Soft Tissue Tumour Management Overview

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Questions and Answers

What is the recommended management approach for dermatofibrosarcoma protuberans if positive margins are found post-resection?

No further action is needed

Administer chemotherapy

Proceed with radiotherapy only

Resect more tissue (correct)

Which statement regarding the management of sarcomas is true?

Surgery is considered if there are no metastases (correct)

Sarcomas are exclusively treated with medication

Chemotherapy is the primary treatment for all sarcomas

Radiotherapy is never used for sarcomas

What is the percentage of sarcomas that typically receive radiotherapy as part of their management?

30%

10%

70%

50% (correct)

Which of the following best describes the commonality of sarcomas among new cancers?

They represent 1% of new cancers Signup and view all the answers

What is the approximate local recurrence rate with unplanned margins after surgery for sarcomas?

30% Signup and view all the answers

What factor limits the efficacy of radiotherapy in sarcoma treatment?

Involvement of critical structures Signup and view all the answers

For patients with limb-sparing surgery, what potential risk is associated with this approach compared to amputation?

Higher recurrence rate Signup and view all the answers

Which biopsy type includes the pseudocapsule of the tumor?

Wide biopsy Signup and view all the answers

What is the estimated mortality rate associated with sarcomas at around 50 years of age?

50% Signup and view all the answers

What role does chemotherapy play in the treatment of sarcomas?

Has a modest effect as part of a multi-modal approach Signup and view all the answers

What is the primary characteristic of benign soft tissue tumors?

They are usually asymptomatic. Signup and view all the answers

Which of the following types of tumors is classified as an aggressive soft tissue tumor?

Desmoid tumour Signup and view all the answers

What is a common management strategy for painful neurofibromas?

Local excision Signup and view all the answers

Which treatment is generally recommended for hemangiomas if there are cosmetic concerns?

Corticosteroid injection Signup and view all the answers

What is a significant risk associated with deeper neurofibromas?

They can be malignant. Signup and view all the answers

What is the typical course of action for benignSchwannomas?

Resection with nerve preservation. Signup and view all the answers

For deep fibromatosis, what is a common treatment choice proposed?

Watch and wait policy. Signup and view all the answers

What is the main reason for excising benign soft tissue tumors such as lipomas?

When there is cosmetic concern or functional impairment. Signup and view all the answers

What treatment can be used for superficial fibromatosis?

Surgical excision of contracture band Signup and view all the answers

Which of the following is not a characteristic of benign soft tissue tumors?

They often require aggressive treatment. Signup and view all the answers

Study Notes

Soft Tissue Tumours Introduction

Soft tissue tumours have a mesenchymal origin, categorized by their tissue type and characteristics: benign, aggressive, or malignant.
Common types include:
- Benign: Fibroma, Dermatofibroma, Lipoma, Leiomyoma, Lymphangioma, Neurofibromas, Schwannomas.
- Aggressive: Fibromatosis, Atypical lipoma, Dermatofibrosarcoma protuberans.
- Malignant: Fibrosarcoma, Malignant fibrous histiocytoma, Liposarcoma, Leiomyosarcoma.

Management of Benign Soft Tissue Tumours

Excision is recommended for cosmetic concerns, growth, functional impairment, or pain.
Lipomas are the most frequently excised benign soft tissue tumours, typically managed as day surgical procedures.
Neurofibromas may require local excision, particularly if cutaneous, while deeper tumours necessitate caution for potential malignancy.
Hemangiomas usually resolve spontaneously but can be treated with beta blockers or corticosteroids if they affect crucial structures.
Schwannomas are benign, with resection prioritized in superficial cases, ensuring nerve preservation in significant nerves.

Management of Fibromatosis

Superficial fibromatosis (e.g., Palmar, Plantar, Peyronie's disease) treats with surgical excision, ultrasound ablation, or medication (steroids, collagenases).
Deep fibromatosis (desmoids) can be managed through:
- Surgery aiming for clear margins (30-50% local recurrence rate).
- Watchful waiting due to spontaneous regression (30-50%).
- Chemotherapy options include tyrosine kinase inhibitors.
- Thermo/cryotherapy and endocrine therapy (e.g., Tamoxifen) yield around 60% response.

Management of Dermatofibrosarcoma Protuberans (DFSP)

Diagnosis confirmed via biopsy; imaging is essential for margin assessment.
Treatment involves wide local excision; flap closure or skin grafting may be necessary.
Re-excision is required if margins remain positive post-resection, with radiotherapy as an option for resected positive margins.

Sarcomas Overview

Sarcomas account for around 1% of new cancer cases; there is a significant disparity of benign STT to sarcomas (100:1).
Common signs: painful lesions, deep location, size over 4 cm, rapid growth.
More than 100 subtypes exist, with liposarcoma being the most common. Diagnosis is confirmed via biopsy and staging using CT or MRI.

Sarcoma Management

A multidisciplinary team (MDT) is critical for managing sarcomas, with surgical intervention being preferred when metastasis is absent.
Adjuvant options include radiotherapy and chemotherapy, though the latter has modest effectiveness.

Surgical Approaches

Surgery types include biopsy, marginal, wide (includes pseudocapsule), and radical resection.
Surgical planning is vital, with a local recurrence rate (LRR) of 3% for planned margins and 30% for unplanned margins.
Limb-sparing techniques are often considered similar in survival prospects to amputation, though recurrence rates may be higher.

Radiotherapy Considerations

Radiotherapy can be utilized alone or in conjunction with other modalities to enhance local control in sarcoma treatment.
Approximately 50% of sarcomas receive radiotherapy, serving both curative and palliative purposes.
Pre-surgery, it may help shrink tumours for better surgical outcomes, but risks include less toxicity and limitations due to critical structures.

Conclusion

Soft tissue tumours are prevalent, with benign cases typically addressed through excision.
Aggressive lesions and sarcomas require comprehensive MDT involvement with multiple treatment avenues.
Surgical options are central for the management of desmoids and sarcomas, especially in non-metastatic instances.

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Description

This quiz covers the management of soft tissue tumors, focusing on their classification based on tissue origin and characteristics such as benign, aggressive, or malignant forms. It is suitable for those studying medicine and health sciences, particularly in oncology and pathology.