Sarcoma of soft tissues

Description:

Sarcoma of soft tissues – extensive group of the malignant new growths coming from a primitive embryonal mesoderm (an average germinal leaf). Primary mesenchyma which is a part of a mesoderm gives rise to various options of the connecting fabric which is a part of sinews, sheaves, muscles, etc. later. From them and formation of sarcoma is possible. However some sarcomas have the ectodermal and epithelial origin characteristic of cancer.

Symptoms of Sarcoma of soft tissues:

Sarcomas of soft tissues arise in any part of a body. Approximately at a half the tumor is localized on the lower extremities. Most often the hip is surprised. At 25% of the diseased sarcoma is located on upper extremities. At the others on a trunk and occasionally on the head.
The malignant tumor of soft tissues has an appearance of a roundish node of whitish or yellowish-gray color with a hilly or smooth surface. The consistence of a new growth depends on a histologic structure. It can be dense (fibrosarcoma), soft (liposarcomas and angiosarcomas) and even jellylike (myxomas). Have no true capsule of sarcoma of soft tissues, however in the course of growth the new growth squeezes surrounding fabrics, the last are condensed, forming the so-called false capsule which quite accurately konturirut a tumor.
The malignant new growth usually arises in the thickness of deep layers of muscles. In process of increase in the sizes the tumor gradually extends to a body surface. Growth accelerates under the influence of an injury and physiotherapy.

Tumor usually of an odinochn, but multiple defeats are characteristic of some types of sarcomas. Sometimes they arise widely spaced (multiple liposarcomas, malignant neurinoma at Reklinkhauzen's disease).

Innidiation of malignant new growths of soft tissues happens in preferential hematogenous way (on blood vessels). Favourite localization of metastasises are lungs. Less often the liver and bones are surprised. Metastasises in lymph nodes meet in 8–10% of cases.
Feature of new growths of soft tissues is existence of group of tumors, intermediate between high-quality and malignant. These tumors have mestnoretsidiviruyeshchy infiltriruyushchy growth, often recur, but do not give metastasises or metastasize extremely seldom (desmoidny tumors of an abdominal wall, intermuscular or embryonal lipomas and fibromas, the differentiated fibrosarcomas, etc.)
Emergence of a painless node or swelling of a rounded or oval shape is the leading sign. The sizes of a node vary from 2-3 to 25-30 cm. Character of a surface depends on a type of a tumor. New growth borders in the presence of the expressed false capsule accurate, at a deep bedding of a tumor swelling contours indistinct, are hard to determine. Skin is usually not changed, but in comparison with the healthy party over a tumor there is a local temperature increase, and at the massive educations which are quickly growing and reaching a surface the network of expanded saphenas, cyanochroic coloring and infiltration or an ulceration of skin appears. Mobility of the probed education is limited. It serves one of the symptoms, most characteristic and important for diagnosis.
Occasionally sarcomas of soft tissues lead to deformation of extremities, cause feeling of weight and awkwardness at the movements, but function of an extremity is broken seldom.

"Alarm signals" in the presence of which suspicion of sarcoma of soft tissues has to be stated are:
- existence of gradually increasing tumoral education;
- restriction of mobility of the available tumor;
- emergence of the tumor proceeding from deep layers of soft tissues;
- emergence of a swelling after an interval from several weeks to 2–3 years and more after an injury.

Reasons of Sarcoma of soft tissues:

Environment factors. Communication with an injury is traced seldom, however sarcomas can develop on site the hems which remained after burns, fractures, operations, implementation of foreign bodys.

From chemical carcinogens, povidimy, polycyclic aromatic hydrocarbons, asbestos and dioxine matter.

Iatrogenic factors. Sarcomas of bones and soft tissues quite often develop 5 and more years later after radiation therapy of other malignant tumor. At the same time sarcomas almost always arise in the field of radiation. Over time the risk of sarcomas increases.

Viruses. Predisposition of the infected VICh-1 to development of sarcoma of Kaposha gave an impetus to a research of a role of viruses in a pathogeny of this tumor. The sequences of DNA similar to DNA of gerpesvirus were found in patients not only an epidemic, but also classical form of sarcoma of Kaposha (in particular, in not infected HIV of homosexuals).

Therefore there was a hypothesis that the new representative of family of gerpesvirus - герпесвирус the person of type 8 is the reason of sarcoma of Kaposha.

Immunological factors. The inborn and acquired immunodeficiencies, including caused by immunosuppressive therapy, often are followed by development of sarcomas.

Genetic factors. Li-Fraumeni's syndrome caused by generative mutations of a gene suppressor of tumoral growth of TP53 is shown by the increased incidence of sarcomas of soft tissues and other malignant tumors, including a breast cancer, an osteosarcoma, brain tumors, leukoses and cancer of adrenal glands.

Treatment of Sarcoma of soft tissues:

Sarcomas of soft tissues are subject to complex treatment which consists in broad excision of a tumor, radiation therapy and chemotherapy. An operative measure remains the leading element of radical treatment. The volume of operation depends on extent of distribution and localization of a tumor. Standard operation is broad excision of a new growth in a complete muscular and fascial case within an anatomic zone. Tumors of intermuscular space delete with sites of adjacent muscles. At germination of a tumor in the main vessels, large nervous trunks or in a bone, at unsuccessful carrying out repeated safe, operations amputation of an extremity is shown. It is also necessary to resort to amputation as a palliative measure at the started forms of a tumor complicated by disintegration and bleeding or which are followed by intolerable pain.

Radiation therapy is applied in addition to an operative measure. At new growths of the small sizes apply postoperative radiation which reduces risk of a recurrence.
Effectively also preirradiation. Which is applied at new growths of the considerable sizes, however it is used with care because of risk of development of complications from a postoperative wound.

The chemotherapy at malignant new growths of soft tissues began to be applied widely in recent years. The adjuvant chemotherapy allows to reduce risk of emergence of a recurrence and metastasises after operational treatment. Adriamycin is most effective. At independent use from causes remission in 30% of patients.