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Soft Tissue Tumours

Overview

What are Soft Tissue Tumors?

Soft Tissue Tumors are those tumors that arise in the Somatic Soft Tissues, which includes skeletal muscle, fat tissue, fibrous connective tissue, blood vessels, lymph vessels, tendons, ligaments, etc. Tumors arising from the peripheral nervous system are also considered as Soft Tissue Tumors.

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

Orthopaedic Oncologist

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.

About Doctor >

Faq’s – Patient Guide

Frequently Asked Question On Soft Tissue Tumours

Is Soft Tissue Sarcoma dangerous?

This may seem a silly question indeed as most people are aware that ‘cancer means danger’. As with any cancer, Soft Tissue Sarcoma is also dangerous and can be life threatening if not detected in time and treated appropriately.

What is more important to know is, it is treatable and that, earlier the detection and treatment, better is the outcome. This is just to reinforce that information.

Can a patient with Soft Tissue Tumor be cured of the disease?

Most benign Soft Tissue Tumors can be cured with surgery.

Malignant Soft Tissue Tumors (STS) on the other hand, are less predictable. However, generally, if a STS is detected early and treated appropriately, there is a good chance of cure.

Most Benign Soft Tissue Tumors can be cured with surgery. There are some Benign Soft Tissue Tumors‚ which are locally aggressive, i.e. they have a high incidence of local recurrence, even after appropriate treatment. Despite this, they rarely pose a threat to the patient’s life or limb, unless they occur in a difficult location, involving vital organs, making surgery difficult or dangerous.

Malignant Soft Tissue Tumors (STS) on the other hand, are less predictable. There are various factors, which affect the outcome of treatment in a patient with Soft Tissue Sarcoma. Generally, if a STS is detected early and treated appropriately, there is a good chance of cure.

How common is Soft Tissue Sarcoma?

Malignant Soft Tissue Tumors are very rare. In adults, less than 1% of all cancers are soft tissue. 

It is a surprising fact that, although somatic soft tissues make up more than 2/3rd of the body weight in an adult human being, malignant soft tissue tumors are very rare as compared to the other malignant tumors like breast cancer, lung cancer, prostate cancer, thyroid cancer, etc. In adults, less than 1% of all cancers are Soft Tissue Sarcomas.

STS are more common than bone sarcomas. STS are most common in middle aged and older adults. However, they are relatively more common in children and young adults. In children, about 7% of all cancers are STS.

Who can be affected by Soft Tissue Sarcoma?

Soft Tissue Sarcomas can affect people from all classes of life, and it can occur at any age. There is no real way to identify people at risk, except those with rare familial disorders mentioned earlier. Some types of STS are more common in certain age groups.

Who can be affected by Soft Tissue Sarcoma?

Soft Tissue Sarcomas can affect people from all classes of life, and it can occur at any age. There is no real way to identify people at risk, except those with rare familial disorders mentioned earlier. Some types of STS are more common in certain age groups.

What are the tests done to diagnose a Soft Tissue Tumor?

The general approach to the diagnosis of a Soft Tissue Tumor is clinical evaluation, radiological investigations and biopsy.

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    Benign:

    Angioleiomyoma

    Angiolipoma

    Angiomatosis

    Angiomyofibroblastoma

    Arteriovenoushaemangioma

    Calcifying aponeurotic fibroma

    Calcifying fibrous tumor

    Capillary haemangioma

    Cavernous haemangioma

    Chondroidlipoma

    Desmoplasticfibroblastoma

    Elastofibroma

    Epithelioidhaemangioma

    Fibroma of tendon sheath

    Fibromatosiscolli

    Giant cell tumor of tendon sheath

    Glomus tumor

    Hibernoma

    Intramuscular haemangioma

    Intramuscular myxoma

    Juxta-articular myxoma

    Lipoblastoma

    Lipoma

    Lipomatosis

    Lymphangioma

    Myolipoma

    Myopericytoma

    Myositis ossificans

    Nodular fasciitis

    Proliferative fasciitis

    Proliferative myositis

    Rhabdomyoma

    Soft tissue chondroma

    Synovial haemangioma

    Venous haemangioma

    Locally Aggressive tumors:

    Atypical lipomatous tumor

    Desmoid-type fibromatoses

    Superficial fibromatoses

    Lipofibromatosis

    Rarely metastasizing tumors:

    Angiomatoid fibrous histiocytoma

    Haemangiopericytoma

    Infantile fibrosarcoma

    Low grade myofibroblastic sarcoma

    Myoepithelioma

    Ossifying fibromyxoid tumor

    Solitary fibrous tumor

    Malignant:

    Adult fibrosarcoma

    Alveolar rhabdomyosarcoma

    Alveolar soft part sarcoma

    Angiosarcoma of soft tissue

    Clear cell sarcoma of soft tissue

    Dedifferentiated liposarcoma

    Desmoplastic small round cell tumor

    Embryonalrhabdomyosarcoma

    Epithelioidhaemangioendothelioma

    Epithelioid sarcoma

    Extraskeletal Ewing tumor

    Extraskeletalmyxoidchondrosarcoma

    Extraskeletal osteosarcoma

    Leiomyosarcoma

    Liposarcoma

    Malignant glomus tumor

    Malignant mesenchymoma

    Mesenchymalchondrosarcoma

    Myxofibrosarcoma

    Myxoidliposarcoma

    Pleomorphic liposarcoma

    Malignant Fibrous Histiocytoma

    Pleomorphic rhabdomyosarcoma

    Pleomorphic sarcoma

    Round cell liposarcoma

    Synovial sarcoma