Surgical Procedures: Surgery and Staging for Soft Tissue Sarcomas

Soft tissues make up key parts of our body. Muscles, tendons, fat, blood and/or lymph vessels, nerves and the tissue surrounding bony joints, fibrous tissue, and deep skin tissues are all made up of soft tissue. When cancerous cells form within these areas, it is called a soft tissue sarcoma (STS). There are over 50 types of sarcomas, which are classified and named based on the type of tissue in which they started. You can learn more about the types of sarcoma on OncoLink. 

What is staging and how is it performed? 

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For STS, these tests may be: 

Physical Exam:  This is an exam to look at your body and to talk about your past health issues. 

Imaging: Radiology tests can look inside your body to look at the cancer and see if it has spread. These tests can include:  

• Chest X-Ray, general X-Ray.  
• CAT scan (CT scan). 
• Positron emission tomography scan (PET scan).  
• Magnetic resonance imaging (MRI). 
• Ultrasound.  

Procedures:  These may include: 

• Incisional biopsy:  A small part of tumor or abnormal tissue is removed for testing. 
• Fine needle aspiration (FNA): A thin needle removes a piece of the suspicious tissue. This may be done using an ultrasound or CT scan to help guide your provider.
• Core biopsy:  A larger piece of tissue is removed with the use of a thick needle. As with an FNA, this may be done with an ultrasound or CT scan to guide your provider. 
• Excisional biopsy: The entire tumor is removed.

In some cases, lymph nodes or other tissues that appear abnormal may also be tested. Your healthcare provider will discuss the need for more tissue testing with you. The biopsy samples are taken to the lab where they are looked at under a microscope by a pathologist (a doctor that specializes in looking at tissues). The samples may have more testing to help identify the type of STS. This information is then reported in a pathology report that is sent to your healthcare provider. 

Staging of soft tissue sarcoma is determined by many factors, including: 

• Tumor grade (how abnormal it appears under a microscope). 
• Tumor size. 
• How close it is to the surface of the skin (superficial or deep). 
• Lymph node involvement. 

Soft tissue sarcomas are described as stages I-IV, based on the above findings. Your healthcare team will discuss with you in greater detail the stage of the STS. 

Surgical Procedures Used in the Treatment of STS 

Surgery can be used to treat some cases of STS. The type of surgical procedure will depend on several factors, including the size and location of the cancer. Your surgeon will talk to you about your procedure, based on your situation. 

Some common surgical procedures to treat STS include: 

• Mohs microsurgery:  The removal of thin layers of the skin until cancer is no longer seen under the microscope. This is reserved for visible skin lesions. 
• Wide local excision:  Removal of the tumor and part of the normal-appearing tissue that surrounds the cancer, trying to leave a “clean margin” of cancer-free tissue. 
• Limb-sparing surgery:  This procedure is used to keep as much of the limb’s function as possible, and to help save the appearance of the affected limb. Only the bone and tissue affected by the sarcoma is removed, to avoid amputation. During the surgery, the cancerous bone and tissue is removed and replaced with bone and tissue grafts and/or artificial bone implants or other material. 
• Amputation:  Removal of part of or all of the affected limb. 
• Lymphadenectomy:  Removal of lymph nodes to test them for cancer. 

More surgical procedures may be used depending on the location of the STS, your health and other factors. 

What are the risks associated with surgery to treat STS? 

As with any surgery, there are risks and possible side effects. These can be: 

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure). 
•  Bleeding. 

• Blood clots. 
• Infection. 
• Urinary retention (not being able to urinate normally).  

Before surgery, your surgeon will talk to you about any other risks based on your health and the specific surgery you are having.  

What is recovery like? 

Recovery from surgery to treat a STS will depend on the type of procedure you had. A hospital stay and rehabilitation services may be needed. 

You will be told how to care for your surgical incisions and will be given any other instructions before leaving the hospital. 

Your medical team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions. 

Your healthcare provider will discuss your activity restrictions, which will depend on the surgery you have had. They will also discuss whether or not you will need rehabilitation and provide instructions on when to contact the office. 

How can I care for myself? 

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity. 

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms. 

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.  

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense. 

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders. 

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.