Liposarcoma surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Liposarcoma}} | {{Liposarcoma}} | ||
{{CMG}} ; {{AE}} {{Ammu}} | |||
==Overview== | ==Overview== | ||
The predominant [[therapy]] for liposarcoma is [[Resection|surgical resection]]. Adjunctive [[chemotherapy]] and [[Radiation therapy|radiation]] may be required. | |||
==Surgery== | ==Surgery== | ||
Surgery is the key treatment | * [[Surgery]] is the key treatment of [[Metastasis|non-metastasized]] liposarcoma. | ||
* [[Tumor]] along with a wide margin of healthy [[tissue]] is removed to ensure that only healthy [[Tissue (biology)|tissue]] is retained. | |||
* [[Cancer staging|Stage 1]] liposarcomas of [[Limb (anatomy)|limbs]], [[trunk]], [[head]] and [[neck]] are treated with [[surgery]]. | |||
* [[Cancer staging|Stage 2]] and [[Cancer staging|3]] may require [[radiation]] and [[chemotherapy]] along with [[surgery]]. | |||
* Following is a [[classification]] for surgical resection:<ref name="pmid7449206 [">{{cite journal| author=Enneking WF, Spanier SS, Goodman MA| title=A system for the surgical staging of musculoskeletal sarcoma. | journal=Clin Orthop Relat Res | year= 1980 | volume= | issue= 153 | pages= 106-20 | pmid=7449206 [ | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7449206 }} </ref> | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width:600px" align="center" | |||
| valign="top" | | |||
|+ | |||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Surgical resection}} | |||
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Proceedure}} | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Intraleisional | |||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Curettage]], partial [[tumor]] removal | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Marginal | |||
| style="padding: 5px 5px; background: #F5F5F5;" |May leave [[microscopic]] [[tumor]] behind | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Wide | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Remove [[tumor]] and surrounding cuff of [[Tissue (biology)|tissue]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Radical | |||
| style="padding: 5px 5px; background: #F5F5F5;" |Remove entire [[Compartment (anatomy)|compartment]], includes [[amputation]] | |||
|} | |||
===Treatment by Stage=== | |||
* Treatment by [[Cancer staging|stage]] involves some basic criteria given below:<ref name="NCCN">{{cite web | title = NCCN | url = http://www.nccn.org/professionals/physician_gls/f_guidelines.asp }}</ref> | |||
====Treatment of Stage 1 Sarcoma==== | |||
*Primary treatment is [[surgery]]. | |||
*If the margins are cut >1 cm sparing the [[fascia]], "care" after [[surgery]] is the [[adjuvant treatment]]. | |||
*"Care" includes the following.: | |||
:*Rehabilitation if needed | |||
:*[[Medical history]] and [[physical examination]] every 3 - 6 months for every 2 - 3 years | |||
:*[[Chest]] [[imaging]] every 6 - 12 months | |||
:*[[Tumor]] site [[imaging]] right after [[surgery]] and then at regular intervals of time | |||
*If the margins are cut <1 cm with the [[fascia]], for [[Cancer staging|stage 1A]] consider [[radiation therapy]] and "care" after treatment and for [[Cancer staging|stage 1B]] consider [[radiation therapy]]. | |||
====Treatment of Stage 2 and Stage 3 Sarcoma==== | |||
* For [[Cancer staging|stage 2A]], [[radiation]] is given as [[neoadjuvant therapy]] followed by [[surgery]] as a primary treatment and then [[Radiation therapy|radiation]] boost as an [[adjuvant therapy]]. | |||
* For [[Cancer staging|stage 2B or 3]], [[radiation]]/[[chemotherapy]]/[[chemoradiation]] are given as [[neoadjuvant therapy]] followed by [[surgery]] as a primary treatment and [[Radiation therapy|radiation]] boost or [[chemotherapy]] as an [[adjuvant therapy]]. | |||
* For [[Tumor|tumors]] which cannot be [[Surgery|surgically]] [[Resection|resected]], [[radiation therapy]]/chemoradiation/[[chemotherapy]]/isolated [[Limb (anatomy)|limb]] [[chemotherapy]] is given as primary treatment. | |||
:* It is followed by [[surgery]] if possible and [[Radiation therapy|radiation]] boost/[[chemotherapy]] as a follow up treatment option. | |||
:* If [[surgery]] is still not feasible, [[radiation]]/[[Palliative therapy|palliative]] [[chemotherapy]] or [[surgery]]/[[amputation]]/supportive care are the treatment options. | |||
====Treatment of Stage 4 Sarcoma==== | |||
=====Confined Cancer Spread===== | |||
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 25%;" | |||
! style="width: 500px;background: #4479BA" |{{fontcolor|#FFF| '''''For confined cancer spread'''''}} | |||
|- | |||
| style="width: 120px; background: #F5F5F5" | [[Surgery]], to remove [[Metastasis|metastatic lesions]] with [[chemotherapy]] and [[Radiation therapy|radiation]] before and after [[surgery]] | |||
|- | |||
| style="width: 120px;background: #DCDCDC" |[[Ablation]] | |||
|- | |||
| style="width: 120px;background: #F5F5F5" |Observation | |||
|- | |||
| style="width: 120px;background: #DCDCDC" |Stereotactic Body Radiation Therapy (SBRT) | |||
|- | |||
| style="width: 120px;background: #F5F5F5" |[[Embolization]] | |||
|} | |||
=====Widespread cancer===== | |||
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 25%;" | |||
! style="width: 500px;background: #4479BA" |{{fontcolor|#FFF| '''''For widespread cancer'''''}} | |||
|- | |||
| style="width: 120px; background: #F5F5F5" |[[Palliative therapy|Palliative]] [[chemotherapy]] | |||
|- | |||
| style="width: 120px;background: #DCDCDC" |[[Palliative therapy|Palliative]] [[radiation therapy]] | |||
|- | |||
| style="width: 120px;background: #F5F5F5" |[[Palliative therapy|Palliative]] [[surgery]] | |||
|- | |||
| style="width: 120px;background: #DCDCDC" |[[Stereotactic Body Radiation Therapy]] (SBRT) | |||
|- | |||
| style="width: 120px;background: #F5F5F5" |[[Embolization]] | |||
|- | |||
| style="width: 120px;background: #DCDCDC" |Observation if [[asymptomatic]] | |||
|- | |||
| style="width: 120px;background: #F5F5F5" |[[Ablation]] | |||
|- | |||
| style="width: 120px;background: #DCDCDC" |Supportive care | |||
|} | |||
==== Recurrent Sarcoma in Distant Sites is Treated with the Following Options: ==== | |||
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 60%;" | |||
|+ '''Recurrent Tumor''' | |||
|- | |||
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Cancer spread}} | |||
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Treatment options}} | |||
|- | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Tumor]] in one [[Organ (anatomy)|organ]] | |||
| style="background: #DCDCDC; padding: 5px;" | [[Surgery]] with [[chemotherapy]]/[[radiation]] before and after [[surgery]] | |||
|- | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Confined area | |||
| style="background: #DCDCDC; padding: 5px;" | | |||
* [[Lymph node]] [[surgery]] with [[chemotherapy]]/[[radiation]] | |||
* [[Surgery]] to remove [[metastasis]] with [[chemotherapy]]/[[radiation]] | |||
* Stereotactic Body Radiation Therapy (SBRT) | |||
|- | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Widespread | |||
| style="background: #DCDCDC; padding: 5px;" |<br> [[Palliative therapy|Palliative]] [[chemotherapy]]<br> [[Palliative therapy|Palliative]] [[radiation therapy]]<br> [[Palliative therapy|Palliative]] [[surgery]]<br> Stereotactic Body Radiation Therapy (SBR)<br> [[Embolization]]<br> [[Ablation]] | |||
|} | |||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Types of cancer]] | [[Category:Types of cancer]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
{{WikiDoc Sources}} | {{WikiDoc Sources}} | ||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] |
Latest revision as of 20:29, 29 May 2019
Liposarcoma Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Liposarcoma surgery On the Web |
American Roentgen Ray Society Images of Liposarcoma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
The predominant therapy for liposarcoma is surgical resection. Adjunctive chemotherapy and radiation may be required.
Surgery
- Surgery is the key treatment of non-metastasized liposarcoma.
- Tumor along with a wide margin of healthy tissue is removed to ensure that only healthy tissue is retained.
- Stage 1 liposarcomas of limbs, trunk, head and neck are treated with surgery.
- Stage 2 and 3 may require radiation and chemotherapy along with surgery.
- Following is a classification for surgical resection:[1]
Surgical resection | Proceedure |
---|---|
Intraleisional | Curettage, partial tumor removal |
Marginal | May leave microscopic tumor behind |
Wide | Remove tumor and surrounding cuff of tissue |
Radical | Remove entire compartment, includes amputation |
Treatment by Stage
Treatment of Stage 1 Sarcoma
- Primary treatment is surgery.
- If the margins are cut >1 cm sparing the fascia, "care" after surgery is the adjuvant treatment.
- "Care" includes the following.:
- Rehabilitation if needed
- Medical history and physical examination every 3 - 6 months for every 2 - 3 years
- Chest imaging every 6 - 12 months
- Tumor site imaging right after surgery and then at regular intervals of time
- If the margins are cut <1 cm with the fascia, for stage 1A consider radiation therapy and "care" after treatment and for stage 1B consider radiation therapy.
Treatment of Stage 2 and Stage 3 Sarcoma
- For stage 2A, radiation is given as neoadjuvant therapy followed by surgery as a primary treatment and then radiation boost as an adjuvant therapy.
- For stage 2B or 3, radiation/chemotherapy/chemoradiation are given as neoadjuvant therapy followed by surgery as a primary treatment and radiation boost or chemotherapy as an adjuvant therapy.
- For tumors which cannot be surgically resected, radiation therapy/chemoradiation/chemotherapy/isolated limb chemotherapy is given as primary treatment.
- It is followed by surgery if possible and radiation boost/chemotherapy as a follow up treatment option.
- If surgery is still not feasible, radiation/palliative chemotherapy or surgery/amputation/supportive care are the treatment options.
Treatment of Stage 4 Sarcoma
Confined Cancer Spread
For confined cancer spread |
---|
Surgery, to remove metastatic lesions with chemotherapy and radiation before and after surgery |
Ablation |
Observation |
Stereotactic Body Radiation Therapy (SBRT) |
Embolization |
Widespread cancer
For widespread cancer |
---|
Palliative chemotherapy |
Palliative radiation therapy |
Palliative surgery |
Stereotactic Body Radiation Therapy (SBRT) |
Embolization |
Observation if asymptomatic |
Ablation |
Supportive care |
Recurrent Sarcoma in Distant Sites is Treated with the Following Options:
Cancer spread | Treatment options |
---|---|
Tumor in one organ | Surgery with chemotherapy/radiation before and after surgery |
Confined area |
|
Widespread | Palliative chemotherapy Palliative radiation therapy Palliative surgery Stereotactic Body Radiation Therapy (SBR) Embolization Ablation |
References
- ↑ Enneking WF, Spanier SS, Goodman MA (1980). "A system for the surgical staging of musculoskeletal sarcoma". Clin Orthop Relat Res (153): 106–20. PMID [ 7449206 [ Check
|pmid=
value (help). - ↑ "NCCN".