Leiomyosarcoma: A Brief Note
Leiomyosarcoma is a rare type of malignant tumor/cancer affecting the smooth muscle. They grow from immature smooth muscle cells and later invade into the mature cells. It is a type of soft tissue sarcoma mostly occurring in adults and they can affect any tissue such as large blood vessels, pelvis, uterus, thighs and gastrointestinal tract. It is known to affect mostly adults in the age group of 65-70s. If metastasis occurs it can spread to the bloodstream, lung and liver.
What Is The Treatment For Leiomyosarcoma?
Since leiomyosarcoma tumors are very rare they need a team of multispecialty doctors in a specialized center. Surgery is the mainstay of treatment in combination with radiation therapy and chemotherapy.
Local control of soft tissue sarcoma is done by resecting or removing the tumor with special care taken of the infected margins (by use of wide surgical margins) of the tumor, which may cause recurrence of the tumor.
Radiotherapy is important as it can provide local control of the leiomyosarcoma where surgical margins are very close, especially in advanced tumors or high grade tumors where extensive metastasis has occurred. It can be given preoperatively, which is also known as neoadjuvant therapy or postoperatively, which is known as adjuvant therapy.
Chemotherapy is usually done for metastatic tumors. It does not cure the leiomyosarcoma, but helps in preventing progression of the disease. The agents used in chemotherapy are doxorubicin, ifosfamide, gemcitabine and ecteinascidin. Preoperative chemotherapy has been known to shrink tumors and help in better surgical outcomes.
Signs and Symptoms of Leiomyosarcoma
The signs and symptoms of leiomyosarcoma can vary from person to person depending upon their location, size and spread of the tumor. For instance in the early stage, a person can be asymptomatic (without any obvious symptoms of sarcoma). While a person with an advanced disease may have symptoms of fever (high to low grade), fatigue (generalized weakness), sudden weight loss, nausea, vomiting and malaise (feeling of being in ill health).
Pain is an uncommon symptom but can occur sometimes associated with the site of disease. Swelling is present as a mass in the region of affected area. Leiomyosarcoma in the gastrointestinal tract can cause tarry (black colored) foul smelling stools known as melena. Hematemesis or vomiting of blood and discomfort in the abdomen is usually present. A tumor in the uterus will manifest as abnormal uterine bleeding, which is usually associated with vaginal discharge and altered bladder and bowel habits.
Leimyosarcomas are aggressive form of tumors that spread very rapidly into other body parts such as lungs and liver and can lead to life threatening complications, which can prove to be fatal if the tumor is not diagnosed early with effective treatment. It also has rate of recurrence if not treated in the early stages.
The exact cause of leiomyosarcoma is not known, but studies suggest that it may be affected by genetic factors (a person affected with leiomyosarcoma in a family will be more prone to it). The presence of oncogenes (cancer causing genes) and dysfunction of tumor suppressor genes will lead to uncontrolled growth of cells. A research suggests that a defect lies in the DNA (deoxyribonucleic acid) of a person, which is the carrier of their genetic code. However, these abnormal genetic changes may occur spontaneously leading to malignant change in the normal cells.
Diagnosis for Leiomyosarcoma
A diagnosis of leiomyosarcoma is based on a person’s detailed history, thorough clinical tests and biopsy (microscopic examination of tissue) of the part of tumor. It is also important to differentiate a leiomyoma (benign tumor) from a leiyomyosarcoma (malignant tumor) for better treatment options. A diagnosis of leiomyosarcoma is confirmed by FNAC (fine needle aspiration cytology) in which a thin hollow needle is inserted into the mass to take a small sample of the tissue. The sample is then sent to a pathology lab for histopathologic studies under a microscope. Other techniques such as CT scan, MRI and X-rays can help to evaluate the size, spread and location of the tumor.