Soft tissue sarcoma

Question 1

Aetiology

Answer 1

HIV is linked with Kaposi’s sarcoma
most cases are sporadic
prev rt

Question 2

epidemiology

Answer 2

4-5 per 100k in europe
most common in 50-70 diagnosed > 65

Question 3

Area most affect in STS

Answer 3

limbs upper and lower
h&n
retroperitoneum
trunk
viscera

Question 4

pathology STS

Answer 4

large fleshy associated with haemorrhage necrosis.
increased vascularity
invades local nerves & blood vessels

Question 5

striated/voluntary muscle

Answer 5

Rhabdomyosarcoma

Question 6

fibrous tissue

Answer 6

Fibrosarcoma

Question 7

fatty tissue

Answer 7

liposarcoma

Question 8

smooth/involuntary tissue

Answer 8

leiomyosarcoma

Question 9

blood vessel walls

Answer 9

Angiosarcoma

Question 10

peripheral nerves

Answer 10

neurofibrosarcoma

Question 11

STS spread

Answer 11

early bread-borne spread to lungs, liver, bone marrow and brain
lymphatic spread common esp in rhabdomyosarcoma

Question 12

STS signs & symptoms

Answer 12

abdominal pain
limited movement in limbs
painless lump under skin
increases in size over time
cough/breathlessness if lung area

Question 13

STS investigations

Answer 13

full clinical exam & history
ultrasound
MRI
Biopsy (essential)

Question 14

Prognosis

Answer 14

survival aged 25-39 70% at 5yrs
limb tumour prognosis better than retroperineal
5yr survival for limb conservation & LGT: 90%

Question 15

surgery

Answer 15

standard for sts
wide local excision with - margins

Question 16

RT STS

Answer 16

RT is inferior to surgery
IMRT best technique
immobilisation sarcoma board, bds, hr

Question 17

pre-op RT

Answer 17

50Gy, 200cGy per #

Question 18

post-op RT

Answer 18

60-66Gy, 200cGy per #
larger irradiated vol
joint stiffness/ fibrosis
poor functional outcome