Leiomyosarcoma


Leiomyosarcoma is a rare malignancy of the smooth muscles. The National Institutes of HeaIth in the US considered this be a rare condition because there are less than 200,000 cases in America [1, 2].

What is Leiomyosarcoma?

Sarcomas are malignancies of the soft tissues of the body and leiomyosarcoma is the cancer of the smooth muscles. Muscles are differentiated as voluntary and involuntary depending if the brain has conscious control over it. Smooth muscles are under the involuntary type because the brain has no control on their reaction to different stimuli. Examples of places where smooth muscles are the skin, digestive tract lining and salivary glands. Since this type of muscle is found I the entire body, a leiomyosarcoma can start anywhere in the body. The most common location for this malignancy to develop are the abdominal cavity, gastrointestinal tract and the uterus [1, 2, 3].

This type of malignancy is more commonly found in those who are aged 50 and above. The survival rate for this condition have greatly improved since the 1970’s wherein early detection of the condition gives the best possible outcome. The 3-year survival rate for leiomyosarcoma is currently at 50% while the 5-year survival rate is at 64% [1, 2, 3]. Figure 1 shows an example of leiomyosarcoma in the extremity.

Leiomyosarcoma image


Figure 1- Leiomyosarcoma


Staging

The American Joint Committee on Cancer has developed the staging for leiomyosarcoma [4].

Stage IA – The tumor is less than 5cm in diameter and it is either superficial or deep to the fascia. No metastasis have been identified.
Stage IB – The mass is greater than or equal to 5cm in diameter and attaches superficially to the fascia. No evidence of metastasis is seen.
Stage IIA – Cancer growth is greater than or equal to 5cm in diameter and has deep attaches to the involved muscle. The mass is still confined to the muscle.
Stage IIB – Leiomyosarcoma is smaller than 5cm in size and is either embedded superficially or deep into the muscle. No sign of metastasis has been seen.
Stage IIC – Tumor growth is equal or larger than 5cm in diameter and attaches superficially. It is still confined to its original location.
Stage III – The sarcoma can be equal or larger than 5cm in diameter and the attachment is deep to the muscle. Metastasis to other organs is not present.
Stage IV – Key characteristic of a stage IV leiomyosarcoma is the metastasis to other organs. It can be of any size but it has already spread to other organs.


Causes

Similar to other malignancies, the direct cause of leiomyosarcoma is yet to be identified. One of the factors being investigated are abnormal structural changes of tumor suppressing genes or oncogenes. These cells controls the division of cells and ensure that they die at the right time. Abnormalities in these cells may lead to uncontrolled cell growth. It may occur spontaneously or it may be inherited [2, 4].

Signs and Symptoms

The symptoms that are experienced depends on the part that is affected. Those that experienced during the early stages are general symptoms that are associated with cancer and these include weight loss, fatigue, fever, nausea and vomiting. Pain may be present but this is uncommon. If the leiomyosarcoma developed in the gastrointestinal tract, the patient may have black, tarry stools as a result of bleeding in the tract. Leiomyosarcoma of the uterus may cause abnormal bleeding and discharge. A change in the bladder and bowel habit may also be experienced [2, 3, 4].

Diagnosis

Health history and physical examination

The patient may seek consultation due to either the presence of symptoms or after feeling a lump or swelling. The physician will elicit information regarding the symptoms and perform a physical examination to identify the cause of the symptoms [2, 3, 4].


Imaging tests

Since around 50% of all the cases of leiomyosarcoma involves the abdominal cavity, tests such as CT scans and MRI scans will aid the physician to identify the full extent of the mass and stage the malignancy. It is also beneficial in identifying the presence of metastasis or to verify the possibility of a surgical intervention [1, 2, 4].

Biopsy

Performing a biopsy is invaluable because it will be able to distinguish this aggressive malignancy to its more benign counterpart, the leiomyoma. In this procedure, a tissue sample is obtained from the tumor growth and examined using a microscope. This test will identify the cellular structure of the mass and identify its type [1, 2, 4].

Treatment

Surgery

The treatment of choice for leiomyosarcoma is surgically removing the tumor along with a margin of healthy cells to ensure that no cancer cells remain. However, this option is dependent on the on the location, size and potential metastasis of the tumor. Its location may also entail a need for a reconstructive surgery after removing the tumor [1, 2, 4].

Radiotherapy

If performing a surgery is not feasible due to its size or location, a physician may advise a radiation therapy. In this method, high energy beams eliminate fast-dividing cells. Because of its potential adverse effect to other healthy cells of the body, the machine that produces the beams calculate the dosage that is required and focusing it to the tumor. The result will either be a decrease in size or elimination of the tumor [2, 3, 4].

Chemotherapy

A chemotherapy may be recommended for those who are diagnosed with advance types of leiomyosarcoma. In this treatment, anticancer drugs are either taken orally or injected intravenously to the patient. This will eliminate the cancer cells and may cause shrinking of the tumor. Because of the limited success of only using radiation therapy or chemotherapy in treating leiomyosarcoma, they are done in combination with the surgical procedure. They may be performed before or after the surgery to ensure that the tumor can be excised and no cancer cells will be left behind [1, 2, 3, 4].

Prognosis and Survival Rate

The outcome of patients diagnosed with leiomyosarcoma depends on some factors. These factors include the progression of the disease upon diagnosis, leiomyosarcoma grade, the treatment received by the patient and the state of health of the patient during the treatment process.

The 5-year survival rate for a localized tumor of this type is about 63%. If the malignancy have spread to adjacent lymph nodes and tissues, the survival rate drops to 36%. When leiomyosarcoma have already spread to distant organs and lymph nodes, the survival rate further to 14%. This include stage IVA and IVB tumors
References

  • The Meyer Law Firm, PC. (2015). Leiomyosarcoma Incidence and Statistics. Retrieved from Leiomyosarcoma.org: http://www.leiomyosarcoma.org/statistics/
  • Brennan, M., & Schmidt, B. (2012). Leiomyosarcoma. Retrieved from National Organization for Rare Disorders: http://rarediseases.org/rare-diseases/leiomyosarcoma/
  • Web MD. (2015, May 28). Leiomyosarcoma. Retrieved from Web MD: http://www.webmd.com/cancer/leiomyosarcoma-general
  • Weaver, M. J., & Abraham, J. (2007, April). An Introduction to Leiomyosarcoma of the Bone and Soft Tissue. Retrieved from Sarcoma Help: http://sarcomahelp.org/leiomyosarcoma.html

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