Is There A Surgery For Myxofibrosarcoma?
Yes, surgery is the main modality that is used to treat myxofibrosarcoma (MFS), along with surgery radiotherapy and or chemotherapy is given according to the stage and grade of the tumor.
The treatment modality and what specific treatment should be carried out depend on several factors:
Size Of The Tumor. A tumor more than 5cm in length, depth and width needs extensive surgery and sometimes radiotherapy and/or chemotherapy before and/or after surgery.(2)
Depth. Tumors in between muscle layers are more aggressive.
Grades. There 3 grades:
- Low – contains mainly inactive cells, actively dividing cells are much less and there aren’t any dead cells present in this grade. These tumors are the least aggressive tumors out of the 3 categories.
- Intermediate – actively dividing cells are found more in intermediate grade lesions.
- High – contain excessive numbers of actively dividing cells along with dead cells.
Previous Treatment. myxofibrosarcoma has an increased risk of local recurrence, the tumor that arises for the second time is usually aggressive and at a higher grade.(2)
The goal of myxofibrosarcoma surgery is to remove the tumor completely along with 1-2cm of normal tissue surrounding the tumor to make sure that all cancer cells are removed.
After the removal of the tumor, the pathologist examines it under the microscope to check if the edges of the tumor contain cancer cells.
Positive Margins – if cancer cells are present in the edges of the removed specimen then it’s labeled as positive margins. That means cancer cells might have been left behind after surgery therefore; further treatment with second surgery or radiotherapy might be needed to completely remove the cancer cells.(1)
Negative Or Clear Margins – if there are not any cancer cells present in the edges of the removed specimen it’s labeled as negative or clear margins. The cancer is completely removed and there is very little chance for a recurrence. Further treatment is not needed since all cancer cells are removed.(1)
Sometimes it will be difficult to remove all cancer cells or have removed a margin of normal tissue if the tumor is located near a blood vessel or a vital organ.
Limb-Sparing Myxofibrosarcoma Surgery
Myxofibrosarcoma that are located in the limbs is removed with a 1-2cm of normal tissue without amputation of the limb. This surgery is commonly done nowadays and an implant or a tissue graft is used to replace the tissue that is removed. Radiotherapy might be needed after surgery.
Amputation. Earlier amputation of the whole limb was carried out for myxofibrosarcoma in an extremity. But now it’s done only in circumstance where limb amputation is unavoidable. If cancer involves the blood vessels, nerves, muscles then removing only the tumor would not be sufficient and without the key nerves, blood vessels and muscles the limb would not function normally. Therefore, in this circumstance, the whole limb is removed to avoid chronic pain and recurrence of myxofibrosarcoma.(1)
Lymph Node Dissection. If the lymph nodes near the tumor are swollen cancer might have spread to those lymph nodes. So, the swollen nodes can be removed and send to the lab to check if cancer cells are present. If it’s positive then radiotherapy is needed.(1)
Surgery For Myxofibrosarcoma At An Advanced Stage. If myxofibrosarcoma has spread to distant sites such as the lungs then if all tumors can be removed surgically (if only a few isolated lesions in the lungs) then surgery is carried out to remove the primary tumor and other distant lesions. Additional radiotherapy or chemotherapy might be needed. If all lesions cannot be removed surgically and if the cancer is an advanced stage then surgery is not carried at all instead chemotherapy and radiotherapy is carried out.
Conclusion
Surgery is the main treatment modality for myxofibrosarcoma, along with surgery additional radiotherapy and/or chemotherapy is needed. The treatment modality depends on the size, grade, and depth of the tumor and if previous treatment was given. The main surgical methods are limb-sparing surgery or amputation of a limb, surgical removal of all lesions in an advanced stage and lymph node dissection.
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