Introduction:
Liposarcoma is a soft tissue tumor classified as cancer because it carries the potential to recur locally and also spread to distant areas of the body. It can occur anywhere in the body. Most frequently, it occurs in the extremities of the body, abdomen, thigh, and behind the knee. Some patients with liposarcoma will notice the presence of a painless deep-seated lump or mass in the soft tissue; when the tumor increases in size, pain and functional impairment may occur.
What Causes Liposarcoma?
Experts are not exactly sure what causes liposarcoma. But it occurs when cells in the body undergo changes and grow out of control (genetic mutation). These changes are attributed to genetic syndromes, radiation therapy, exposure to some chemicals, and a damaged lymphatic system.
How Many Types Of Liposarcoma Are There?
-
Well-differentiated Liposarcoma: This type of liposarcoma is found in the abdominal cavity or an arm or leg. It presents itself as a large painless mass and is one of the least aggressive types of liposarcoma.
-
Myxoid Liposarcoma: This type of sarcoma is highly recurring and is found frequently in legs and other soft tissue areas or bones (spine and pelvis).
-
Round Cell Liposarcoma: This is a common type of liposarcoma and is similar in occurrence to myxoid liposarcoma.
-
Pleomorphic Liposarcoma: A rare type of liposarcoma occurring in the arm or leg and is aggressive when compared to other liposarcomas. This spreads to other sites of the body, such as the lung, and into soft tissues.
-
Mixed Type Liposarcoma: This type of liposarcoma is very rare and is a combination of two or more subtypes of liposarcomas.
-
Dedifferentiated Liposarcoma: A more aggressive form of well-differentiated liposarcoma; less aggressive than high-grade liposarcomas.
What Are The Symptoms?
Liposarcoma is generally asymptomatic until it has grown enough to produce symptoms. Symptoms depend on the size of the tumor. Tumors in the abdomen can grow big before causing problems.
Symptoms may include:
- Painful swelling or numbness in the area around the lump.
- Growth of an existing lump or new lump elsewhere in the body.
As the tumor grows, liposarcoma in the abdomen can cause:
- Black, bloody, or tarry stool.
- Vomiting blood.
- Stomach pain or cramps.
How Is Liposarcoma Diagnosed?
The doctor will ask about health history, symptoms, risk factors, and family history, followed by a physical examination. The most critical step in the diagnosis of liposarcoma involves performing a biopsy of the tumor mass.
1) Physical Examination: Looking at and feeling any lump.
2) Biopsy: A biopsy is when tissue is retrieved from the tumor to be evaluated under the microscope to assess whether or not the tumor has tumor-specific features. Since many of these tumors are deeply embedded into the body, imaging such as ultrasound can be used as a guide where the needle is relative to the mass and to ensure that the sample is retrieved specifically from the mass. There are two main types of biopsy:
-
Needle Biopsy - A syringe is used to extract a small piece of tissue from the tumor mass. Pain will not be felt as it is done under anesthesia. This procedure takes an hour to complete.
-
Surgical Biopsy - The tumor mass is removed by placing a cut through the skin; in other words, the tumor mass is removed surgically.
The location, incision, and technical aspects of biopsy can affect treatment options and outcomes. Hence the biopsy must be planned by a surgeon or radiologist experienced in sarcomas.
3) Imaging Tests: These tests can find a tumor. They can also find the extent of the tumor and how far it spreads. These tests include X-rays, MRIs (magnetic resonance imaging), CTs (computed tomography), ultrasound, EUS (endoscopic ultrasound scan), PET (positron emission tomography, histopathology, and various blood tests
The stage of how much and how far it spreads is very important to know while planning cancer treatment.
What Are The Stages Of Cancer?
Identifying the stage and grade of cancer helps the doctor to deliver the best treatment plan for a patient. The stage of cancer is measured by how much it has grown or spread, which can be seen in various tests and scans, as discussed earlier.
Grading:
- Slow Grade: Cancer cells are slow-growing, less aggressive, and less likely to spread.
- Intermediate Grade: These cells are slightly faster in growing and look more abnormal.
- High Grade: These cells are much more aggressive and spread faster to other sites of the body.
Staging:
-
Stage 1: Small (less than 5 cm), low-grade cancer.
-
Stage 2: Cancer is of any grade, usually larger than stage 1, and has not spread yet to other parts of the body.
-
Stage 3: High-grade cancer that has not spread to other parts of the body.
-
Stage 4: Cancer is of any grade or size but has spread to other sites of the body.
What Is The Treatment For Liposarcoma?
1. Surgery:
Surgery is the treatment option for liposarcomas that have not spread to other parts of the body. In most cases, the surgeon will remove the tumor along with a wide margin of the healthy tissue around the tumor, aiming to leave the area free of disease and prevent the tumor from returning.
Most tumors can be successfully removed while sparing the involved limb.
Occasionally amputation may be the choice of treatment to remove cancer and restore the functional life of the patient. Complete surgical removal of the tumors within the abdomen is difficult because of the difficulty in getting clear margins of healthy and normal tissue.
2. Radiotherapy:
Radiotherapy is used for intermediate and high-grade tumors and when the margins are quite close. Radiation therapy is used according to the grade and stage of the tumor. Radiation therapy is used before, after, and during the surgery.
- Before surgery, the aim of radiation therapy is to reduce the size of the tumor and prevent the recurrence of the tumor.
- After surgery, the aim of radiation therapy is to destroy any remaining cancer cells at the operating site.
- When used during surgery, it is called IORT (Intraoperative Radiation Therapy); Its aim is to sterilize the tissue around the tumor by killing tumor cells.
The combination of surgery and radiotherapy has been shown to prevent recurrence at the surgical site in about 85 to 90% of the liposarcomas.
3. Chemotherapy:
This treatment uses anti-cancer drugs to destroy cancer cells. It is used in patients with a high risk of cancer coming back or if it has spread to other parts of the body. The FDA (Food and Drug Administration) has approved new therapeutic options for tumors that are not amenable to surgical removal. Eribulin mesylate (Halaven) is administered by injection that targets a critical step in cell division that prevents cells from dividing and ultimately kills off tumor cells.
How Can Liposarcoma Be Prevented?
Liposarcoma is a malignant tumor of soft tissue which cannot be prevented. The risk of having liposarcoma can be prevented by avoiding exposure to certain chemicals and radiation for a prolonged time period. Patients with family history and genetic syndromes are suggested to take regular health check-ups in order to identify and treat liposarcomas at early stages.
Key Points About Liposarcoma:
- Liposarcoma is a rare type of cancer that develops in soft tissues.
- Genetic syndromes raise a person’s risk of having cancer.
- Liposarcoma is often asymptomatic that can be seen or felt under the skin
- A biopsy is a must to arrive at a diagnosis.
- Surgery is the most common treatment option.
- Liposarcoma, when left untreated, becomes life-threatening.
Conclusion:
Liposarcoma is a rare cancer of the fat cells in the body. Though it is not preventable, early diagnosis will ensure successful treatment, a better prognosis, and improved quality of life. However, advanced stages are life-threatening and may require continued treatment to prevent the spread of the disease and other fatalities.
