Soft tissue sarcoma

The most common symptom of a malignant soft tissue sarcoma is a painless, gradually enlarging lump. The growth rate varies with the aggressiveness of the tumour, low grade tumours can grow slowly while aggressive high grade tumours can develop and enlarge rapidly. Diagnosis relies on clinical examination, imaging, and laboratory analysis. Laboratory diagnosis should be made by a specialist soft tissue pathologist to determine the grade and stage of the tumour.  The grade determines how aggressive the tumour behaves in terms of growth rate and likelihood of spread. The stage is determined by tumour size, grade, depth and evidence of spread and gives an indication regarding the long-term prognosis.  

Any soft tissue lump showing any of the following four clinical signs should be considered to be malignant until proved otherwise:

• Increasing in size
• Bigger than 5 cm
• Deep in the body (i.e. not just under the skin)
• Painful

Types of soft tissue sarcoma

The majority of sarcomas occur in patients aged 50 years and over. However, the age profile of patients diagnosed with soft tissue sarcoma depends on the type of the sarcoma. Sarcomas have been traditionally classified according to the adult tissue they most resemble, and the World Health Organisation has defined about 50 subtypes, dividing soft tissue sarcomas into tumours of smooth muscle, skeletal muscle, vascular and so on. Rhabdomysarcomas, which grow in the active muscles of the body, are most common in children and adolescents, and synovial sarcomas, which occur in the linings of joints such as the knee and elbow, have a higher occurrence in young adults.

Treatment

All patients with a suspected sarcoma should be managed by a specialist Sarcoma centre as specified in the NICE guidance. Decisions about surgery, chemotherapy, radiotherapy and the timing of all of these treatments should be made by specialists in dialogue with a Sarcoma multidisciplinary team.