Leiomyosarcoma natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2] Rekha, M.D.
Overview
Leiomyosarcoma most commonly metastasizes to the lungs, liver, abdomen, pelvis, and pelvic or paraaortic lymph nodes.[1]Bone and brain metastases are less common sites of involvement.[2]Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor.Overall survival rate ranges from 15% to 25% with a median survival of only 10 months. Prognosis depends mainly on the age of the patient, race, FIGO stage, mitotic index and hormonal receptor expression in the tumor. [3]
Natural History
Most Leiomyosarcoma are diagnosed incidentally at an advanced stage. A leiomyosarcoma, especially in the early stages, may not be associated with any obvious symptoms (asymptomatic).The majority of patients with leiomyosarcoma remain asymptomatic for decades. General symptoms associated with cancer may occur including fatigue, fever, weight loss, a general feeling of ill health (malaise), and nausea and vomiting. This heterogeneous group of mesenchymal neoplasms are relatively rare and may arise in soft tissue, skin or various organs, and show a broad range of differentiation, such as smooth muscle (leiomyosarcoma), adipocyte (liposarcoma), striated muscle (rhabdomyosarcoma), endothelium (angiosarcoma) or fibroblast (e.g., dermatofibrosarcoma)
Complications
They are invariably aggressive that may metastasize to other areas of the body such as the lungs or liver, potentially causing life-threatening complications. Leiomyosarcoma has a high risk of recurring of about 53% to 71% after treatment, if not diagnosed early.[4]
Prognosis
The prognosis of leiomyosarcoma is poor and it depends on varying factors including site of tumor, size, and type, as well as the extent of tumor spread. Some patients with low grade tumors or with tumors that have not spread beyond Stage I have had excellent . There are numerous long term survivors from this group. In general, high-grade tumors that have spread widely throughout the body have less favorable survival rates.
- Tumor location
- Tumor type/Grade[5]
- DNA content
- Hormonal receptor status
- cellular division and mitotic rate
- local and distant extension
- Whether or not the tumor can be removed by surgery
- The patient’s general health
Survival Rate of Leiomyosarcoma by staging:
| Stage | Percentage |
| stage 1 | 60 |
| stage 2 | 35 |
| stage 3 | 28 |
| stage 4 | 15 |
References
- ↑ Cooley CL, Jagannathan JP, Kurra V, Tirumani SH, Saboo SS, Ramaiya NH et al. (2014) Imaging features and metastatic pattern of non-IVC retroperitoneal leiomyosarcomas: are they different from IVC leiomyosarcomas? J Comput Assist Tomogr 38 (5):687-92. DOI:10.1097/RCT.0000000000000097 PMID: 24834891
- ↑ Moskovic E, MacSweeney E, Law M, Price A (1993). "Survival, patterns of spread and prognostic factors in uterine sarcoma: a study of 76 patients". Br J Radiol. 66 (791): 1009–15. doi:10.1259/0007-1285-66-791-1009. PMID 8281375.
- ↑ . doi:10.1684/bdc.2013.1801. Missing or empty
|title=(help) - ↑ Gadducci A (2011) Prognostic factors in uterine sarcoma. Best Pract Res Clin Obstet Gynaecol 25 (6):783-95. DOI:10.1016/j.bpobgyn.2011.06.002 PMID: 21764643
- ↑ Giuntoli RL, Metzinger DS, DiMarco CS, Cha SS, Sloan JA, Keeney GL et al. (2003) Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol 89 (3):460-9. PMID: 12798712