Leiomyosarcoma is a malignancy of smooth muscle cell origin. Muscles can be involuntary (no control of nervous system) and voluntary (under the control of the nervous system) and smooth muscles are involuntary muscles. Smooth muscles are found all over the body, thus leiomyosarcoma can occur in all the parts of the body where these set of muscles are found. These include heart, liver, blood vessels, pancreas, gastrointestinal tract, skin, uterus, genitourinary tract and retroperitoneum. Gastrointestinal tract leiomyosarcoma are now classified as gastrointestinal stromal tumors (GIST). Uterine leiomyosarcoma is the most common among others.
Leiomyosarcoma is also a soft tissue sarcoma. Soft tissues include muscles, fats, nerves, tendons, blood and blood vessels. The exact cause of leiomyosarcoma is yet unknown and there is speculation around its genetic propensity. Leiomyosarcoma affects both males and females in an equal ratio; however, it is more common in adults than in children/adolescents and occurs in 5th or 6th decade of life.
What Is The Prognosis For Leiomyosarcoma?
Leiomyosarcoma is a very rare tumor and it is prevalent only in 1% of American population, so the studies on it to improve treatment and prognosis are limited. Prognosis of the tumor depends on the staging of the tumor along with other factors such as health of the patient, time of diagnosis, and treatment. The staging on leiomyosarcoma is developed by American Joint Committee on Cancer (AJCC), which is as follows:
Stage 1A: Low grade/size less than 5 cm/superficial or deep/no metastasis.
Stage 1B: Low grade/size less or more than 5 cm/superficial/no metastasis.
Stage 2A: Low grade/size less or more than 5 cm/deep/no metastasis.
Stage 2B: High grade/size less than 5 cm/superficial or deep/no metastasis.
Stage 2C: High grade/size less or more than 5 cm/superficial/no metastasis.
Stage 3: High grade/size less or more than 5 cm/deep/no metastasis.
Stage 4: Any grade/any size/any location/metastasis is present.
Low grade tumors that are localized and detected early have really good prognosis for leiomyosarcoma. High grade tumors have a propensity to spread quickly and metastasize, thus they have poor prognosis. The survival window for leiomyosarcoma is 5 year. If the tumor is localized then the five year survival rate is 63%. If the tumor spreads to adjacent lymph nodes, then the survival rate is 36%. If the tumor has metastasized, then the survival rate reduces to 14%. Since, leiomyosarcoma is an aggressive tumor; it is best when detected early and treated with surgical excision and timely follow up. This provides good prognosis for leiomyosarcoma patient with greater chances of survival.
Symptoms of Leiomyosarcoma
The symptoms of leiomyosarcoma depend on the location, size and extent of the tumor. In the early stages, leiomyosarcoma may be non-symptomatic. Pain may or may not be present in the affected area; however, it is not common. The most common symptom is the presence of a growth or a mass in the area. The general symptoms associated with cancer include fatigue, malaise, fever, nausea and vomiting along with weight loss. Other symptoms are specific to the location of the tumor such as in uterine tumor, the symptoms of abnormal uterine bleeding, abnormal vaginal discharge along with change in bowel and bladder habits are perceived. In gastrointestinal tract tumors, the symptoms will include gastrointestinal bleeding that will result in black, tarry and foul smelling stools, abdominal discomfort and hematemesis.
Diagnosis and Treatment of Leiomyosarcoma
A leiomyosarcoma is diagnosed based on the history of the patient, signs and symptoms, clinical evaluation and tests. Tests include blood tests, biopsies, FNAC and imagings (X-rays, ultrasound, CT scan and MRIs). The main aspect of diagnosis is the differentiation of benign tumor from malignant one.
Leiomyosarcoma is managed by oncologists and radiation oncologists. The treatment of leiomyosarcoma highly depends on the staging, grading of the tumor as well as its metastasis along with the age, health and medical condition of the patient. Based upon the above factors, the treatment includes surgical excision of the tumor in adjunct to radiation therapy and the chemotherapy.