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oncology

Soft Tissue Sarcoma

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 55-year-old man presents with a 6-month history of a growing lump in his left thigh. It is painless but has been increasing in size. He has no systemic symptoms. On examination, there is a 10cm firm, deep mass in the anterior thigh. It is fixed to underlying structures but not to skin. There is no lymphadenopathy. MRI shows a heterogeneous mass deep to the fascia, >5cm in size.
Axial T2-weighted MRI of the left thigh showing a large, heterogeneous soft tissue mass in the anterior compartment. The mass is well-circumscribed with high T2 signal and areas of necrosis. It displaces the femoral vessels but does not encase them. The size (>5cm), depth (deep to fascia), and heterogeneous appearance are concerning for high-grade sarcoma. Biopsy is required before treatment.
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Axial T2-weighted MRI of the left thigh showing a large, heterogeneous soft tissue mass in the anterior compartment. The mass is well-circumscribed with high T2 signal and areas of necrosis. It displaces the femoral vessels but does not encase them. The size (>5cm), depth (deep to fascia), and heterogeneous appearance are concerning for high-grade sarcoma. Biopsy is required before treatment.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

What are the clinical features that suggest malignancy in a soft tissue mass?

Question 2 (5 marks)

Describe the imaging and biopsy approach for soft tissue tumors.

Question 3 (6 marks)

What are the principles of surgical management?

Question 4 (5 marks)

Discuss the role of radiation therapy in soft tissue sarcoma.

Question 5 (4 marks)

What is the role of chemotherapy and targeted therapy?

Question 6 (4 marks)

Describe the common subtypes and their prognosis.

Exam Day Cheat Sheet

Must Mention

  • •Warning signs: >5cm, deep, growing
  • •Core needle biopsy along future excision
  • •Wide margin: 1cm or fascial plane
  • •Limb salvage >95%
  • •Pre-op RT: smaller field, more wound issues
  • •Chemotherapy: limited role except specific subtypes

Common Pitfalls

  • •Wrong biopsy approach
  • •Excisional biopsy of large mass
  • •Missing radiation role
  • •Wrong margin requirements
  • •All chemo works equally
  • •Wrong survival by stage