CA: A Cancer Journal for Clinicians, Vol 11, 210-231, Copyright
© 1961 by American Cancer Society
Sarcomas of the Soft Tissues
Arthur Purdy Stout M.D.1
1 The Laboratory of Surgical Pathology, Columbia University, New York, New York.
Although there are at least 21 different varieties of malignant soft tissue tumors, some general statements can be made about the problems of their diagnosis and treatment. In the first place benign tumors are at least five times as common in the soft tissues as are malignant growths. Of all the regions, the lower extremities are most frequently involved and the thigh in particular is a favored site for sarcoma growth. Because so many of them are deeply seated, growth is apt to be insidious. The tumor seldom causes pain or interference with function so that even after the patient notices a swelling or a definite lump no attention may be paid to it until it has been increasing in size for months or even over a year, and occult blood stream metastases may already be present. If the tumor is a sarcoma, in the vast majority of cases no matter how circumscribed it may feel, the probabilities are that growth has been by infiltration at the periphery as well as by expansion so that there will be no true capsule. Metastases, when they occur, most commonly go by embolism through the blood stream and rarely travel through the lymphatics to the regional nodes. In the great majority of eases successful treatment means very radical surgery with minimal disturbance of the local tumor. Radical surgery can be deforming and crippling and is a deplorable procedure if the tumor is benign. Since the only way to be certain that a tumor is malignant is by microscopic examination, biopsy should be carried out first. This serves two purposes: Not only does it determine whether the tumor is benign or malignant but it also reveals its histological type and whether it is a primary or secondary growth or some nonneoplastic lesion. Information of this sort is essential if the treatment is to be carried out with intelligence. If the biopsy procedure is done carefully in a relatively bloodless field, the hazard of spreading tumor by cutting into it is slight. This is further minimized by so placing the biopsy wound that the whole wound area can be removed with the tumor if it should prove to be malignant. Cutting out the mass alone without biopsy is to be deplored because this distributes tumor cells widely throughout a large wound area and increases the danger of metastases even if later a more radical removal of the entire wound area is done. Excision without biopsy is only justifiable when a tumor is small and is so situated that sacrifice of a wide clinically free zone all around it can be carried out without causing important crippling and deformity. [SEE TABLE 1 IN SOURCE PDF].
There is little hope of inducing patients to consult doctors at an earlier time for asymptomatic soft tissue tumors. There is hope that physicians and surgeons can be induced to insist on biopsies of deep-seated soft tissue masses and institute an earlier and more intelligent planning of therapy.
