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Sarcoma - classification, diagnosis and treatment
Sarcoma - classification, diagnosis and treatment
Soft tissue sarcoma - a large group of malignant neoplasms that originate from primitive embryonic mesoderm (middle embryonic layer). Primary mesenchyme, which is part of the mesoderm, and later gives rise to different variants of the connective tissue, which is part of the tendons, ligaments, muscles, etc. Of these, and possibly the formation of sarcomas. However, some sarcomas have ectodermal and epithelial origin, characteristic of cancer.
Most cases of sarcoma occur spontaneously, ie, for no apparent reason, but the risk factors for this disease include chemical carcinogens, ionizing radiation, hereditary predisposition.
Soft tissue sarcoma can occur at any age but is most common in people with white skin after 40 years (mean age of cases - 50 years). Other significant patterns were found.
Soft tissue sarcoma is a rare, with a frequency of about 1 case per 1 million people a year, or about 6,000 cases per year in absolute terms among the world's population. Mortality from sarcomas is quite high: about half of the patients who developed sarcoma, dies.
The most frequent site of sarcoma - the lower limbs. The higher, the less common sarcoma. If the lower extremities sarcoma occurs in approximately 40% of cases, the head and neck region, only 5%.
In addition to the normal characteristics of the tumor (histological structure, size, presence of nearby and distant metastases), sarcomas can be divided by grade: The low degree of malignancy. This includes features such sarcomas, such as high cell differentiation and low mitotic activity of them, actually a small amount of tumor cells and stroma in a large number of sarcoma, a small number of vessels and a small number of foci of necrosis.
The high degree of malignancy. This includes opposing characteristics of sarcomas, such as high cell differentiation and low mitotic activity of, a small amount of the actual tumor cells and stroma in a large number of sarcoma, a small number of vessels and a small number of foci of necrosis
According to the degree of malignancy determine prognosis, and hence the probability of treatment success.
Examples of soft tissue sarcomas are:
alveolar soft tissue sarcoma;
angiosarcoma;
malignant hemangiopericytoma;
mezenhimoma malignant;
malignant fibrous histiocytoma;
malignant schwannoma;
leiomyosarcoma;
liposarcoma;
rhabdomyosarcoma;
synovial sarcoma;
fibrosarcoma;
epithelioid sarcoma.
Usually sarcoma is characterized by slow growth and painless for a sufficiently long time, so the identification of a long-term swelling and causeless (palpable education in the extremities, abdomen and other parts of the body) should be alerted immediately and get to see a doctor for further diagnosis. The most frequent metastatic sarcomas occur in the lungs, at least - in the regional lymph nodes.
Diagnosis of sarcoma is carried out by a specialist inspection, the use of medical imaging, biopsy and subsequent examination of the tumor tissue, and some other advanced techniques.
Of all the means of medical imaging (ultrasound, X-ray computed tomography, magnetic resonance imaging) MRI is considered the most informative, although in each case the choice of method of diagnosis should be made individually.
A biopsy of the tumor may be incisional (cut through), and the needle. Open (incisional) biopsy has the advantage in the case of the refined specification of an existing treatment plan.
Treatment of soft tissue sarcoma primarily surgical. Almost all operations are organ that allows you to quickly restore function. If radical surgery is not possible, as complementary methods are used chemotherapy and / or radiation therapy sarcoma. Unfortunately, their efficiency is still low, and in case of detection of metastatic cure probability tends to zero.
The factors that improve the prognosis of the disease, include tumor doubling time of more than 20 days, the disease-free interval of more than a year, the number of nodes less than 4. Radical removal of tumor and metastases in the lungs can give a 5-year survival rate of approximately 20% of patients. The main problem is the recurrence of the disease. The lowest risk of relapse - for tumors of the lower limbs (less than 25%), the highest - for the retroperitoneal space (approx. 75%).
The factors that improve survival, include: age less than 50 years; low grade sarcoma, pain in the tumor, small tumor size and its location on the extremities, the absence of metastases.
