• Soft-tissue sarcomas present as asymptomatic large masses in the extremities or retroperitoneum but may also develop occasionally in the neck or within the abdominal viscera
• Originate from a wide variety of mesenchymal cell types and include:
• Tumor grade rather than the cell of origin determines natural history
• Most soft-tissue sarcomas arise de novo; rarely result from malignant degeneration of a benign lesion
• Sarcomas generally metastasize via a hematogenous route, most commonly to the lung
• Most important prognostic factors include tumor size and grade
• Account for 1% of all new cancer diagnoses
• 50% of soft-tissue sarcomas arise in the lower extremities, most commonly in the thigh
• There are familial syndromes that genetically predispose patients to the formation of soft-tissue sarcomas:
• Risk factors include:
• Asymptomatic large soft-tissue mass
• Nerve compression/invasion may result in pain, parasthesias, or neuropathy
• Venous compression/invasion may result in deep venous thrombosis (DVT) formation
• Thorough history and physical exam
• Core needle or incisional biopsy to establish diagnosis
• CT or MRI (preferred) to define extent of tumor and invasion of surrounding structures
• Chest x-ray or CT to evaluate for evidence of pulmonary metastases
• A multidisciplinary approach is essential to ensure optimal outcomes, including an oncology surgeon, medical oncology, and radiation-oncology
• Establish diagnosis histologically with a core needle biopsy or incisional biopsy
• Radiographically define extent of tumor and invasion of surrounding structures
• Evaluate for pulmonary metastases
• Surgical wide local excision with a 2 cm margin
• Postoperative radiation therapy for all high-grade sarcomas and those > 2 cm
• Sometimes adjuvant chemotherapy
• Preoperative radiation therapy for patients with tumors larger than 10 cm or to facilitate limb-sparing procedures
• Initial incisional biopsy to establish diagnosis (always orientate extremity incision longitudinally)
• Therapeutic wide local excision, ideally with 2 cm margin vs amputation in patients whose tumors cannot be resected ...
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