Sarcoma and Soft Tissue Tumor Surgery
What are Abdominal Soft Tissue Tumors?
Soft tissue tumors can occur anywhere in the body. They can grow in muscles, nerves, ligaments and blood vessels. There are many tumor that fall under this category, they vary in size, location and behavior. Some can be very aggressive and require major surgery. Common tumors which can be classified as benign soft tissue tumors are lipoma, angiolipoma, fibroma, benign fibrous histiocytoma, neurofibroma, schwannoma, hemangioma, giant cell tumor of tendon sheath, and myxoma. A small number of these tumors may be related to an underlying inherited condition. We specialize in the surgical removal of intra-abdominal soft tissue tumors.
What is a Sarcoma?
A sarcoma is a very rare kind of soft tissue cancers. It originates from different connective tissue cell types and can potentially grow anywhere in the body. There are more than 50 types of sarcoma, however they can be grouped into two main groups: soft tissue sarcomas and bone sarcomas. We specialize in surgery of soft tissue sarcomas growing in the abdomen. The most common types of sarcoma in adults are undifferentiated pleomorphic sarcoma (previously called malignant fibrous histiocytoma), liposarcoma, and leiomyosarcoma. We specialize in the surgical removal of intra-abdominal sarcoma.
Sarcoma Risk Factors
- Family history of sarcoma
- A bone disorder called Paget’s disease
- A genetic disorder such as neurofibromatosis, Gardner syndrome, retinoblastoma, or Li-Fraumeni syndrome
- Exposure to radiation, most commonly during treatment for an earlier cancer
Common Symptoms of Sarcomas
Sarcoma symptoms vary widely. Most sarcomas are asymptomatic early on and most commonly become symptomatic as they impinge on surrounding organs and obstruct nearby visceral structures. Sarcomas develop in flexible, elastic tissues, the tumor can often push normal tissue out of its way as it grows. Therefore, a sarcoma may grow quite large before it causes symptoms. Eventually, it may cause pain as the growing tumor begins to press against nerves and muscles, symptoms include:
- Pain: caused by the tumor affecting local tissues, nerves, or muscles, it is usually felt as pain in the general area.
- Mass or lump: asymptomatic when small but becomes symptomatic as it grows
- Local tumor mass effects: these can vary widely and can include, but not limited to bleeding into an organ, decreased appetite, early satiety, vomiting, abdominal distention,…
- Systemic effects: weight loss, fevers, fatigue
Treatment of sarcomas should be done by a team of specialists in various medical disciplines, including surgeons/surgical oncologists, medical oncologists, radiation oncologists, gastroenterologists, radiologists, nutritionists and support groups. Sarcoma cancer treatment is a multimodality treatment and includes surgery, chemotherapy and sometimes radiation therapy. Recent advances include immunotherapy if other treatments fail, in addition to palliative surgery/therapy.
Surgery is the mainstay treatment for sarcomas. The only cure for the disease is to find it and remove it as early as possible, with goo margins to prevent recurrence.
Surgery for sarcoma include a wide variety of procedures, basically depending on the location of the tumor itself. It is not uncommon to remove parts of surrounding organs when performing a sarcoma surgery. The aim is to remove the entirety of the tumor with clean margins all around it, even if that means resecting part of a surrounding structure.
Radiation therapy is an important part of the multimodality approach to sarcoma cancer, it might be given before or after surgery depending on the stage of the disease and the treatment team preference, and the involvement of surrounding structures.
Chemotherapy is also used as adjunct to surgery and radiation therapy in the treatment of sarcomas, however success rate depends on the specific type of sarcoma, as most do not respond well to systemic chemotherapy. Specific types of sarcomas, like gastrointestinal stromal tumors(GISTs), respond very well to targeted chemotherapeutic agents.
The extent of sarcoma surgery is dictated by the location of the disease. If cancer isn’t growing into the edges of the tissue removed, it is said to have negative or clear margins. The sarcoma has much less chance of coming back after surgery if it is removed with clear margins. When the tumor is in the abdomen, removing the tumor with enough normal tissue to get clear margins could be difficult because the tumor could be next to vital organs that can’t be taken out. When cancer cells are left after surgery, the patient may need more treatment − such as radiation or another surgery. Most of the time, surgery cannot cure a sarcoma once it has spread. But if it has only spread to a few spots in the lung, the metastatic tumor can sometimes be removed. This can cure many patients, or at least lead to long-term survival.
Palliative Sarcoma Surgery
When tumors cannot be technically removed by surgery and they are causing a mechanical obstruction for the outflow of food from the stomach, palliative surgery is used to allow these patients to eat again and bypass the area of obstruction. This type of surgery is only done for palliative reasons and is not curative by any mea