Sarcoma Surgery
Soft Tissue Sarcoms are a rare and diverse group of malignant tumors that arise from mesenchymal (connective tissue) tissues, including bone, cartilage, fat, muscle, blood vessels, and connective tissue. They are broadly classified into two main categories: soft tissue sarcomas and bone sarcomas.
Soft Tissue Sarcomas (STS) usually originate from the soft tissues of the body such as fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. Over 50 histologic subtypes of STS have been identified. Common types include:
- Liposarcoma (arising from fat)
- Leiomyosarcoma (from smooth muscle)
- Rhabdomyosarcoma (from skeletal muscle)
- Synovial sarcoma (around joints)
- Angiosarcoma (from blood vessels)
- Undifferentiated pleomorphic sarcoma (formerly malignant fibrous histiocytoma)
Unlike more common cancers, STS can develop almost anywhere in the body, though they most frequently occur in the arms, legs, and abdomen. Certain variants are very aggressive and spread rapidly through the body.
Causes and Risk Factors
The exact cause of STS is often unknown. However, some risk factors include:
- Previous radiation therapy
- Exposure to certain chemicals (e.g., herbicides, dioxins)
- Genetic syndromes such as Li-Fraumeni syndrome or neurofibromatosis
- Chronic lymphedema
Symptoms of Soft Tissue Sarcoma
Soft tissue sarcomas often begin as painless lumps or swellings. These may go unnoticed at first, but as the tumor grows, it can start to affect nearby tissues and organs. Common symptoms include:
- A firm or growing lump under the skin
- Pain or tenderness, especially if the tumor presses on nerves or muscles
- Swelling or inflammation in the affected area
- Functional issues, depending on the location of the tumor
- Difficulty swallowing (if in the throat or esophagus)
- Abdominal pain or bowel obstruction (if in the abdomen)
- Restricted movement (if near joints)
Early signs are often subtle, so it’s important to get any unusual or persistent lumps checked by a your doctor. Never ignore any lump or a bump in your body.
How Soft Tissue Sarcoma is Diagnosed
An accurate diagnosis is essential to guide treatment. The process usually involves:
- Imaging Tests
- MRI (Magnetic Resonance Imaging) is the preferred method for evaluating soft tissue tumors.
- CT scans are often used to assess deeper tumors, especially in the abdomen or chest.
- Biopsy
- A core needle biopsy or incisional biopsy is performed to collect a tissue sample.
- The sample is examined under a microscope for cellular features and may undergo molecular testing to identify specific genetic changes.
- Staging Investigations
- Imaging such as chest CT or PET scans helps determine if the cancer has spread (metastasized), most commonly to the lungs.
Surgical Treatment of Soft Tissue Sarcoma
Surgery is the cornerstone of treatment for most soft tissue sarcomas (STS), offering the best chance for long-term cure or disease control. The primary goal is to remove the tumor completely while preserving as much normal function as possible. Surgical planning is often done within a multidisciplinary team that includes surgical oncologists, medical oncologists, radiation oncologists, radiologists, and pathologists.
Aims of Surgery
- Complete removal of the tumor with negative (clear) margins
- Preservation of limb or organ function wherever possible
- Minimization of recurrence through careful surgical technique and, when appropriate, adjunct therapies
Multimodal Approach
Surgery is often part of a broader treatment plan that may include:
Neoadjuvant Therapy: Radiation or chemotherapy before surgery to shrink the tumor
Adjuvant Therapy: Radiation or chemotherapy after surgery to reduce recurrence risk
Outcomes and Prognosis
Follow-Up is essential as sarcomas have a high recurrence rate. Regular surveillance to detect local recurrence or distant metastasis, particularly in the lungs is necessary.
Surgical outcomes depend on several factors, including tumor size, grade, depth, location, and margin status. When surgery achieves clear margins and is combined with appropriate adjunct therapy, local control rates are high.
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Types of Surgical Procedures
Wide Local Excision
This is the most common surgical approach. It involves removing the tumor along with a rim of healthy surrounding tissue to ensure no cancer cells are left behind. Margins are assessed postoperatively by pathology.
Limb-Sparing Surgery
In extremity sarcomas, the vast majority of patients can undergo limb-sparing surgery rather than amputation. This is often combined with pre- or post-operative radiotherapy to maintain function and reduce recurrence.
Amputation
Now rarely needed, amputation may be considered only if the tumor involves major blood vessels, nerves, or bones, and if limb-sparing surgery cannot achieve clear margins without severely impairing function.
Compartmental Resection or En Bloc Resection
For tumors involving specific anatomical compartments or deep-seated areas (e.g., retroperitoneum), surgeons may remove the tumor along with adjacent organs or structures if required for oncologic control.
Reconstruction and Rehabilitation
Depending on the location and extent of resection, reconstructive procedures may be required:
- Plastic surgery techniques for skin, muscle, or nerve reconstruction
- Prosthetics or orthotics in cases of major structural loss
- Physical therapy for rehabilitation and functional recovery
After& Before
