Soft Tissue Sarcoma Flashcards
What kinds of tumors are soft tissue sarcomas
1) Fibrosarcoma
2) Peripheral Nerve Sheath Tumor
3) Malignant Mesenchymoma
4) Myxosarcoma
5) Liposarcoma
6) Spindle Cell Sarcoma
others: Leiomyosarcoma, synovial cell sarcoma, anaplastic sarcoma, rhabdomyosarcoma, lymphangiosarcoma, Undiff Sarcoma
What are the types of NON soft tissue sarcomas sarcomas
Histocytic Sarcoma, osteosarcoma, chondrosarcoma, hemangiosarcoma, etc.
What is the typical clinical presentation of a soft tissue sarcoma
Cutaneous of subcutaneous mass
1) usually non-painful
2) very variable in consistency
3) often normal haired skin overlying
4) variable in growth rate
5) can occur anywhere
T/F: soft tissue sarcomas can occur anywhere
True
T/F: tumors do not grow their own nerves but they can grow their own lymphatics and blood
True
what is the biologic behavior of soft tissue sarcomas
1) Locally invasive/ infiltrative
2) Reccurence is common after conservative excision
3) Relatively low metastatic rate
4) Visceral sarcomas typically more aggressive (exception is GI leiomyosarcomas)
Visceral sarcomas are typically more aggresive, with the exception being
GI leiomyosarcomas
T/F: soft tissue sarcomas has a low chance of recurrence after conservative excision
False- recurrrence is common after conservative excision
What can occur if soft tissue sarcomas growth rate is greater than that of the skin
erosions and the potential for infections to occur
Fine needle aspirates of soft tissue sarcomas are generally
poorly exfoliative or blood
consider larger gauge needle or syringe aspiration vs “bare needle” technique
excessive blood or a dry need should prompt further investigation
How do you diagnose soft tissue sarcomas
1) FNA
2) Biopsy- incisional (punch, tru-cut, or wedge) or excisional (for diagnostic purposes)
3) Thoracic rads- metastatic rate is low but not zero
4) FNA of regional lymph node- LN mets less common than with other histotypes but certainly seen
(popliteal, subscapular, axillary)
For soft tissue sarcomas are incisional or excisional biopsies for diagnostic purposes
Excisional
T/F: Soft tissue sarcoma metastatic rate is low
True- but it is not zero so maybe do thoracic radiographs
What margins of a soft tissue sarcoma should you get
3cm or width of mass margins on each side
at least one fascial plane beneath, include Bx tract
what is the treatment of soft tissue sarcomas **
Aggressive surgery is the mainstay of treatment
-Wide local excision
3cm margins laterally at least one fascial plane beanth, include Bx tract
Identify margins for histopathology with ink or suture
How hsould you identify margins for histopathology
Ink
Suture
How do most soft tissue sarcomas metastasis
hematogenously NOT lymphatically
why most spread is in the lungs
is CT or MRI better for imaging of soft tissue sarcoma
CT
MRI tends to exacerbate the extent of a soft tissue sarcoma
A tumor removal is clean if there is
no cancer cells at the margin
For soft tissue sarcomas, aggressive surgery is the mainstay of treatment but what radical procedures might you need to consider
-Mandibulectomy, maxillectomy
-Amputation
-Body wall resection
What are the ideal surgical margins for wide local excision of a soft tissue sarcoma? *****
3cm laterally and 1 uninvolved fascial plane below
Soft tissue sarcomas that are anaplastic and undifferentiated have a higher
metastatic rate
For a soft tissue sarcoma, what should you do if you have incomplete surgical margins
-Second surgery
-Radiation therapy
-chemotherapy?
but avoid multiple marginal excisions = best chance to cure is with the first surgery
What is the prognosis of radiation therapy with soft tissue sarcomas
much more effective in the context of microscopic disease
-aggressive, high dose protocol is necessary
-85% 3 year local control after incomplete excision (except oral cavity) *
-50% 1 year control rate if treating gross disease
radiation has a _________ 3 year local control after incomplete incision of soft tissue sarcoma (except oral cavity) ***
85%
What is the downside to radiotherapy
1) mild to severe acute local reaction
2) multiple general anesthesias
3) hospitalization itme
4) lots of money
the best chance to cure a soft tissue sarcoma is with the _________*
first surgery
What are the indications for chemotherapy for soft tissue sarcomas
1) Higher grade (Grade III), anaplastic, undifferentiated- higher metastatic rare (40-50%)
2) Certain histotypes (histocytic, liposarcoma)
3) young dogs?
4) aggressive local therapy declined or not possible
What is a major chemotherapeutic drug used for soft tissue sarcomas
Doxorubicin 30mg/m^2
What is a factor of injection site sarcoma (ISS)
chronic inflammation
genetic predisposition?
What is the time line after injection for injection site sarcoma (ISS)
variable
<3 months to >3 years
4weeks to 10 years
have variable metastatic rates (5-25%) depending on the study
T/F: injection site sarcoma (ISS) is histologically and biologically aggressive
True
Is injection site sarcoma (ISS) only a cat disease?
isolated reports in ferrets and dogs following injections
sarcomas have been reported secondary to foreign bodies and metallic implants in some dogs
Unknown why cats seem predisposed
How do you treat injection site sarcoma (ISS)
Aggressive/ radical surgery superior to conservative surgery
325 days vs 79 days
How do you locally. excise injection site sarcoma (ISS)
1) 5cm margins laterally
2) at least 2 fascial planes below
needs to be very wide
Do injection site sarcoma (ISS) on the limbs or body have better outcomes
Limbs (325d) body (66d)
cats with tumors on limbs treated with amputation virtually only cures
injection site sarcoma (ISS) that are recurrent may have
a higher metastatic rate
so get aggressive early, dont wait for recurrence
In addition to surgery, what can be done for injection site sarcoma (ISS)
1) Radiation on margins
2) Chemotherapy (Carboplatin, Doxorubicin, Doxil, Vincristine, Lomustine)
How can you prevent injection site sarcoma (ISS)
1) Limit vaccine frequency (titers?)
2) Vaccine location
-Rabies RH
-Leukemia LH
-FVRCP RF
3) Avoid multiple vaccines in same site
4) Alternative routes
5) Non-adjuvanted products?
Where is it recommend that you give vaccines
tail
distal limbs
Where should you give rabies vx to cat
RH
Where should you give leukemia vx to cat
LH
Where should you give FVRCP vx to cat
RF
for injection site sarcoma (ISS), what should you tell the owner for education *
3-2-1 rule
3) Lump persist for more than 3 months after vaccination
2) It becomes larger than 2 cm in diameter
1) It is increasing in size 1 month after vaccination
How is a diagnosis of injection site sarcoma made in affected cats?
fill in later
