Soft tissue sarcomas tend to grow along tissue planes rarely traverse or violate major fascial planes or bone. They tend to spread via the bloodstream and can spread to the lungs.
- Can occur anywhere
- Gradually enlarging, painless mass
- Pain or symptoms associated with compression by the mass, including
- Paresthesias or edema in an extremity
- Rarely constitutional symptoms, such as fever and/or weight loss
What Does Soft Tissue Sarcoma Look Like?
Sarcomas don’t have a typical appearance and are usually masses that are felt.
Unlike melanoma, soft tissue tumors rarely spread to lymph nodes except in a few specific histologic subtypes.
- Synovial sarcoma
- Epithelioid sarcoma
- Clear cell sarcoma
- Vascular sarcomas (including angiosarcomas)
Diagnosis and Evaluation
Tissue diagnosis is one the most important steps in patients with soft tissue sarcomas. Specific treatments differ based on the histologic subtypes. All patients should be presented in a multidisciplinary tumor board to get input from radiation oncologist, medical oncologist, genetic specialist, pathologist, radiologist and surgical oncologist.
Initial evaluation should include questions about history of when the mass was first noticed, how quickly it has been growing and if there are symptoms to suggest the mass is growing or pushing on vitals structures. A thorough physical exam should be performed.
- Surgery – Removal of all cancer with intent of getting negative margins. Surgery remains the standard treatment of primary tumors. Important factors to consider are obtaining negative margins, re-operating if possible to get negative margins and not disrupting the tumor.
- Radiation – in certain cases, can be given before or after surgery. Radiation is typically used in larger, higher grade tumors.
- Targeted therapy – newer agents are being developed to target specific genes or proteins.
- Chemotherapy – can be used alone or in combination with surgery and radiation. Some subtypes have better responses to chemotherapy and should be evaluated at a center that routinely treats sarcoma.
- Immunotherapy – ongoing clinical trials are evaluating the role of immunotherapy in soft tissue sarcomas.