Sarcoma Flashcards
Sarcoma: give 5 factors for prognosis
- Size (>5cm)
- Grade
- Location
- Able to resect
Sarcoma
4 subtypes with clear distinct biology that could alter treatment
chemo/radiosensitive
Ewings
Primitive neuroectodermal tumor
Rhabdomyosarcoma
gleevec/targeted therapy
GIST
Sarcoma
When to do amputation?
Does it improve survival?
invasion with destruction of a joint.
No survival benefit, only local control.
Sarcoma
Post op surveillance?
CTscan of chest for mets and of primary surgical site for local recurrence.
Sarcoma
effect of radiation on survival and local control?
no survival benefit
improves local control, debated adjuvant v neoadjuvant.
Sarcoma - adjuvant treatment?
first agent for stage IV
Not clear benefit over waiting until a recurrence is developed.
If unresectable mets then would use doxorubicin as first line agent.
Extremity Sarcoma
How do you biopsy?
Core needle biopsy - mark skin site where needle
is placed so it can be excised with the sarcoma.
Open biopsy - incisional if >2cm. Make biopsy
incision parallel to muscle group so can be re-excised
when resection done.
Retroperitoneal Sarcoma
How do you biopsy?
do not percutaneously biopsy
unless there is a high likelihood this is something else
other than sarcoma
Sarcoma: key physical exam points
assess for any circulatory or neurologic deficit in the extremities
Sarcoma
what is the goal margin?
2 cm, but often have to cheat to preserve limbs or vital structures and never has been validated.
retroperitoneal sarcoma
how do you get margins?
do not remove organs to attempt 2 cm margins.
If the sarcoma is adherent to a structure, carefully dissect it free;
If there is invasion by the sarcoma, resect en bloc.
retroperitoneal sarcoma
What do you do after removing specimen?
Place clips at the margin of the surgical bed in the event that radiation therapy is needed post-operatively.
What are other options besides external beam radiation?
brachytherapy
intraoperative radiation therapy
No oncologic benefit, but may have less radiation toxicity.
Sarcoma surgery
What structures can be sacrificed?
Extremity arteries - can reconstruct
Femoral nerve - tolerable defect
IVC - can reconstruct; create a distal AV fistula?
Sarcoma surgery
What structures should be preserved?
Sciatic nerve - DE functionalizes leg
Large central veins - causes edema
