Soft-tissue sarcoma

Last reviewed: 29 Oct 2022
Last updated: 27 Sep 2022

Summary

Definition

History and exam

Key diagnostic factors

  • mass
  • upper/lower gastrointestinal bleed
  • rash
  • purplish macular-papular lesions
  • abnormal¬†uterine bleeding
  • increased abdominal girth
  • history of HIV infection
  • features of acute abdomen
  • neuropathic pain
More key diagnostic factors

Other diagnostic factors

  • weight loss
  • fatigue
  • anorexia
  • abdominal bloating, discomfort, pain
  • unilateral extremity swelling
Other diagnostic factors

Risk factors

  • genetically inherited syndromes
  • radiation
  • human herpesvirus-8 (HHV-8) infection
  • congenital disorders
  • lymphedema
  • history of exposure to chemical carcinogens
More risk factors

Diagnostic investigations

1st investigations to order

  • CT scan of primary tumor
  • MRI of primary tumor
  • CT scan chest
  • biopsy for histology
More 1st investigations to order

Investigations to consider

  • HIV test
  • ultrasound of primary tumor
  • chest x-ray
  • positron emission tomography (PET) scan
  • endoscopy
  • complete blood count (CBC)
  • blood urea nitrogen (BUN)
  • creatinine
  • liver function tests (LFTs)
  • echocardiogram or multigated acquisition (MUGA) scan
  • gene rearrangement testing
More investigations to consider

Treatment algorithm

ACUTE

extremity: stage I

extremity: stage II-III, resectable

extremity: stage II-III, unresectable

extremity: stage IV, single organ + limited tumor bulk or regional nodes

extremity: stage IV, disseminated metastases

retroperitoneal/intra-abdominal: resectable

retroperitoneal/intra-abdominal: unresectable or stage IV

gastrointestinal stromal tumors: localized or potentially resectable

gastrointestinal stromal tumors: unresectable or metastatic

ONGOING

recurrence

Contributors

Authors

James S. Hu, MD, FACP

Associate Professor of Clinical Medicine

USC Norris Comprehensive Cancer Center

Los Angeles

CA

Disclosures

JSH declares that he has no competing interests.

Sant P. Chawla, MD, FRACP

Director

Sarcoma Oncology Center

Santa Monica

CA

Disclosures

SPC declares that he has no competing interests.

Acknowledgements

Dr James S. Hu and Dr Sant P. Chawla would like to gratefully acknowledge Dr Swati Sikaria, Dr Jonathan C. Trent, Dr Saira Hassan, and Dr David Thomas, previous contributors to this topic.

Disclosures

SS, JCT and SH each declare that they have no competing interests. DT has received research support from Pfizer, Amgen, and Novartis.

Peer reviewers

Alfio Ferlito, MD, DLO, DPath, FRCSEd

Director

Department of Surgical Sciences

Professor and Chairman

ENT Clinic

University of Udine

Udine

Italy

Disclosures

AF declares that he has no competing interests.

Adrienne Flanagan, MB BCh FRCPath PhD

Professor of Musculoskeletal Pathology

Institute of Orthopaedics and Musculoskeletal Science

University College London

Stanmore

UK

Disclosures

AF declares that she has no competing interests.

Robert Maki, MB, PhD

Medical Oncologist

Memorial Sloan-Kettering Cancer Center

New York

NY

Disclosures

RM declares that he has no competing interests.

  • Differentials

    • Lipoma
    • Gastrointestinal ulcer
    • Lymphoma
    More Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: gastrointestinal stromal tumors (GIST)
    • NCCN clinical practice guidelines in oncology: soft tissue sarcoma
    More Guidelines
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