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Leiomyosarcoma: Definition/Diagnosis

What is Leiomyosarcoma?

Leiomyosarcomas are uncommon malignant tumors that grow from immature smooth muscle cells, accounting for up to 20 percent of all soft tissue sarcomas. They appear most often in large blood vessels and the pelvic area, including the uterus, and, to a lesser extent, in the extremities like the thighs. In its metastatic state, leiomyosarcoma most commonly spreads to the bloodstream, lung, and liver. Age is considered a high-risk factor for this disease.  It can affect people of different ages, but the median age is 58 and a half.

Common leiomyosarcoma symptoms

Symptoms of leiomyosarcoma vary depending on the location of the tumors. They frequently cause discomfort, swelling, blood clots, and pain.

Treatments for leiomyosarcoma

Treatments for leiomyosarcoma include:

Surgery:  tumor resection – a surgical operation to remove the tumor, including wide margins beyond the tumor to enhance the potential for a non-recurrence.  Surgery, with as wide a margin of removal as possible, has generally been the most effective and preferred method of treatment for leiomyosarcoma.  If surgical margins are narrow or not clear of tumor, or in some situations where tumor cells were left behind, chemotherapy or radiation have been shown to give a clear survival benefit.  While LMS tends to be resistant to radiation and chemotherapy, each case is different and results can vary widely.

Radiation therapy: Radiation therapy may be used on leiomyosarcoma tumors to destroy cancer cells while working to preserve the function of surrounding organs.

Chemotherapy: Chemotherapy drugs, typically gemcitabine-docetaxel, may be combined to attack and destroy leiomyosarcoma cells. Other possible drugs include trabectedin.

Targeted drug therapy: Targeted drug therapy is directed at specific molecular features of cancer. Pazopanib, an oral therapy approved for leiomyosarcoma, is often combined with chemotherapy and/or radiation therapy as part of a leiomyosarcoma treatment plan.

Immunotherapy: Immunotherapy is a treatment that uses certain parts of your body’s immune system to help fight cancer. On the horizon for LMS.

Tests For Diagnosis

The following tests and procedures may be used to detect and diagnose soft tissue cancer:
  •  Physical exam that includes a check for any signs of disease, including lumps or other abnormalities.
  •  X-ray of the possible area of cancer to look for tumors or to see if there is any spread beyond the cancer’s origin.
  •  Computed tomography (CT) scan, which is a painless, non-invasive way to see inside the body using X-ray imaging. Multiple images taken from different angles create cross-sectional images of soft tissue, organs, blood vessels, and bone. The digital images can be combined to create 3-D pictures.
  •  MRI (magnetic resonance imaging) scan to capture detailed images of the inside of the body.
  • PET (positron emission tomography) scan that is combined with a CT scan to track the possible presence of cancer cells. During the exam, a mildly radioactive substance is injected with a solution of glucose. Cancer cells absorb glucose more quickly than healthy cells and will display on the PET scan.
  • Ultrasound imaging, through which sound waves are used to create a picture of organs, veins, and arteries.
  • Needle biopsy or incisional biopsy where tissue samples are gathered through a needle or surgically through an incision of the skin and checked for cancer cells

DNA damage seen in patients undergoing CT scanning | News Center | Stanford Medicine

Medical Tests used For Soft Tissue Sarcoma / Leiomyosarcoma (LMS)

Medical History and Physical Exam:

  • By now you will have had discussions with your oncologist about your medical history, any recent illnesses, injuries, and new symptoms to especially note, medications you are taking, and family history information.
  • Blood tests – are not used to diagnose soft tissue sarcoma, but rather for signs of disease and assessment of your general health. Blood tests may be used to assess the response to drug treatment.  Abnormal levels of certain chemicals in the blood can also be an assessment of the cancer having spread elsewhere in the body.
  • A comprehensive metabolic panel can include tests for up to 14 chemicals – and abnormal level results can be caused by cancer or other health issues.The metabolic panel involves chemicals in your blood that come from your liver, bone, and other organs.
  • Complete Blood Count and differential – a CBC (complete blood count) measures the number of blood cells in a blood sample, including white blood cells.
  • Imaging Tests: Imaging tests – images taken of the inside of your body, to see where your tumor is located – your primary tumor or the original site of the tumor.

The recommended imaging tests for Leiomyosarcoma:

CT –  (Computed Tomography)  – X-ray beam taking images  from different angles around your body – chest, abdomen, pelvis. Before having at CT scan, you will be asked to drink “contrast” or have it injected in your veins, or both.  It may cause you to feel warm and flushed.  Reactions to this are rare but can happen.  Make sure you are well informed.

MRI –  (Magnetic Resonance Imaging) –  radio waves and powerful magnets ( no X -rays) take images inside your body –  the spine, soft tissues, and abdomen, pelvis areas to check treatment results and potential spread of the disease. Again, contrast may be required for clearer images to result.

PET Scan –  Positron emission tomography) – shows how active your cells are by showing how fast they use a simple form of glucose.  A sugar radiotracer is put in the body by injection into a vein, and it emits a small amount of energy that is detected by the machine that takes the pictures.  Active cancer cells use sugar faster than normal cells so the cancer cells will light up brighter.

NOTE:  Sometimes a PET scan is combined with a CT scan – called a PET/CT scan.

X-Ray –  Uses a small amount of radiation to capture images of the organs and tissue inside the body.  A tumor changes the way radiation is absorbed and will show up on the x-ray.  Chest x-rays are not as effective to find tumors as a CT scan would be.

Ultrasound –  a test that uses sound waves to form images of the inside of the body.

Angiogram –  a test that uses an x-ray to check blood vessels and the flow of blood to detect any blockage or leakage.  Contrast is used – put into a catheter (thin, flexible tube) to assess the blood vessels.  This procedure may cause soreness.  Make sure your doctor goes over this procedure with you.

Information highlights – from the NCCN Guidelines (2020)

Pathology Report

Dr. Alexander J. Lazar is a research pathologist with MD Anderson Cancer Center.  In two videos he explains Understanding a Molecular Pathology Report and The Pathologist’s Role in Sarcoma Care.  Please click the video titles to view them.

Medical Terminology

The National Cancer Institute (NCI) offers a guide to cancer terminology (of which there are 7,857 cancer terms).  The NCI Dictionary is a nice, easy-to-use resource that offers patients and their families assistance in being able to better comprehend medical articles that are read. Medical articles contain unfamiliar medical terminology that can be most challenging. To find medical/cancer terminology, look up terms in the NCI Dictionary of Cancer Terms below: