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.
Stage 1: (1A / 1B grade) Primary Treatment
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)
Follow up Care: 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 heath
are always taken into consideration in treatment
options to be considered.
Primary Treatment Options
Surgery following radiation therapy
Radiation followed by surgery
Follow Up Care: 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.
STAGE 3 Primary Treatment Options
(Stage lllA or lllB
grade 2 – 3) Surgery followed by radiation therapy /
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
Follow-Up Care: Same as Stage 2 indicated above
STAGE 4 Primary Treatment Options
Treatment as indicated for stages 2 or
Surgery to remove metastases with or
without chemotherapy before or after
surgery; with or without radiation
therapy – such as Ablation, SBRT,
embolization, other modalities;
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
WIDESPREAD Primary Treatment Options:
Chemotherapy, radiation therapy /SBRT
surgery. Observation if no symptoms
Same as indicated for Stage 4 above
R E C U R R E N C E
Location: Treatment Options:
Local testing; treatment based on
stage (extent of disease)
More treatment as listed above
Isolated Regional disease
or lymph nodes Regional node dissection with
or without radiation therapy,
with or without chemotherapy
Isolated limb infusion/per-
fusion plus surgery
Widespread Palliative chemotherapy
Palliative radiation therapy
SBRT, ablation, embolization.
Observation if no symptoms
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.