08 November 2021, Monday
Treatment For a Benign Soft Tissue Tumor and Malignant Soft Tissue Tumor?
Treatment For a Benign Soft Tissue Tumor
This depends on the nature, location, size, etc. of the soft tissue tumor. A small superficial benign Soft Tissue Tumor which is not causing any symptoms and, which has been present for a long time and is not growing or evolving in any way, may be just observed; whereas a benign tumor causing symptoms, or is growing, may be considered for treatment.
Surgery is the treatment of choice for most Benign Soft Tissue Tumors. The plan for surgical treatment should take into account the exact diagnosis of the tumor, its anatomical location, its relationship to the surrounding structures, etc.
All care is taken to preserve important nerves and blood vessels, even if they are in close proximity to the tumor, so that maximum function is retained and the limb is not endangered in any way.
In general, with benign tumors, a small risk of recurrence of the disease is acceptable if that risk allows the preservation of useful function. This is because, in benign tumors, the risk of disease recurrence is only local (i.e., in the area of previous disease), which, if it happens, can be surgically removed again without posing a risk to the life or limb of the patient.
In most Benign Soft Tissue Tumors, there is no role of chemotherapy or radiotherapy. However, there are some rare situations where chemotherapy and/or radiotherapy may be used in the treatment of certain benign soft tissue tumors.
Treatment For a Malignant Soft Tissue Tumor
Surgery‚ in the form of ‘Wide Excision’ of the tumor is the primary treatment for most Soft Tissue Sarcomas. Generally (not always), in cases of STS‚ radiotherapy is a part of the treatment and is usually administered to the affected area after the surgical excision.
In some STS‚ chemotherapy also plays an important role in the treatment. Rarely‚ all three modalities may be employed in the treatment of some STS.
In any cancer treatment,‚ the first thing to be decided, is the ‘Goal’ of treatment; i.e. whether the goal is to achieve ‘Cure’ or ‘Palliation’. This depends on various factors like‚ the extent of the disease‚ the stage of the tumor‚ the general health of the patient‚ etc.
Asisevident to all, the goal of ‘Cure’ implies that the treatment is directed at complete eradication of the disease from the patient and ensuring the lowest possible risk of relapse of the cancer.
On the other hand, ‘Palliation’ implies partial treatment of the condition‚ the goal being‚ to control the disease (not cure)‚ so as to ease the symptoms and discomfort caused by it, or‚ to slow the progression of the disease‚ so as to avoid or delay the adverse complications due to it; thus offering the patient better survival and better quality of life.
Surgery is the primary treatment for most Soft Tissue Sarcomas. Surgery for a STS always includes a margin of normal tissues in the excision, along with the biopsy scar and biopsy tract; the whole thing is removed as one single piece of tissue (en bloc). This is called as Wide Excision of the tumor.
‘Wide Excision’ means surgical removal of the tumor tissue (with the scar and track of biopsy)‚ along with a good margin of surrounding healthy normal tissue, in one single piece. This is done with the intention of ensuring the complete removal of the cancer tissue.
Cancer begins with just one abnormal cell that eventually forms the tumor, which is made of billions of copies of this original parent cell. Therefore‚ hypothetically speaking‚ just leaving one cancer cell behind is enough for this tumor to grow back again.
Thus‚ in the surgery for a Soft Tissue Sarcoma, there is no justification for removing the tumor in pieces, as doing so defeats the very purpose of the surgery. (Even when the surgery is done with a palliative intention, the tumor is removed with a wide margin, unless such a surgery is likely to cause more morbidity‚ disability, and discomfort to that patient.). When important structures like blood vessels‚ nerves‚ bone‚ joint‚ skin‚ etc.
are in close proximity to the tumor‚ the operating surgeon has to take crucial decisions on whether to preserve them or sacrifice them, based on various details like‚ the nature of the tumor‚ its grade‚ size‚ location‚ etc.
These decisions are usually taken before surgery‚ based on the clinical findings‚ MRI images‚ pathology findings‚ etc.‚ and appropriate plans are made to repair or reconstruct the damaged/sacrificed vital structure/s. This may involve the role of other specialists, like plastic surgeons, vascular surgeons, etc.‚ in the surgery.
In some situations, where such repair or reconstruction options are not available/possible/feasible‚ amputation of the limb may be considered.
Generally (not always), in cases of STS‚ radiotherapy is a part of the treatment. Radiotherapy is a form of cancer treatment where a certain type of energy called as ‘Ionizing radiation’ is used to kill/damage cancer cells and shrink tumors.
‘Ionizing radiation’ is made of either powerful electromagnetic rays (X-rays/gamma rays)‚ or high energy sub-atomic particles like atomic nuclei‚ protons‚ neutrons‚ etc. Radiation therapy injures or destroys cells in the area being treated by damaging their genetic material (DNA)‚ either killing them or affecting their ability to grow and multiply.
Although radiation damages both cancer cells and normal cells‚ cancer cells are much more vulnerable to the damaging effects of radiation, while most normal cells can recover from its effects and function properly.
This is one of the reasons why radiation in most cases is given in divided doses over a number of days‚ which gives normal cells/tissues time to repair and recover. This is called as ‘fractionation’ of the radiation dose. The goal of radiation therapy is to damage or destroy as many cancer cells as possible‚ while limiting harm to surrounding healthy tissue.
In STS‚ radiation is usually given after the surgery to the region of surgical treatment with the intention of killing any stray cancer cell or cells‚ which may have been inadvertently left behind‚ thus providing additional security against the possibility of local recurrence of the disease.
This is called as adjuvant radiotherapy. Adjuvant radiotherapy may be given as ‘External Beam Radiotherapy’ or as ‘Brachytherapy’, or sometimes, both. In some cases radiotherapy may be given before surgery to shrink the size of the tumor, to make surgery safer and easier. This is called as NeoadjuvantRadiotherapy.
In some STS‚ chemotherapy has an important role. Whenever chemotherapy is a part of the treatment‚ it is usually started first. This is called as NeoadjuvantChemotherapy. This shrinks the tumor‚ which becomes smaller in size and bulk. It also reduces the vascularity of the mass, i.e. it reduces the amount of blood circulating through the mass at any given time.
This reduces the blood loss during surgery. All of this makes surgery simpler and safer. Wide Excision surgery is done after a few cycles of chemotherapy. Chemotherapy is again resumed‚ a few days after the surgery. This is now called as Adjuvant Chemotherapy.
Sometimes all three modalities of treatment (i.e. surgery‚ radiotherapy and chemotherapy) may be used to treat a particular sarcoma.
When the intention of care is ‘palliative’‚ although surgery certainly has an important role in such a treatment‚ often the treatment may be limited to just radiotherapy‚ or in some cases‚ radiotherapy with chemotherapy.
The decision regarding the treatment plan is taken by your treating doctor based on all the available information.
Dr. Chetan Anchan
MS - Orthopaedics, Diploma in Orthopaedics,
FCPS - Mid. & Gynae, MBBS
About Author - Dr. Chetan Anchan is an expert and well known orthopaedic surgeon and oncologist from Mumbai. He has a vast experience in treating all types of Malignant and Benign, Bone and Soft Tissue Tumors, and Skeletal Metastases.
To book an appointment, call: +91 – 93244 27302
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