http://www.cancerstreatment.com/2008/03/24/sarcoma/ Mon, 06 Sep 2010 11:17:35 -0400 http://wordpress.org/?v=2.8 hourly 1 http://www.cancerstreatment.com/2008/03/24/sarcoma/comment-page-1/#comment-1374 Cancer. Cancer treatment. » Soft tissue sarcomas Mon, 24 Mar 2008 14:23:19 +0000 http://www.cancerstreatment.com/2008/03/24/sarcoma/#comment-1374 [...] Now what do we do in terms of a work-up? Well, first of all we want to find the local extent of the tumor and probably the best test for extremity, trunk and head and neck is an MRI. But in addition to that, if it’s in the retroperitoneal area or an intraabdominal sarcoma, we want to get a CT because we want to look at the abdominal contents and also evaluate the liver where the tumor can metastasize to. Then in addition, for all these sites, they have the potential to metastasize to the lung. So we want to get a chest CT as well. Now there are several major prognostic factors. Histologic rate is extremely important. Low grade tumors tend to stay locally, tend not to metastasize, tend to have a much better prognosis. We need to know the extent and location of surgical margins and those should be delineated by the surgeon. We want, if possible, to get margins of at least 1-2 cm. That is not always possible, depending where the tumor is. It’s much harder if it’s in the retroperitoneal area, much easier in the extremity area. Size becomes important. Those tumors greater than 5 cm and even greater than 10 cm are much more likely to recur and have a worse prognosis. The primary site becomes important. Distal tumors usually do better than proximal tumors, they are picked up earlier, usually easier to resect. Those tumors that are subcutaneous usually do better than deep. Those tumors that are intra-compartmental usually do better than extra-compartmental. Those tumors that are in the extremities usually do better than the trunk, and head and neck usually do better than the retroperitoneum. Retroperitoneum tumors are usually picked up late because they are usually very big, the patient doesn’t have any symptoms, then once they are picked up they are usually very near vital structures and it’s very hard to do an adequate full resection to remove all the tumor. In fact, for most patients who are at major centers getting surgery for retroperitoneal tumor, approximately 75% of the time a vital organ or part of a vital organ has to be removed in addition to the sarcoma. [...] [...] Now what do we do in terms of a work-up? Well, first of all we want to find the local extent of the tumor and probably the best test for extremity, trunk and head and neck is an MRI. But in addition to that, if it’s in the retroperitoneal area or an intraabdominal sarcoma, we want to get a CT because we want to look at the abdominal contents and also evaluate the liver where the tumor can metastasize to. Then in addition, for all these sites, they have the potential to metastasize to the lung. So we want to get a chest CT as well. Now there are several major prognostic factors. Histologic rate is extremely important. Low grade tumors tend to stay locally, tend not to metastasize, tend to have a much better prognosis. We need to know the extent and location of surgical margins and those should be delineated by the surgeon. We want, if possible, to get margins of at least 1-2 cm. That is not always possible, depending where the tumor is. It’s much harder if it’s in the retroperitoneal area, much easier in the extremity area. Size becomes important. Those tumors greater than 5 cm and even greater than 10 cm are much more likely to recur and have a worse prognosis. The primary site becomes important. Distal tumors usually do better than proximal tumors, they are picked up earlier, usually easier to resect. Those tumors that are subcutaneous usually do better than deep. Those tumors that are intra-compartmental usually do better than extra-compartmental. Those tumors that are in the extremities usually do better than the trunk, and head and neck usually do better than the retroperitoneum. Retroperitoneum tumors are usually picked up late because they are usually very big, the patient doesn’t have any symptoms, then once they are picked up they are usually very near vital structures and it’s very hard to do an adequate full resection to remove all the tumor. In fact, for most patients who are at major centers getting surgery for retroperitoneal tumor, approximately 75% of the time a vital organ or part of a vital organ has to be removed in addition to the sarcoma. [...]

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