Clinical evaluation of soft tissue tumors

CLINICAL ASSESSMENT

Clinical evaluation of soft tissue tumors begins with the history and physical examinationIt is important to determine the function of adjacent joints, nerves and vessels. 

Xrays (roentgenograms)  have limited value. Nevertheless this limited value can be suprisingly useful sometimes - soft tissue shadows are isodense with muscle, soft tissue osteosarcoma are preferably diagnosed with xrays, phleboliths are seen in haemangiomas, cartilaginous juxta-articular masses are seen in synovial chondromatosis, mature ossification in myositis ossificans, amorphous calcium in tumoral calcinosis and bone effects like erosion, periosteal reaction and bone remodelling are best appreciated on xrays (and CT scans).

Magnetic resonance imaging is valuable for pre-operative staging, excluding differential diagnoses, biopsy and surgical planning, response to neoadjuvant treatment and determining recurrence.

Ultrasound scans are especially useful for differentiated benign from malignant in small tumors through blood flow studies.

Computed Tomography chest scans are done routinely although abdomen and pelvis scans are used for myxoid liposarcomas and round cell liposarcoma (ieintermediate grade).

Other scans may be necessary depending on the given tumour and are not considered routine. These include FDG-PET, angiograms and additional CT scans.

BIOPSY

This is covered elsewhere on this site. It is our prefence to do biopsies in the clinic as these can be up to 10 times cheaper than doing them in the operating theatre.

STAGING

Following the clinical evaluation, one should have some idea of how advanced the tumor is and this is expressed as it's stage. Staging systems are varied but generally the AJCC system is preferred today (Figure 1).

Figure 1. The three common staging systems for soft tissue tumors are described here with the American Joint Committee on Cancer (AJCC) system being the most prefered.