Soft Tissue Sarcoma

Description

Soft tissue sarcomas are a group of solid tumors that can develop anywhere in the body, and originate in soft tissues such as cartilage, fat, muscle, nerves, blood vessels, or deep skin tissues. Although soft tissue sarcomas can occur anywhere in the body, they most commonly occur (about 43%) in the arms and legs.

Epidemiology Data (US & Europe)

Diagnoses of soft tissue sarcoma represent about 0.7% of all new cancer cases in the United States. These tumors can occur at any age, and account for 7-10% of pediatric cancers. It is estimated that about 12,000 new cases (between 3 and 4 cases per every 100,000 people) of adult soft tissue sarcoma will be diagnosed this year in the United States. The rate of new soft tissue sarcoma cases in Europe is similarly low, and is estimated to be between 4 and 5 new cases per every 100,000 adults.

Risk Factors

Risk factors that increase the chance for developing soft tissue sarcoma include exposure to radiation or certain chemicals, genetic predisposition, and for at least one type of soft tissue sarcoma (lymphangiosarcoma), a damaged lymphatic system.

Survival

It is estimated that almost 5,000 patients will die of soft tissue sarcomas in the United States this year. The estimated 5-year survival rate of people with newly diagnosed soft tissue sarcoma is around 50%. For patients with soft tissue sarcomas of stage I, II, or III, without tumors that have spread to the lymph nodes, the 5-year survival rate is 83%. For patients with stage III tumors that have spread to the lymph nodes, the 5-year survival rate is 54%. For patients with soft tissue sarcoma that has spread to more distant parts of the body, the 5-year survival rate is 16%.

Types

There are about 50 different types of soft tissue sarcoma. In adults, the most common types are undifferentiated pleomorphic sarcoma, liposarcoma, and leiomyosarcoma. Rhabdomyosarcoma is the most common soft-tissue sarcoma in childhood.

Classification of Molecular Alterations

Because of the many different types of soft tissue sarcoma, the molecular changes in each tumor can significantly vary. Nevertheless, soft tissue sarcomas can be broadly characterized by the type of genetic and molecular alterations involved in their development. Three common genetic changes include: activation of genes involved in cell growth and proliferation (e.g. KIT gene in gastrointestinal stromal tumors, duplication or deletion of certain genes (e.g. amplification of MDM2 genes in well-differentiated liposarcomas), and rearrangements of DNA (e.g. the reciprocal translocation between chromosome 18 and chromosome X in synovial sarcoma).

Symptoms

Symptoms vary by soft tissue sarcoma type, however, general symptoms include a soft tissue lump that is (1) increasing in size, (2) is greater than 5 cm, (3) extends to deeper tissues, and (4) is painful.

Staging

Progression of soft tissue sarcoma is divided into four stages (I-IV), with stages I and II having sub-stages of IA (tumor size ≤5 cm), IB (>5 cm), IIA (≤5 cm), and IIB (>5 cm). For all stages, the primary tumor may be either just beneath the skin or deeper in the muscle and connective tissue. Staging is identified by the likelihood of tumor growth and spread, with stage I tumors being likely to grow and spread slowly, and stage III tumors, likely to grow and spread quickly. Stages I and II soft tissue sarcomas are localized at the site of primary growth, whereas those of stages III and IV have spread to nearby lymph nodes, and more distant parts of the body, respectively.

Treatment Options

Surgery is the primary treatment for soft tissue sarcoma. Radiation therapy may also be added for high-grade, deep tumors and for select low-grade tumors that are closer to the surface. Chemotherapy may be started before or after surgery. The efficacy of chemotherapeutic agents varies, depending on tumor type.

Ovarian Cancer

Description

Ovarian cancer is a disease in which cancer cells are found in the ovaries. In addition to forming in the ovary, cancers that form in the nearby fallopian tube or in the peritoneum (the membrane that lines the abdominal cavity) and spread to the ovary are often considered ovarian cancer, therefore following the same course of treatment. Most ovarian cancers form after menopause, with over half being found in women of 63 years of age or older.

Epidemiology Data (US & Europe)

The number of new cases of ovarian cancer has been slowly decreasing every year since the mid-1980s. New diagnoses of ovarian cancer make up about 3% of new cancer cases in American women. It is estimated that about 21,000 and 66,000 women in the United States and Europe, respectively, will be diagnosed with ovarian cancer this year, and about 1.3% of women will be diagnosed with ovarian cancer at some point during their lifetime.

Risk Factors

Family history is the single most important risk factor in the development of ovarian cancer. Women with familial cancer syndromes, or with inherited mutations in the genes BRCA1 or BRCA2 are at increased risk. Other risk factors include increased age, being overweight, and the use of estrogen in postmenopausal women.

Survival

More than 14,000 and 43,000 women are estimated to die of ovarian cancer this year in the United States and Europe, respectively, making this disease the fifth leading cause of cancer-related deaths in women. The relative 5-year survival rate for women with ovarian cancer is around 46%. For patients with ovarian tumors of stage I, II, or III, without tumors that have spread to the lymph nodes, the 5-year survival rate is 92%. For patients with stage III tumors that have spread to the nearby lymph nodes, the 5-year survival rate is 73%. For patients with ovarian tumors that have spread to more distant parts of the body, the 5-year survival rate is 28%.

Types

Ovarian cancer can develop from three different cell types: epithelial cells that form the tissue that covers the ovaries, stromal cells that produce hormones or form connective tissue within the ovary, and germ cells, or egg cells. About 90% of ovarian cancers are ovarian epithelial tumors, with the rest being stromal cell or germ cell tumors. Ovarian stromal cell tumors and germ cell tumors have a slightly greater prognosis, with 5-year survival rates of 75% and 90%, respectively.

Classification of Molecular Alterations

Common genetic changes found in ovarian cancer include the inactivation of tumor suppressor genes, which act to prevent abnormal cell growth in normal cells, and the activation of oncogenes, which stimulate the uncontrolled growth of cancer cells. Mutations in the tumor suppressor genes BRCA1, BRCA2, p53, and PTEN are commonly seen in ovarian tumors, as are mutations in the oncogenes BRAF, KRAS, and HER2.

Symptoms

The most common symptoms of ovarian cancer include bloating, pelvic/abdominal pain, trouble eating or feeling full quickly and changes in the urgency or frequency of urination. Although these symptoms are more likely to be noticed if the cancer has spread beyond the ovaries, early-stage cancers can also cause these symptoms.

Staging

Ovarian cancer progression is divided into four stages (I-IV), with numerous sub-stages, depending on the exact locations of the tumor spread. Stage I indicates a cancer that is localized within the ovary (or ovaries) or fallopian tube(s), and has not spread to other tissues. Stage II ovarian cancer is present within one or both ovaries or fallopian tubes, and has spread to other organs within the pelvis. Stage III ovarian cancer may or may not have spread to nearby organs, but is indicated by spread to nearby lymph nodes or to the lining of the abdomen (the peritoneum). In the most advanced stage of ovarian cancer, stage IV, the cancer has spread to the spleen, lungs, liver, or other organs outside of the abdomen.

Treatment Options

Two or more different types of treatment are most commonly used to treat ovarian cancer. Surgery is the primary treatment for ovarian cancer, and is used to both correctly evaluate the cancer and to remove as much of the cancerous material as possible. Other treatments include the use of one or more chemotherapeutic agents, targeted therapy, which unlike traditional chemotherapy, specifically targets cancer cells, and radiation therapy. Additionally, for ovarian stromal tumors, hormone therapy may be used.

The information contained here is purely for informational purposes and does not, in any event, seek to take the place of a consultation with a medical professional. In the event of doubt or if you have symptoms, you should always consult a medical professional.

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