Soft Tissue Masses: Diagnosis and Surgery for Benign and Cancerous Tumors (Sarcoma)
Last updated Friday, January 18, 2008
Management and treatmentTreatment Upon diagnosis, a soft tissue mass can be observed or
prepared for removal from the patient’s body.
Benign fat tumors (lipoma), for example, can be observed,
rather than removed, with a recommendation of routine surveillance for the
patient – an MRI every six to 12 months, depending on the tumor’s location.
Patients have lived for decades with slow-growing benign tumors instead of
having them removed immediately.
If a sarcoma (cancerous growth) is diagnosed, doctors
recommend expeditious treatment involving surgery, chemotherapy, radiation
therapy or a combination thereof.
For any soft tissue tumor, the surgeon's goal is to remove
all of the tumor. With cancerous tumors, surgeons more aggressively remove
surrounding tissue. But doing so may leave a greater resulting soft-tissue
defect for the patient, requiring the expertise of a reconstructive surgeon to
help fill or make the area more cosmetically appealing.
The
challenge of surgery depends largely on the tumor's location. Proximity of
blood vessels, nerves and other vital tissues contribute to a surgery's
technical difficulty. The tumor's size and its etiology contribute to the
length of the procedure and the surgeon's ability to remove all of the tumor.Self-management Patients
cannot treat soft tissue tumors. If a patient suspects a soft-tissue tumor, he
or she could take the initiative to schedule an appointment with a family
doctor.Health care team Soft
tissue masses can emerge anywhere in the body, and specialists cross the
spectrum of physician expertise. A fundamental principle of soft tissue tumor
management is that the biopsy and surgery be performed by the same individual. Orthopedic
oncologists tend to perform resections from the arms and legs, pelvis, spine
and occasionally the chest wall; general surgical oncologists tend to operate
when tumors are oriented in the abdomen or pelvis. Otolaryngologists and/or
neurosurgeons typically perform surgery to remove head and neck tumors. Spinal
specialists often assist with spinal surgeries. Vascular surgeons may be
necessary if reconstruction of a an artery is necessary.Pain and fatigue Acetaminophen,
nonsteroidal anti-inflammatory drugs, and, infrequently, narcotic pain
medicines may be used for relief from pain caused by soft tissue tumors.Diet Diet
is not known to be able to beneficially treat a soft tissue tumor.Exercise and therapy Exercise,
therapy, rest and posture changes are not known to help treat a soft tissue
tumor.Medications Most
of the times, medications are not called for in treating benign soft tissue
masses. For tissue masses diagnosed as sarcomas (cancerous growths), chemotherapy
medications may be used in treatment. Hormonal therapy or non-steroidal
anti-inflammatory medicine have been used with varying results to treat
desmoids (benign, locally aggressive fibrous tumors).Surgery
When
performed by an experienced surgeon, excision/resection of a soft tissue mass
is very effective. Benign soft tissue tumors are treated with surgery alone. In
cases of sarcoma (cancerous growth), surgery often is indicated as the best
potential resolution, often in concert with chemotherapy and radiation
treatment.
For a
patient facing such surgery, a comprehensive clinical evaluation of the patient
should have been done one or two visits beforehand. Patients should educate
themselves about surgical options and risk, and their doctor's experience, in
advance of surgery.
Many soft
tissue resections require patients to stay overnight afterward, at least one or
two days and potentially longer, depending on the invasiveness of the
procedure. Many patients have drains inserted with surgery so edema fluid does
not build up under the wound. Postoperatively, hospital staff monitors the
drainage as well as signs of infection and healing. Many patients receive oral
antibiotics to prevent infection, and receive pain medication orally or by IV
for a day or two after surgery.
Patients
who have been treated with radiation before surgery are more vulnerable to infection
afterward, as radiation can affect the integrity of the skin, making wound
healing more problematic.
Patients
may have residual discomfort from surgery, and take anti-inflammatory or pain
medication orally for a week or two afterward. Most patients can manage pain
well after surgery.
Depending
on the location of surgery, patients may need to go therapy to fully recover to
their preoperative strength and activity level. Tumors that involve a major
portion of muscle in the lower leg, for example, could need weeks or months of
a physical therapy program. Some patients may require amputation of a limb if
the soft tissue tumor cannot be safely removed otherwise. Those patients could
face a prolonged recovery.Joint aspiration Joint
aspiration is the process of removing some fluid from the sore joint(s). It is
not indicated as a treatment for soft tissue tumors.Splints or braces In
cases in which a tumor is excised from a leg and adversely affects musculature
that enables a patient to walk, the patient might benefit from use of a brace or
splint in rehabilitation.Alternative remedies Some
practitioners and patients suggest that yoga, acupuncture, and relaxation
techniques may be integrated with more traditional approaches to yield a more
holistic healing.Social impacts Chemotherapy
and radiation treatment for a sarcoma (cancerous growth) can have side effects
such as lethargy, hair loss and nausea that likely would impact a patient’s
energy for social interactions.
Removal
of a large tumor also could leave a visible deficit, or sunken area, which
might not entirely be repairable by reconstructive surgery. Such a deficit
might affect a patient’s outlook or heighten a feeling of self-consciousness.
The
diagnosis of a sarcoma involves long-term follow-up with a physician. Some
patients need to travel long distances to see their specialist. This may pose
challenges to one’s personal life.Long-term management If not
removed entirely by surgery, the growth of benign tumors should be monitored
regularly by the patient and every six months to a year by the physician.
In cases
of sarcoma (cancerous growth), patients should have regular rechecks of their
condition to monitor whether the cancer has metastasized or recurred. Often
tumors are treated with weeks or months of radiation to combat their likelihood
of recurrence. The risk of recurrence is related to the type of tumor, the
adequacy of initial surgical excision, and tumor location.
Patients
for whom safe removal of sarcoma necessitated amputation of a limb could face a
prolonged therapeutic recovery.Unproven remedies Naturopathic
approaches for treatment of soft tissue tumors are largely unproven.Surgery for masses at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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