Leiomyosarcoma Health Article

Clinical staging, treatments, and prognosis

Staging

The purpose of staging a tumor is to determine how far it has advanced. This is important because treatment varies depending on the stage. Stage is determined by the size of the tumor, whether the tumor has spread to nearby lymph nodes, whether the tumor has spread elsewhere in the body, and what the cells look like under the microscope.

Examining the tissue sample under the microscope, using special chemical stains, the pathologist is able to classify tumors as high grade or low grade. High-grade tumors have the more rapidly growing cells and so are considered more serious.

Tumors are staged using numbers I through IV. The higher the number, the more the tumor has advanced. Stage IV leiomyosarcomas have involved either lymph nodes or have spread to distant parts of the body.

Treatment

Treatment for leiomyosarcoma varies depending on the location of the tumor, its size and grade, and the extent of its spread. Treatment planning also takes into account the patient's age, medical history, and general health.

Leiomyosarcomas on the arms and legs may be treated by amputation (removal of the affected limb) or by limb-sparing surgery to remove the tumor. These tumors may also be treated with radiation therapy, chemotherapy, or a combination of both.

Generally, tumors inside the abdomen are surgically removed. The site, size, and extent of the tumor determine the type of surgery performed. Leiomyosarcomas of organs in the abdomen may also be treated with radiation and chemotherapy.

Side effects

The surgical treatment of leiomyosarcoma carries risks related to the surgical site, such as loss of function resulting from amputation or from nerve and/or muscle loss. There also are risks associated with any surgical procedure, such as reactions to general anesthesia or infection after surgery.

The side effects of radiation therapy depend on the site being radiated. Radiation therapy can produce side effects such as fatigue, skin rashes, nausea, and diarrhea. Most of the side effects lessen or disappear completely after the radiation therapy has been completed.

The side effects of chemotherapy vary depending on the medication, or combination of anticancer drugs, used. Nausea, vomiting, anemia, lower resistance to infection, and hair loss (alopecia) are common side effects. Medication may be given to reduce the unpleasant side effects of chemotherapy.

Alternative and complementary therapies

Many patients explore alternative and complementary therapies to help to reduce the stress associated with illness, improve immune function, and feel better. While there is no evidence that these therapies specifically combat disease, activities such as biofeedback, relaxation, therapeutic touch, massage therapy, and guided imagery have been reported to enhance well-being.

Prognosis

The outlook for patients with leiomyosarcoma varies. It depends on the location and size of the tumor and its type and extent of spread. Some patients, such as those who have had small tumors located in or near the skin surgically removed, have excellent prognoses. Their 5-year survival is greater than 90%. Among patients with leiomyosarcomas in organs in the abdomen, survival is best when the tumor has been completely removed. In general, high-grade tumors that have spread widely throughout the body are not associated with favorable survival rates.

Coping with cancer treatment

Fatigue is one of the most common complaints during cancer treatment and recovery. Many patients benefit from learning energy-conserving approaches to accomplish their daily activities. They should be encouraged to rest when tired and take breaks from strenuous activities. Planning activities around times of day when energy is highest is often helpful. Mild exercise, small, frequent nutritious snacks, and limiting physical and emotional stress also help to combat fatigue.

Depression, emotional distress, and anxiety associated with the disease and its treatment may respond to counseling from a mental health professional. Many cancer patients and their families find participation in mutual aid and group support programs helps to relieve feelings of isolation and loneliness. By sharing problems with others who have lived through similar difficulties, patients and families can exchange ideas and coping strategies.

Clinical trials

Several clinical studies were underway as of 2001. For example, doctors at Memorial Sloan-Kettering Cancer Center were using specific chemotherapeutic drugs to treat patients with leiomyosarcoma that cannot be removed by surgery or has recurred. These drugs, gemcitabine, docetaxel, and filgrastim (G-CSF), work by stopping tumor cells from dividing, so they cannot grow. To learn more about this clinical trial and the availability of others, patients and families may wish to contact Memorial Sloan-Kettering Cancer Center at (212) 639-6555, or visit the National Cancer Institute (NCI) web-site at <http://cancertrials.nci.nih.gov>.