Soft tissue sarcomas are malignant (cancerous) tumors that start in the soft tissues.These tumors can grow in soft tissues in any part of the bodybut generally appears on the abdomen, arms, and legs.
Soft tissue is the tissue that supports and connects structures around the body. Soft tissue includes fat, muscle, blood vessels, nerves, tendons, bones, and joints.
Soft tissue sarcoma can affect any age, but is more common in middle-aged and elderly people. A person's risk of developing soft tissue sarcoma also increases with age.
Types of Soft Tissue Sarcomas
Based on the location of the appearance of cancer cells, soft tissue sarcomas are divided into the following types:
- Angiosarcoma, which can form in the lymph vessels or in the blood vessels
- Osteosarcoma, formed in bone tissue
- chondrosarcoma, formed in cartilage
- Gastrointestinal stromal tumor, which is formed in the digestive tract
- Leiomyosarcoma, which is formed in smooth muscle tissue
- Liposarcoma, which is formed in fat tissue
- Neurofibrosarcoma, which forms in the peripheral nerve sheaths
- Rhabdomyosarcoma, which is formed in skeletal muscle tissue
Causes of Soft Tissue Sarcoma
Cancer occurs when the DNA in cells undergoes mutations or changes, so that cells grow abnormally and uncontrollably. These abnormal cells then form tumors that can spread and invade other parts of the body.
It is not known what causes these cells to mutate. However, there are several factors that can increase a person's risk of developing soft tissue sarcoma, namely:
- Having genetic disorders inherited from parents, such as neurofibromatosis, hereditary retinoblastoma, Li-Fraumeni syndrome, Gardner syndrome, tuberous sclerosis, or familial adenomatous polyposis
- Exposure to radiation for a long time, for example from cancer treatment with radiotherapy or working in a high-radiation environment
- Prolonged exposure to chemicals, such as arsenic, dioxins, and herbicides
- old age
Symptoms of Soft Tissue Sarcoma
In its early stages, soft tissue sarcomas generally do not cause any signs or symptoms. However, when the tumor gets bigger, symptoms can appear with different characteristics, depending on where the tumor grows.
The following are examples of symptoms that can occur:
- Abdominal pain and constipation, if the tumor grows in the soft tissues of the intestine
- Cough and shortness of breath, if the tumor grows in the soft tissue around the lungs
- Solid, firm lumps (difficult to move) that are painless but can be clearly seen to enlarge over time, if the tumor grows in soft tissue near the surface of the skin
When to go to the doctor
Although not all lumps are cancer, you still need to consult a doctor if you notice a lump in any part of the body. Immediately do an examination to the doctor if a lump appears that is getting bigger, is located a little deep, causes pain, or reappears after being removed.
Soft Tissue Sarcoma Diagnosis
The doctor will ask about the symptoms experienced by the patient, followed by a physical examination of the lump. After that, the doctor will perform additional examinations to confirm the diagnosis, such as:
- Scanning with X-rays, CT scans, MRI, or PET Scans on body parts suspected of having a tumor
- Biopsy or sampling of tumor tissue using a needle (core needle biopsy) or through open surgery, to determine whether the tumor is malignant and to determine the type of tumor
From the results of the above examination, the doctor can determine the severity (stage) or spread of soft tissue sarcomas. This will help the doctor in choosing the right treatment method.
The severity or stage of soft tissue sarcoma can be divided into:
- Stage 1A
At this stage, the tumor is 5 cm in size, with a slow growth rate and has not spread to lymph nodes or other organs.
- Stage 1B
Stage 1B indicates that the tumor can be > 15 cm in size, but the tumor growth is slow and has not spread to lymph nodes or other organs.
- Stage 2
In stage 2, the tumor is 5 cm in size, appears to be able to grow and spread very quickly, but has not spread to lymph nodes or other organs.
- Stage 3A
In stage 3A, the tumor is 6–10 cm in size, appears to be growing rapidly, but has not spread to lymph nodes or other organs.
- Stage 3B
Stage 3B indicates that the tumor is > 5 cm in size, appears to be able to grow and spread very quickly, but has not spread to lymph nodes or other organs.
- Stage 4
At this stage, the tumor can be of any size and has spread to nearby lymph tissue or has spread to distant organs, such as the lungs.
Soft Tissue Sarcoma Treatment
Treatment for soft tissue sarcomas depends on the type, location, and size of the tumor. Some of the treatment methods that can be done are:
Surgical procedure
Soft tissue sarcomas can be treated with surgical removal of the tumor. The tissue around the tumor will also be partially removed to make sure no cancer tissue is left behind.
However, in some cases soft tissue sarcomas can be very large and located on the feet or hands. Surgical procedures to remove these tumors can require amputation or cause disability. In cases like this, the doctor may choose another treatment method first.
Chemotherapy
Chemotherapy is the administration of drugs to kill cancer cells, especially in cases of soft tissue sarcoma that has spread. Some types of soft tissue sarcomas also respond better to chemotherapy, for example rhabdomyosarcoma.
Chemotherapy drugs can be given in pill form or through an IV. Types of chemotherapy drugs used include:
- Docetaxel
- ifosfamide
- Gemcitabine
Chemotherapy may also be given before surgery to reduce the size of the cancer to make it easier to remove, or after surgery, to make sure all the cancer cells are gone. However, if the sarcoma cannot be removed surgically, the doctor will combine chemotherapy with radiotherapy to treat it.
Radiotherapy
Radiotherapy is a therapy to destroy cancer cells using high-energy rays, such as X-rays or gamma rays. Radiotherapy can be done in three options, namely:
- Before surgery, to shrink the tumor for easy removal
- During surgery (intraoperative radiation), to minimize radiation-induced damage to healthy tissue around the cancer
- After surgery, to kill any remaining cancer cells
Radiotherapy may also be used to prevent sarcoma from progressing when surgery cannot be performed.
Target therapy
Targeted therapy specifically attacks certain genes or proteins that play a role in the development of cancer cells. This therapy aims to prevent cancer cells from growing while reducing damage to healthy cells.
Some types of drugs used in targeted therapy are:
- Imatinib
- Pexdartinib
- Tazemetostat
Complications of Soft Tissue Sarcoma
Complications that arise from soft tissue sarcomas depend on the size and location of the cancer. Given that soft tissue sarcomas can occur in any part of the body, large tumors can cause various disorders, for example:
- The tumor presses on the nerves and causes severe pain
- Tumor presses on blood vessels and blocks blood flow to healthy tissues or organs
- The tumor presses on the intestines and causes obstruction of the intestines
Tumors can also spread and damage surrounding or even distant tissues. In addition, soft tissue sarcomas from any part of the body can form new tumors in vital organs, such as the brain, bones, lungs, and liver, and cause organ damage that can be life threatening.
The patient's chance to recover will be more difficult if the sarcoma has spread. However, treatment can be given to relieve symptoms and slow the spread of the cancer.
Prevention of Soft Tissue Sarcoma
Although soft tissue sarcoma cannot be completely prevented, you can lower your risk of developing the disease by doing the following:
- Avoid radiation exposure
- Avoid exposure to chemicals
- Check with the doctor if you suffer from genetic disorders
It is important to remember that sarcomas detected at an early stage have a greater chance of healing. Conversely, the larger the size of the sarcoma and the higher the stage, the greater the chance that the sarcoma will spread to other organs or recur after treatment.