Soft Tissue Sarcoma Flashcards by jared Jensen

What kinds of tumors are soft tissue sarcomas

1) Fibrosarcoma
2) Peripheral Nerve Sheath Tumor
3) Malignant Mesenchymoma
4) Myxosarcoma
5) Liposarcoma
6) Spindle Cell Sarcoma
others: Leiomyosarcoma, synovial cell sarcoma, anaplastic sarcoma, rhabdomyosarcoma, lymphangiosarcoma, Undiff Sarcoma

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What are the types of NON soft tissue sarcomas sarcomas

Histocytic Sarcoma, osteosarcoma, chondrosarcoma, hemangiosarcoma, etc.

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What is the typical clinical presentation of a soft tissue sarcoma

Cutaneous of subcutaneous mass
1) usually non-painful
2) very variable in consistency
3) often normal haired skin overlying
4) variable in growth rate
5) can occur anywhere

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T/F: soft tissue sarcomas can occur anywhere

True

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T/F: tumors do not grow their own nerves but they can grow their own lymphatics and blood

True

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what is the biologic behavior of soft tissue sarcomas

1) Locally invasive/ infiltrative
2) Reccurence is common after conservative excision
3) Relatively low metastatic rate
4) Visceral sarcomas typically more aggressive (exception is GI leiomyosarcomas)

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Visceral sarcomas are typically more aggresive, with the exception being

GI leiomyosarcomas

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T/F: soft tissue sarcomas has a low chance of recurrence after conservative excision

False- recurrrence is common after conservative excision

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What can occur if soft tissue sarcomas growth rate is greater than that of the skin

erosions and the potential for infections to occur

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Fine needle aspirates of soft tissue sarcomas are generally

poorly exfoliative or blood

consider larger gauge needle or syringe aspiration vs “bare needle” technique

excessive blood or a dry need should prompt further investigation

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How do you diagnose soft tissue sarcomas

1) FNA
2) Biopsy- incisional (punch, tru-cut, or wedge) or excisional (for diagnostic purposes)
3) Thoracic rads- metastatic rate is low but not zero
4) FNA of regional lymph node- LN mets less common than with other histotypes but certainly seen
(popliteal, subscapular, axillary)

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For soft tissue sarcomas are incisional or excisional biopsies for diagnostic purposes

Excisional

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T/F: Soft tissue sarcoma metastatic rate is low

True- but it is not zero so maybe do thoracic radiographs

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What margins of a soft tissue sarcoma should you get

3cm or width of mass margins on each side
at least one fascial plane beneath, include Bx tract

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what is the treatment of soft tissue sarcomas **

Aggressive surgery is the mainstay of treatment
-Wide local excision
3cm margins laterally at least one fascial plane beanth, include Bx tract

Identify margins for histopathology with ink or suture

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How hsould you identify margins for histopathology

Ink
Suture

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How do most soft tissue sarcomas metastasis

hematogenously NOT lymphatically

why most spread is in the lungs

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is CT or MRI better for imaging of soft tissue sarcoma

MRI tends to exacerbate the extent of a soft tissue sarcoma

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A tumor removal is clean if there is

no cancer cells at the margin

For soft tissue sarcomas, aggressive surgery is the mainstay of treatment but what radical procedures might you need to consider

-Mandibulectomy, maxillectomy
-Amputation
-Body wall resection

What are the ideal surgical margins for wide local excision of a soft tissue sarcoma? *****

3cm laterally and 1 uninvolved fascial plane below

Soft tissue sarcomas that are anaplastic and undifferentiated have a higher

metastatic rate

For a soft tissue sarcoma, what should you do if you have incomplete surgical margins

-Second surgery
-Radiation therapy
-chemotherapy?

but avoid multiple marginal excisions = best chance to cure is with the first surgery

What is the prognosis of radiation therapy with soft tissue sarcomas

much more effective in the context of microscopic disease
-aggressive, high dose protocol is necessary

-85% 3 year local control after incomplete excision (except oral cavity) *

-50% 1 year control rate if treating gross disease

radiation has a _________ 3 year local control after incomplete incision of soft tissue sarcoma (except oral cavity) ***

85%

What is the downside to radiotherapy

1) mild to severe acute local reaction 2) multiple general anesthesias 3) hospitalization itme 4) lots of money

the best chance to cure a soft tissue sarcoma is with the _________*

first surgery

What are the indications for chemotherapy for soft tissue sarcomas

1) Higher grade (Grade III), anaplastic, undifferentiated- higher metastatic rare (40-50%) 2) Certain histotypes (histocytic, liposarcoma) 3) young dogs? 4) aggressive local therapy declined or not possible

What is a major chemotherapeutic drug used for soft tissue sarcomas

Doxorubicin 30mg/m^2

What is a factor of injection site sarcoma (ISS)

chronic inflammation genetic predisposition?

What is the time line after injection for injection site sarcoma (ISS)

variable <3 months to >3 years 4weeks to 10 years have variable metastatic rates (5-25%) depending on the study

T/F: injection site sarcoma (ISS) is histologically and biologically aggressive

True

Is injection site sarcoma (ISS) only a cat disease?

isolated reports in ferrets and dogs following injections sarcomas have been reported secondary to foreign bodies and metallic implants in some dogs Unknown why cats seem predisposed

How do you treat injection site sarcoma (ISS)

Aggressive/ radical surgery superior to conservative surgery 325 days vs 79 days

How do you locally. excise injection site sarcoma (ISS)

1) 5cm margins laterally 2) at least 2 fascial planes below needs to be very wide

Do injection site sarcoma (ISS) on the limbs or body have better outcomes

Limbs (325d) body (66d) cats with tumors on limbs treated with amputation virtually only cures

injection site sarcoma (ISS) that are recurrent may have

a higher metastatic rate so get aggressive early, dont wait for recurrence

In addition to surgery, what can be done for injection site sarcoma (ISS)

1) Radiation on margins 2) Chemotherapy (Carboplatin, Doxorubicin, Doxil, Vincristine, Lomustine)

How can you prevent injection site sarcoma (ISS)

1) Limit vaccine frequency (titers?) 2) Vaccine location -Rabies RH -Leukemia LH -FVRCP RF 3) Avoid multiple vaccines in same site 4) Alternative routes 5) Non-adjuvanted products?

Where is it recommend that you give vaccines

tail distal limbs

Where should you give rabies vx to cat

Where should you give leukemia vx to cat

Where should you give FVRCP vx to cat

for injection site sarcoma (ISS), what should you tell the owner for education *

3-2-1 rule 3) Lump persist for more than 3 months after vaccination 2) It becomes larger than 2 cm in diameter 1) It is increasing in size 1 month after vaccination

How is a diagnosis of injection site sarcoma made in affected cats?

fill in later