Soft Tissue Cancer (Sarcoma): Definition, Symptoms, Types, and Treatment

Soft tissue cancer, known in medical terms as sarcoma, is a type of malignant tumor that forms in connective tissues and is a rare type of cancer. Soft tissues are those that support, connect, or surround organs in the body, including muscle, blood vessels, nerves, tendons, and the inner lining of joints. Sarcomas can occur in childhood, young adults, and older adults. This cancer type may present as a lump or mass that can be felt in soft tissues. While sarcomas can occur anywhere in the body, they most commonly develop in the arms, legs, and abdominal region. These masses can be either painful or painless. A definitive diagnosis of soft tissue cancer is made through a biopsy, which helps determine the treatment plan. Depending on the progression of the disease, treatment options may include surgical interventions, radiation therapy, chemotherapy, or targeted therapy.

What is Soft Tissue Cancer?

Soft tissue cancer, or sarcoma, is a type of cancer that affects connective tissues. These connective tissues form a broad range of structures, including muscles, deep subcutaneous tissues, fat tissues, blood vessels, and nerve cells. They encompass areas such as the legs, arms, abdomen, neck, and pelvis. This cancer type is difficult to detect unless the swelling, lump, or mass becomes large enough to be visible from the outside. Tumors that form soft tissue cancer may not cause symptoms when small. Soft tissue cancer typically becomes noticeable only when the tumor grows and is accompanied by pain. In advanced stages, sarcomas can lead to severe pain and even affect mobility by compressing surrounding tissues.

Symptoms of Soft Tissue Cancer

Since connective tissues exist throughout the body, sarcomas can develop in numerous locations. The primary symptom of sarcoma is a painless lump. These growths can sometimes become large enough to press against muscles and nerves. In rarer cases, symptoms may include chest pain, difficulty breathing, stomach pain, black or bloody stool, and vomiting blood. Swellings and lumps in the body are not always sarcoma; most swellings are benign tissue clusters. Malignant soft tissue tumors are generally larger than 5 cm and tend to settle in deeper tissues.

Some of the most common symptoms of soft tissue cancer include:

• Swelling or hardness in the tumor area
• Pain in the surrounding tissues of the mass
• Difficulty walking or restricted movement, depending on the size of the mass
• Bone tenderness and fractures
• Difficulty breathing or respiratory insufficiency
• Abdominal pain
• Intestinal obstruction or narrowing
• Anemia (low red blood cell count)
• Weight loss
• Fever
• Fatigue and weakness

Types of Soft Tissue Cancer

Soft tissue cancers include many subtypes. These cancers vary in type and biological characteristics based on the cell type in which the tumor originates. The location of soft tissue cancer also depends on the cell type from which it arises. Some of the main types of these tumors include:

• Liposarcoma: Often seen in individuals aged 40-70. Liposarcoma is one of the most common subtypes of soft tissue cancer, typically found in the body's fat tissue cells.
• Synovial Sarcoma: This type originates from cells around the joints and tendons, especially near the knee.
• Leiomyosarcoma: Tumors derived from smooth muscle cells, found in the digestive, urinary, and reproductive organs.
• Rhabdomyosarcoma: Arises from the skeletal muscles responsible for body movements. Rhabdomyosarcoma is more common in children.
• Fibrosarcomas: Develop from the cells that form connective tissue.
• Gastrointestinal Stromal Tumor (GIST): Arises from connective tissue cells in the intestine.
• Angiosarcoma: A type of cancer that affects blood vessels.
• Kaposi Sarcoma: Typically appears on multiple areas of the skin and may be associated with the human herpesvirus 8 (HHV-8). Kaposi sarcoma primarily affects areas like the nose, mouth, and anus.
• Nerve Sheath Tumors: These arise from the cells covering nerves and are often found in nerves related to functions such as facial sensation, hearing, and balance.
• Radiation-Induced Sarcomas: A type of cancer that can develop after radiation therapy for other conditions. They usually appear in the areas exposed to radiation and may take years to develop.

How Is Soft Tissue Cancer Diagnosed?

Soft tissue cancer is a type of cancer that progresses more subtly and shows symptoms later compared to other cancers. Tumors may not reach a noticeable size or cause pain until the cancer is in advanced stages. Since sarcoma commonly affects areas like the arms and legs, patients initially and typically consult an orthopedics and traumatology specialist. Additionally, sarcomas in the head and neck area are examined by ENT specialists, those in the chest area by pulmonologists, and those in the abdominal area by general surgeons. If doctors suspect cancer during their examinations, they first gather a detailed family history to understand any genetic predispositions. Following a thorough physical examination, advanced imaging tests, such as MRI (magnetic resonance imaging), CT (computed tomography), PET-CT, or ultrasound, are conducted to visualize any lumps or lesions. These tests help determine the cancer’s spread and stage, revealing how large the tumor is, which organs are affected, or if it has spread to surrounding tissues. For a definitive diagnosis, a biopsy is performed to obtain a tissue sample from the affected area. A biopsy is crucial for determining the appropriate treatment for sarcoma. Once soft tissue cancer is diagnosed through biopsy results, the necessary treatment is planned.

How Is Soft Tissue Cancer Treated?

The earlier soft tissue cancer is diagnosed, the higher the success rate of treatment. The treatment plan varies based on the tumor’s size, type, and location. The treatment is carried out using a multidisciplinary approach involving a team of specialists, such as an orthopedic surgeon, radiation oncologist, medical oncologist, cardiovascular surgeon, and plastic surgeon. Additionally, professional psychological support is included in the treatment scope to aid the patient mentally. The main treatment methods for soft tissue cancer are as follows:

Surgical Treatment

The primary treatment for soft tissue cancer is surgery. Surgical interventions aim to remove the tumor along with a margin of healthy tissue to ensure no cancerous cells are left behind. This method is successful when the tumor is not large or has not spread to other tissues. However, in cases where sarcoma has spread to the arms and legs, affecting blood vessels and nerves, limb preservation may not be possible, and amputation surgery may be required.

Radiation Therapy

Radiation therapy involves using high-energy beams to prevent or halt the spread of cancer cells to other organs after tumor removal. In some cases, radiation therapy is also used before surgery to reduce the tumor size, making it easier to remove surgically.

Chemotherapy

Chemotherapy is one of the most effective treatments for killing cancer cells. It is administered at regular intervals and given intravenously (through a vein) to patients. The potent chemicals in chemotherapy drugs target and destroy rapidly growing cancer cells. Due to the strong chemicals used, chemotherapy can cause side effects during the treatment process. Patients should consult their doctor beforehand to learn about these side effects and necessary precautions.

Targeted Therapy

Targeted therapy works by identifying and destroying molecules produced by cancer cells. In some types of soft tissue sarcomas, this treatment may be used alone or in combination with radiation therapy. These drugs are powerful treatments that directly target the tumor.