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Chapter 36: Soft Tissue Sarcomas

All of the following are true about soft tissue sarcoma EXCEPT

A. Most common site is trunk and retroperitoneum.

B. There are more than 11,000 new diagnoses of soft ­tissue sarcoma annually in the United States.

C. Most soft tissue sarcoma-specific deaths are due to uncontrolled pulmonary metastases.

D. The overall 5-year survival rate for all stages of soft ­tissue sarcoma approximates 50 to 60%.

Answer: A

Incidence rates are declining for most cancer sites, but they are increasing among both men and women for melanoma of the skin, cancers of the liver and thyroid. Incidence rates are decreasing for all four major cancer sites except for breast cancer in women. (See Schwartz 10th ed., p. 1465.)

Which of the following is NOT associated with the development of sarcoma?

A. Radiation exposure

B. Herbicide exposure

C. Chronic lymphedema

D. History of trauma

Answer: D

External radiation therapy is a rare but well-established risk factor for soft tissue sarcoma that may be associated with radiation-induced mutations of the p53 gene. Exposure to herbicides, such as phenoxyacetic acids and to wood preservatives containing chlorophenols, has been linked to an increased risk of soft tissue sarcoma. In 1948, Stewart and Treves first described the association between chronic lymphedema after axillary dissection and subsequent lymphangiosarcoma. Although patients with sarcoma often report a history of trauma, no causal relationship has been established. More often, a minor injury calls attention to a pre-existing tumor. (See Schwartz 10th ed., p. 1466.)

Which is NOT part of the AJCC/Internationale Contre le Cancer (AJCC/UICC) sarcoma staging system?

A. Tumor size

B. Number of mitoses per high-powered microscopic field

C. Lymph node metastatic status

D. Retroperitoneal sarcoma nomograms

Answer: D

The seventh edition of the American Joint Committee on Cancer (AJCC) staging system for soft tissue sarcomas is based on histologic grade of aggressiveness, tumor size and depth, and the presence of nodal or distant metastases. Histologic grade is the most important prognostic factor for patients with soft tissue sarcoma. The features that define grade are cellularity, differentiation (good, moderate, or poor/anaplastic), pleomorphism, necrosis (absent, <50%, or ≥50%), and number of mitoses per high-power field (<10, 10–19, or ≥20). ...

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