Soft Tissue Tumours

Overview

In a human being‚ any tissue which is not bone‚ tooth or nail is physically a soft tissue e.g. lungs‚ kidneys‚ brain‚ liver‚ skin‚ muscle‚ fat‚ etc. However the term ‘Soft Tissue ’ in ‘Tissue Tumor’ does not include all of these tissues.

Soft Tissue Tumors are those tumors that arise in the ‘Somatic Soft Tissues’. This is a large group of different tissues‚ the bulk of which is made up of skeletal muscle and fat tissue.

The other somatic soft tissues are fibrous connective tissue‚ blood vessels‚ lymph vessels‚ tendons‚ ligaments‚ etc. What is interesting to note is that‚ in a healthy adult individual of normal weight‚ more than 65% of the body weight is made of these somatic soft tissues!

Although the embryological origin of the peripheral nervous system is different from that of the somatic soft tissues‚ tumors arising from the peripheral nervous system are also considered as Soft Tissue Tumors.

Types

What are the types of Soft Tissue Tumors?

As with all tumors‚ Soft Tissue Tumors‚ based on their biologic behavior‚ can be benign (non-cancerous) or malignant (cancerous). Benign Soft Tissue Tumors are far more common than the malignant tumors.

As with all tumors‚ Soft Tissue Tumors.‚ based on their biologic behavior‚ can be benign (non-cancerous) or malignant (cancerous). Benign Soft Tissue Tumors. do not spread to other regions of the body. Malignant Soft Tissue Tumors. are cancerous tumors‚ which means they can spread to other regions of the body and can pose a serious threat to the life of the patient.

Elaborating further, the W.H.O. has recognized two more categories of Soft Tissue Tumors‚ which have biologic behavior somewhere in-between these two extremes of malignant and benign tumors. They are called intermediate tumors and are recognized as ‘Locally Aggressive’ (high risk of local recurrence following surgery) or ‘Rarely Metastasizing’ (low incidence of metastasis).

Soft Tissue Tumors. form a large group of tumors ranging from the very common lipoma (a benign tumor of fat tissue) to some of the rarest tumors known. Benign Soft Tissue Tumors are far more common than the malignant tumors.

Symptoms

What are the symptoms of a Soft Tissue Tumor?

The most common symptom of a Soft Tissue Tumor is an unexplained, visible or palpable (which can be felt) swelling. It may be hard or soft. It may be painful to touch or, more often, completely painless. In fact, in most cases, they begin as a painless swelling and continue to remain so even when they are growing.

It becomes painful when it starts to stretch the surrounding tissue or, compress or stretch a nerve. Usually, they are single. However, in some benign tumor conditions, more than one such swelling may be found in the same or/and different regions of the body. The size of the swelling may increase slowly or rapidly. A rapidly growing swelling is more likely to be a sarcoma.

Some tumors may present with pain Some tumors may present with pain in the affected area, or a previously painless swelling may become painful. Some tumors may be noticed following an injury. Usually this is because the injury draws attention to the tumor; injury itself is not known to cause the formation of a tumor.

Treatment

When is the treatment for Soft Tissue Tumor started?

Treatment for a Benign Soft Tissue Tumor can begin as soon as the diagnosis is established, but treatment for a Soft Tissue Sarcoma should not be started until staging is over.

If treatment for a malignant tumor is started without staging the disease, it may result in improper therapy as vital information regarding the extent of the disease in the patient will not have been considered in the planning of that treatment.

Treatment for a Benign Soft Tissue Tumor can begin as soon as the diagnosis is established, but treatment for a Soft Tissue Sarcoma (STS) should not be started until staging is over.

Armed with the information regarding the nature of the disease, its location and size, the extent of its presence in the patient, age of the patient, the general health of the patient, etc.‚ a treatment strategy is planned, to give the maximum benefit to the patient in terms of recovering from the disease and preservation of useful function.

If treatment for a malignant tumor is started without staging the disease, it may result in improper therapy as vital information regarding the extent of the disease in the patient will not have been considered in the planning of that treatment. It is important that staging is done before beginning the treatment because treatment can lower the stage of the disease.

For example, let us consider the situation of a patient with Soft Tissue Ewing’s sarcoma of the thigh, who also has lung metastasis, i.e. with ‘Stage IV’ disease. By doing the staging before starting the treatment, the most appropriate treatment strategy for this patient can be employed, which also includes the treatment of the metastasis.

But if the treatment is started before staging the disease, the initial treatment with neoadjuvant chemotherapy would shrink the primary tumor and the tumor metastases.

In many cases, it can cause the metastasis to disappear. If this patient is staged now, no metastasis will be found, and one would erroneously consider him to be at a lower stage (e.g. ‘Stage II’),‚ which would advocate the use of a different, less aggressive, treatment strategy than what was actually needed for this patient. Thus, staging the patient after starting the treatment could completely change the disease picture and might result in sub-optimal treatment.

It is, therefore, important to remember that the real value of staging is only when it is at diagnosis, and not after starting treatment.

Dr. Chetan Anchan is an expert and well-known orthopedic surgeon and oncologist from Mumbai. He has vast experience in treating all types of Malignant and Benign, Bone and Soft Tissue Tumors, and Skeletal Metastases.

Dr. Chetan holds an extensive expertise in managing and treating various bone malignancies.

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Frequently Asked Question On Soft Tissue Tumours