Learn How Soft Tissue Sarcoma Progresses And Its Management Across Stages, From Expert

Soft tissue sarcoma is a rare type of cancer which develops in the soft tissues of the body. Soft tissues refer to the muscle, tendons (band of fibrous tissue that connects muscle to bone), fat, lymph, blood vessels and nerves. These tumours originate from the wall of blood vessel. They can be benign (non-cancerous) or malignant (cancerous). While there are no specific causes of the disease, certain factors such as radiation therapy, diseases or condition which weaken the immune system, genetic abnormalities and exposure to carcinogens or cancer-causing agents can increase risk.

Soft tissue sarcoma is diagnosed through a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to get a detailed view of the tumour. This is followed by a biopsy to confirm the diagnosis and determine the type of tumour. If the diagnosis of soft tissue sarcoma is established, the next step is to determine the cancer's stage, a measure of how much it has spread. This process is called staging. The stage of the cancer is determined basis the size, grade and location of the tumour and the extent to which it has spread in the body.

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Stages and grades of soft tissue sarcoma

According to the American Cancer Society, the staging of the cancer can be determined through the TNM system:

• The extent of the tumour (T): How large is the cancer?
• The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
• The spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs?
• The grade (G) of the cancer: How much do the sarcoma cells look like normal cells?

Basis this staging system, the sarcomas are divided into 3 grades which helps determine how rapidly the cancer will grow and spread. The grading system comprises three factors:

• Differentiation: This factor involves assessing how the cancer cells look, whereby grade 1 is assigned when they look more like normal cells and grade 3 when they appear cancerous
• Mitotic count: This involves the use of a microscope to see how many cancer cells are dividing
• Tumour necrosis: This is used to assess what portion of the tumour comprises dying tissue

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Soft tissue sarcoma: Treatment across stages

Stage I: The tumour in this stage is low-grade and can be of any size. It can form in the arms or legs. The treatment in this stage usually involves surgery comprising the removal of the tumour and some normal tissue surrounding it. In some cases, it is advisable to follow up the surgery with radiation therapy for reducing the chances of recurrence. Also, when the tumour is in the head, neck or abdomen, it may be more difficult to take it out. In such circumstances, a chemotherapy or radiation therapy can be administered ahead of the surgery to shrink the size of the tumour.

Stage II and III: Most of the tumours in this stage are high-grade and tend to grow and spread quickly. Some stage III tumours can also spread to the nearby lymph nodes. The rate of local recurrence in these stages is also high, whereby, the tumours reappear on the site from where it was removed. Surgery is the primary treatment option in these stages and can include lymph node removal in case the cancer has spread. Radiation therapy can be given post-surgery to reduce the chances of recurrence. Chemotherapy and radiation therapy can also be administered before surgery to shrink the tumour as during stage I. In certain cases, where the cancer has spread more, a limb amputation may be required to remove the tumour. Also, in cases where the patient's health, location and size of the tumour does not allow for a surgery, chemotherapy and radiotherapy can be used as treatment options.

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Stage IV: This happens when the tumours spreads to different parts of the body and is rarely curable. However, there are some patients in whom the primary tumour and all parts to which it has spread can be removed surgically. In others, chemotherapy or radiation therapy can be used to relieve symptoms. In certain soft tissue sarcomas, treatment can also be possible through targeted drug therapy.

Recurrent sarcoma: This happens when the tumour comes back post treatment. Recurrence can be local (in the place where the tumour originated) or distant (when the tumour spreads to other organs or tissues). While in the first case, a surgery followed by radiation therapy can be useful, in the second, chemotherapy or targeted drug therapy is recommended.

(Dr Rajeev Agarwal, Director, Division of Breast Services Medanta, The Medicity Hospital)

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