STAGING LMS TUMORS
How is Leiomyosarcoma Staged?
- T stands for the size of the tumor.
- N stands for spread to lymph nodes (small bean-shaped collections of immune system cells found throughout the body that help fight infections and cancers).
- M is for metastasis (spread to distant organs).
- Differentiation — cancer cells are given a score of 1 to 3, with 1 being assigned when they look similar to normal cells and 3 being used when the cancer cells look very abnormal
- Mitotic count — how many cancer cells are seen dividing under the microscope; given a score from 1 to 3 (a lower score means fewer cells were seen dividing)
- Tumor necrosis — how much of the tumor is made up of dying tissue; given a score from 0 to 2 (a lower score means there was less dying tissue present).
STAGING THE TUMOR ONCE IT IS FOUND:
From the NCCN Guidelines for Patients (2018)
- Case Dependent guidance to discuss with your Oncology Care team.
Note: Treatment Planning is important in the first steps of care. All such planning is customized always case-specific – it is not a “one size fits all” situation. Being proactive in your care is important- which means knowing as much as you can, and asking the right questions along the way.
NOTE: For Quality of Life maintenance/rebuilding: Discuss Integrative Medicine & Survivorship Care Planning with your Oncologist – the sarcoma center may have a wealth of supportive resources available in a dedicated survivorship clinic, with program resources available patients and their families.
|Stage||Primary Treatment Options||Follow Up Care|
Stage 1: (1A/1B grade)
Low-Grade tumor Surgery. Recommendations for more treatment is based on size of margin is 1 cm or less and if the fascia was cut. Clean margins around the tumor site (always the goal)
Will begin when treatment is completed. Rehabilitation if needed Imaging – CT Scan, CT/PET scan Note: CT scan for lung surveillance is best Genetic test of the tumor Regular imaging of primary tumor site Follow up appointments with blood work done
STAGE 2: (2 – 3 Grade)
Treatment options are based on whether surgery is possible. Location, size of tumor and overall health are always taken into consideration in treatment options to be considered. Primary Treatment Options: Surgery, Surgery following radiation therapy, Radiation followed by surgery
Rehabilitation if needed Regular Imaging - CT scans, CTG/PET Scans to check for tumor metastasis: usually 3 - 6 months for 2 – 3 years; then every 6 months for 2 years; then repeat every year.
Primary Treatment Options (Stage lllA or lllB grade 2 – 3) Surgery followed by radiation therapy /Adjuvant chemotherapy. Chemotherapy or radiation therapy followed by surgery; then radiation therapy boost with or without adjuvant chemo. Chemotherapy followed by surgery, then Radiation therapy with or without adjuvant chemotherapy.
Same as Stage 2 indicated above
Stage 4 (confined)
Primary Treatment Options: Treatment as indicated for stages 2 or 3 apply. Surgery to remove metastases with or without chemotherapy before or after surgery; with or without radiation therapy – such as Ablation, SBRT, embolization, other modalities; observation
Rehabilitation if needed Imaging tests for surveillance same cycles as indicated for Stages 2 and 3. Consider baseline and regular imaging of primary tumor site
STAGE 4 (WIDESPREAD)
Primary Treatment Options: Chemotherapy, radiation therapy /SBRT surgery. Observation if no symptoms
Same as indicated for stage 4 above
testing; treatment based on stage (extent of disease) More treatment as listed above
Regional disease or lymph nodes Regional node dissection with or without radiation therapy, with or without chemotherapy SBRT Isolated limb infusion/per- fusion plus surgery
Palliative chemotherapy, Palliative radiation therapy SBRT, ablation, embolization. Observation if no symptoms