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Sarcoma- Surgical Perspective

Sarcoma- Surgical Perspective. Lucas Henn. “Mass”. Delays common- nonspecific symptoms- hematoma vs pulled muscle Biopsy mass is no Hx of trauma or after 6 weeks of trauma Biopsy any mass greater than 5 cm or new, enlarging, or symptomatic mass Head, Neck, Trunk, Extr: painless usually

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Sarcoma- Surgical Perspective

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  1. Sarcoma- Surgical Perspective Lucas Henn

  2. “Mass” • Delays common- nonspecific symptoms- hematoma vs pulled muscle • Biopsy mass is no Hx of trauma or after 6 weeks of trauma • Biopsy any mass greater than 5 cm or new, enlarging, or symptomatic mass • Head, Neck, Trunk, Extr: painless usually • Retroperitoneal mass: palp, or pain, fullness, early satiety

  3. Diagnosis • Excisional Biopsy: smaller masses (< 5cm) - Risk malig low, take pseudocapsule • Incisional Biopsy: > 5 cm - Definitive therapy later, scar incorp in next wide re-excision • CT guided FNA- minimized tumor spillage for retro and intra-abd

  4. Pathology • Defined by tumor tissue type not tissue of origin • Grade most important for prognosis and treatment • Low: little cellular atypia, few mitosis, no necrosis • Intermediate: atypia, some mitoses, little/no necrosis • High: atypia, mitosis, necrosis

  5. Extremity • Wide local excision- definitive therapy • 3-5 cm margins around tumor • Deep margin: try for 1 uninvolved fascial plane • Take nerves/vessels unless low grade • Amp

  6. Retroperitoneal • Most patients die of the disease- even low grade- due to late diagnosis • Symptoms are after large size • Therapy: Wide local excision- complete in only 50%- sometime have to take adjacent organs • Leave Clips: for post op XRT- may try intra op XRT • Chemo not effective

  7. Bone • Most Malignant bone tumors are mets or blood • Osteosarcoma: most common primary sarcoma: lung mets 25% at diagnosis- encompases Ewings sarcoma Plain films: irregular, poorly defined borders- Onion Skin- core biopsy (unlike soft tissue sarcoma)

  8. Bone- treament • Tumor excision • Limb sparing surgery with joint reconstruction vs. radical amputation • Also XRT for Ewings

  9. Unresectable • Can be treated with radiation • Need higher doses • Need near 65-75 Gy • Local control in about 30% of patients

  10. Pulmonary Mets • Patients may get 20-30% five year survival with pulm met resection • Need fewer than 4 mets and a 12 month disease free interval • More aggressive with younger patients

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