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Overview

Soft tissue sarcoma is a cancer that can start anywhere in the body, typically muscles, blood vessels, nerves, fat, joints and tissues. Soft tissue sarcomas comprise 2 per cent of all cancers. More than 30 different types of sarcomas have been identified and are usually named according to the type of tissue they start in, like liposarcomas for fat tumours, rhabdomyosarcomas for muscle tumours, angiosarcomas for blood vessel tumours, etc.

Warning signs

  • New lump or increase in size of a pre-existing lump
  • Difficulty in normal movements
  • Pain in lump
  • Fatigue
  • Unintended weight loss

Risk factors

Most of the patients who develop soft tissue sarcomas so not have any risk factor. However, certain factors are associated with an increased risk, including:

  • Inherited genetic syndromes like neurofibromatosis, Li-Fraumeni syndrome and Gardner syndrome
  • Exposure to large doses of radiation, such as those given during radiation therapy for other cancers
  • Exposure to certain chemicals like vinyl chloride, herbicides and dioxin.

Progression

  • Stage I – The tumour is of low grade and has not spread to any lymph nodes or to other parts of the body.
  • Stage II – The tumour is intermediate to high grade but has not spread
  • Stage III – The tumour has spread to the draining lymph nodes but not to other organs
  • Stage IV – The tumour has spread to other organs like lungs, liver, bone etc.

Diagnosis

Primary diagnosis

Imaging tests including radiographs, MRI and/or CT scan

Secondary diagnosis

Biopsy (a procedure to remove a sample of tissue from the tumour for laboratory testing).

Advanced diagnosis

PET scan, CT scan of chest and ultrasonography of draining glands, etc

It is recommended that your biopsy be done at the cancer centre where you will receive treatment. Evaluation at a cancer centre that treats a large number of sarcoma patients and has a specialised sarcoma management team improves chances of correct diagnosis and treatment and reduces the risks of relapse. A wrong biopsy may cause cancer to spread.

Treatment in a nutshell

Surgery

It is the main treatment for soft tissue sarcoma. Limb-sparing surgeries are the most common surgeries performed for the management of these tumours.

Radiation therapy

Almost all patients undergoing limb-sparing surgeries for high-grade soft tissue sarcoma will require radiation therapy. Chemotherapy : It plays a very limited role in the management of these tumours.

Milestones

We at Kokilaben Hospital are using Brachytherapy as a preferred radiation modality for the management of these tumours. Brachytherapy involves placing the radiation catheters during surgery and giving radiation through these catheters, helps in reducing the treatment time of radiation from 30 days to 6 days, lesser radiation to surrounding structures and a better function.

Reported Outcomes

Five year survival rate is as follows:

Stage I 80-90 per cent
Stage II/III 60-65 per cent
Stage IV < 40 per cent

Top tips

The only way to prevent some soft tissue sarcomas is to keep a check on all the risk factors. Most sarcomas, however, develop in people with no known risk factors, so there is no way known at this time to prevent most cases. For people receiving radiation therapy, there is usually little choice. However, if you have risk factors, it's a good idea to discuss them with your healthcare provider and get a proper evaluation.

Remarkable Case

Total Femur Replacement for Osteosarcoma of Femur

Background and diagnosis

In September 2015, a middle-aged man, aged 44, complained of severe pain and swelling in his right thigh. He was diagnosed with a femur fracture, following which he underwent an operation in the UAE and returned to India. The pain returned in a few days; hence, he approached another hospital in India. There, he was evaluated and diagnosed with a benign bone tumour. As a benign tumour doesn't spread, he believed there wasn't much cause for concern. Regular follow-ups and medication should have relieved him from pain. However, the problem persisted despite undergoing the suggested treatment. He then approached Kokilaben Hospital in December 2015, where he was further evaluated and diagnosed with a high-grade sarcoma of the bone.

Treatment

Staging procedure was carried out and neo adjuvant chemotherapy was given to the patient. He underwent total femur excision in view of his previous surgery and local disease contamination. Reconstruction was done with a total femur prosthesis replacing both his hip and knee joints.

Outcome

On the very next day of the surgery, the patient could walk, carrying his complete body weight. He is currently receiving adjuvant chemotherapy.

Our Team

  • Dr. Manish Pruthi

    MS Ortho (PGIMER, Chandigarh); DNB Ortho, Fellowships: Musculoskeletal Oncology (TMH, Mumbai), Diploma Tissue Banking (NUS, Singapore)

    Department

    Bone & Joint , Cancer

    Speciality Interests

    • Musculoskeletal Oncology
    • Bone tumours

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