]] and [[breast cancer]] may develop sarcomas from [[radiation therapy]]. The sarcoma often develops in the area of the [[body]] that had been treated with [[Radiation therapy|radiation]].


*Damaged lymph system: Clinical observations demonstrate lymphangiosarcoma is a very rare complication of chronic lymphedema that is the result of damaged lymph system.
*Damaged [[lymphatic system]]: Clinical observations demonstrate that [[lymphangiosarcoma]] is a very rare [[Complication (medicine)|complication]] of [[Chronic (medical)|chronic]] [[lymphedema]] that is the result of damaged [[lymphatic system]].


*Inherited conditions: Some inherited conditions may increase the risk of developing soft tissue sarcomas, such as [[neurofibromatosis]], [[Gardner syndrome]], [[Li-Fraumeni syndrome]], [[Retinoblastoma]],[[Werner syndrome]],
*[[Inherited]] conditions: Some [[inherited]] conditions may increase the risk of developing [[soft tissue]] sarcomas, such as [[neurofibromatosis]], [[Gardner syndrome]], [[Li-Fraumeni syndrome]], [[Retinoblastoma]],[[Werner syndrome]],
==Prognosis==
==Prognosis==
The prognosis of soft tissue sarcoma is poor and it depends on the following:
The [[prognosis]] of [[soft tissue]] sarcoma is poor and it depends on the following:


*Whether or not the tumor can be removed by surgery
*Whether or not the [[tumor]] can be removed by [[surgery]]


*The stage of the sarcoma:
*The [[Cancer staging|stage]] of the sarcoma:
** The size of the tumor.
** The size of the [[tumor]].
** Benign or malignant.
** [[Benign]] or [[malignant]] nature.
*The patient’s general health.
*The [[Patient|patient’s]] general [[health]].
*Whether the sarcoma has just been diagnosed or has recurred.
*Whether the sarcoma has just been [[Diagnosis|diagnosed]] or has recurred.
==Symptoms==
==Symptoms==
* Painless lump or swelling
* Painless lump or swelling

Revision as of 19:35, 19 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A sarcoma (from the Greek 'sarx' meaning "flesh") is a cancer of the connective or supportive tissue (bone, cartilage, fat, muscle, blood vessels) and soft tissue. This is in contrast to carcinomas, which are of epithelial origin (breast, colon, pancreas, and others).

Classification

Tables

Table 1: Major Types of Soft-Tissue Sarcomas in Adults
Tissue of Origin Type of Cancer Usual Location in the Body
Fibrous tissue Fibrosarcoma Arms, legs, trunk
Malignant fibrous
hystiocytoma		 Legs
Dermatofibrosarcoma Trunk
Fat Liposarcoma Arms, legs, trunk
Muscle
Striated muscle
Smooth muscle

Rhabdomyosarcoma
Leiomyosarcoma
Arms, legs
uterus, digestive tract
Blood vessels Hemangiosarcoma Arms, legs, trunk
Kaposi's sarcoma Legs, trunk
Lymph vessels Lymphangiosarcoma Arms
Synovial tissue
(linings of joint cavities, tendon sheaths) 		Synovial sarcoma Legs
Peripheral nerves Malignant peripheral nerve sheath tumor/Neurofibrosarcoma Arms, legs, trunk
Cartilage and bone-forming tissue Extraskeletal chondrosarcoma Legs
Extraskeletal osteosarcoma Legs, trunk (not involving the bone)
Table 2: Major Types of Soft-Tissue Sarcomas in Children
Tissue of Origin Type of Cancer Usual Location in the Body Most common ages
Muscle
Striated
muscle
Rhabdomyosarcoma
Embryonal
Head and neck, genitourinary tract Infant–4
Alveolar soft part sarcoma
Arms, legs, head, and neck Infant–19
Smooth
muscle
Leiomyosarcoma Trunk 15–19
Fibrous tissue Fibrosarcoma Arms and legs 15–19
Malignant fibrous
histiocytoma 		Legs 15–19
Dermatofibrosarcoma Trunk 15–19
Fat Liposarcoma Arms and Legs 15–19
Blood vessels Infantile hemangio-
pericytoma
Arms, legs, trunk, head, and neck Infant–4
Synovial tissue
(linings of joint cavities, tendon sheaths) 		Synovial sarcoma Legs, arms, and trunk 15–19
Peripheral nerves Malignant peripheral nerve sheath tumor (also called neurofibrosarcomas, malignant schwannomas, and neurogenic sarcomas) Arms, legs, and trunk 15–19
Muscular nerves Alveolar soft part sarcoma Arms and legs Infant–19
Cartilage and bone-forming tissue Extraskeletal myxoid chondrosarcoma Legs 10–14
Extraskeletal mesenchymal Legs 10–14

Types of sarcoma

(ICD-O codes are provided where available.)

Differential Diagnosis

Soft tissue sarcoma needs to differentiated from soft tissue benign tumors such as:

Drug Side Effect

Epidemiology and Demographics

Incidence

  • The estimated number of new cases of soft tissue sarcoma in the United States is approximately 12,000.[4]

Age

Soft tissue sarcomas are more commonly found in older patients (>50 years old) although in children and adolescents under age 20, certain histological sub-types are more common (rhabdomyosarcoma).

Percent Distribution of Soft Tissue Sarcoma by Histology

Risk Factors

Prognosis

The prognosis of soft tissue sarcoma is poor and it depends on the following:

Symptoms

  • Painless lump or swelling
  • Pain or soreness
  • Menstrual cramps
  • Indigestion
  • Constipation

Medical Therapy

Chemotherapy may be used with radiation therapy either before or after surgery to try to shrink the tumor or kill any remaining cancer cells. In general, chemotherapy effects for soft tissue sarcoma have had little impact as opposed to other cancers. If the cancer has spread to other areas of the body, chemotherapy may be used to shrink tumors and reduce the pain and discomfort they cause, but is unlikely to eradicate the disease. The use of chemotherapy to prevent the spread of soft tissue sarcomas has not been proven to be effective. Patients with soft tissue sarcomas usually receive chemotherapy intravenously (injected into a blood vessel).

Surgery

Surgery is the most common treatment for soft tissue sarcomas. If possible, the doctor will remove the cancer and a safe margin of the healthy tissue around it. Depending on the size and location of the sarcoma, it may occasionally be necessary to remove all or part of an arm or leg (amputation). However, the need for amputation rarely arises; no more than 10 % to 15 % of individuals with sarcoma undergo amputation. In most cases, limb-sparing surgery is an option to avoid amputating the arm or leg. It is important to obtain a margin free of tumor to decrease the likelihood of local recurrence and give the best chance for eradication of the tumor.

Radiation Therapy

Radiation therapy (treatment with x-rays or radioactive implants) may be used either before surgery to shrink tumors or after surgery to kill any cancer cells that may have been left behind. In some cases, it can be used to treat tumours that cannot be surgically removed. In multiple studies, radiation therapy has been found to improve the rate of local control, but has not had any influence on overall survival.

References

  1. ↑ Borden EC, Baker LH, Bell RS, Bramwell V, Demetri GD, Eisenberg BL, Fletcher CD, Fletcher JA, Ladanyi M, Meltzer P, O'Sullivan B, Parkinson DR, Pisters PW, Saxman S, Singer S, Sundaram M, van Oosterom AT, Verweij J, Waalen J, Weiss SW, Brennan MF. Soft tissue sarcomas of adults: state of the translational science.Clin Cancer Res. 2003 Jun;9(6):1941-56. Review. PMID 12796356
  2. ↑ Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 2005;100:162-8. PMID 15654796
  3. ↑ Longhi A, Errani C, De Paolis M, Mercuri M, Bacci G. Primary bone osteosarcoma in the pediatric age: state of the art. Cancer Treat Rev. 2006;32:423-36. PMID 16860938
  4. ↑ American Cancer Society: Cancer Facts and Figures 2014. Atlanta, Ga: American Cancer Society, 2014. Available online . Last accessed May 21, 2014.
  5. ↑ Wibmer C, Leithner A, Zielonke N, Sperl M, Windhager R (2010). "Increasing incidence rates of soft tissue sarcomas? A population-based epidemiologic study and literature review". Ann Oncol. 21 (5): 1106–11. doi:10.1093/annonc/mdp415. PMID 19858086.

External Links

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