Sarcoma Cancer Symptoms

This article describes the common symptoms that might arise with sarcoma.  The term sarcoma is a broad umbrella term that actually refers to many possible tumors.  They have in common the cell layers of origin.  Carcinomas or more commonly called cancers usually originate from the cell germ layer called the endoderm.  Sarcomas originate from the germ cell layers of the mesoderm and ectoderm.  Sarcomas are rare tumors and make up about 1% of adult cancers.  They are a bit more common in children and comprise about 10% of childhood cancers.  Sarcomas can also be classified broadly as originating from bone cells or all other tissues being called soft-tissue sarcomas.  Sarcoma can arise in virtually any area or cell type of the body.

While there are many different types of soft tissue sarcomas, some occur more frequently than others.

A partial list of these common sarcomas includes:

  • Gastro-intestinal stromal tumors (GIST)
  • Clear cell sarcoma
  • Alveolar soft part sarcoma
  • Malignant mesenchymoma
  • Angiosarcoma
  • Epithelioid sarcoma
  • Fibrosarcoma
  • Rhabdomyosarcoma
  • Nerve sheath tumor
  • Malignant fibrous histiocytoma
  • Liposarcoma
  • Leiomyosarcoma
  • Synovial sarcoma

A study of 4,550 people with sarcoma classified the locations of these.  The locations of these sarcomas are as follows:

  • Legs (46%)
  • Trunk (18%)
  • Arms (13%)
  • Retropeitoneum – deep abdomen and back (13%)
  • Head / Neck (9%)
  • Chest (1%)

This data raises several important points about the symptoms of sarcoma.  First, they can occur all over the body.  More importantly, over half occurred on either the arms or legs with almost 50% occurring on the lower extremities.  This brings us to the key point of this article.  A painless lump that is found, particularly one on the arms or legs that does not go away quickly, should be brought to the attention of your doctor for further investigation.

Some people do not notice these lumps until they injure themselves and errantly think that the tumor is from the injury.  Over time they realize the lump has not gone away and something else may be going on.  We all have swelling or small lumps from time to time that are not cancer.  For example, if you bump your leg there will be swelling or knot in that area usually for a day or so.  It is very common for small non-cancerous fatty growths to occur on the arms, breast or legs.  Sometimes these are not noticed due to obesity.  As a person loses weight, the lump then seems to “appear” out of nowhere.  It has really always been there but they could not readily appreciate it.

Other transient lumps include hematomas which are types of bruises that cause bleeding under the skin to collect.  These will often change different colors as the blood is broken down by the body – often changing from blue or red to green or yellow.  Another non-cancerous lump is different types of infection.  These may occur from small breaks in the skin, injury, bug bites, infected hair follicles, or complicated pimples.  These lumps will be tender and may be associated with drainage of pus.  It is uncommon for sarcomas to cause severe pain and most are not tender to the touch.  About 30% of sarcomas have a little tenderness.

In addition to noticing a lump or some type of mass on the body the other major symptom set that sarcomas will cause is related to the local compression or invasion that happens as the tumor grows.  This is basically a mass effect as a tumor interferes with the normal function of structures in that region.  An example of this would be a large sarcoma of the thigh.  A tumor of the thigh would cause discomfort with walking and interfere with normal muscular function.  The veins of the leg may be compressed and this would cause impairment of blood leaving the leg and thus swelling of the leg.  A tumor of the thigh may compress the nerves supplying that leg.  Symptoms of nerve compression or invasion would be pain, numbness, and weakness of the leg or even paralysis of the leg.  Sarcomas tend to push on adjacent structures and not grow directly into them.  As the tumor grows other bodily symptoms include weight loss, fatigue and a general feeling of illness.  This happens as many cancers release hormones or cytokines that simulate the feeling of having the flu.

Once a concerning lump is found the first step is not to ignore it.  Many sarcomas are curable if caught early enough. Unlike other cancers, the size of the tumor does not necessarily correlate with the prognosis or aggressiveness of the cancer.  This is because sarcomas are classified based upon how normal or abnormal their cell types are and how they react to adjacent structures.  This classification is the tumors grade.  Grade is the key feature for determining long term outcome and prognosis with sarcoma.  Only about 1% of sarcomas spread to lymph nodes.  When sarcomas spread they generally grow into adjacent areas or spread to the lungs via the bloodstream.  Any new lump that does not go away, particularly if it is painless, should be brought to the attention of a physician.  The steps to figure out what is going on will involve examination and often some type of x-ray study and a sample of the cells in the form of a biopsy.  These are information gathering steps and are important to make a treatment plan.

REFERENCES:

  1. www.cancer.gov/cancertopics/types/soft-tissue-sarcoma
  2. www.nlm.nih.gov/medlineplus/softtissuesarcoma.html
  3. Adult soft tissue sarcomas. A pattern of care survey of theAmericanCollegeof Surgeons.Lawrence W Jr, Donegan WL, Natarajan N, Mettlin C, Beart R, Winchester D.Ann Surg. 1987 Apr;205(4):349-59.PMID:3566372
  4. Abeloff, M.D. (2008). Abeloff: Abeloff’s Clinical  Oncology, 4th ed. Chapters 97.Philadelphia,PA: Churchill Livingstone – Elsevier
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.