A sarcoma is a rare type of cancer that arises from cells of mesenchymal origin. Originating from mesenchymal cells means that sarcomas are cancers of connective tissues such as bone, cartilage, muscle, fat, or vascular tissues. Sarcomas are one of five different types of cancer, classified by the cell type from which they originate. While there are five types under this category, sarcomas are most frequently contrasted with carcinomas which are much more common. Sarcomas are quite rare, making up about 1% of all adult cancer diagnoses and 15% of childhood cancer diagnoses. There are many subtypes of sarcoma, which are classified based on the specific tissue and type of cell from which the tumor originates. Common examples of sarcoma include liposarcoma, leiomyosarcoma, and osteosarcoma. Sarcomas are primary connective tissue tumors, meaning that they arise in connective tissues. This is in contrast to secondary (or "metastatic") connective tissue tumors, which occur when a cancer from elsewhere in the body (such as the lungs, breast tissue or prostate) spreads to the connective tissue. The word sarcoma is derived from the Greek σάρκωμα sarkōma 'fleshy excrescence or substance', itself from σάρξ sarx meaning 'flesh'.
Classification
Sarcomas are typically divided into two major groups: bone sarcomas and soft-tissue sarcomas, each of which has multiple subtypes. In the United States, the American Joint Committee on Cancer (AJCC) publishes guidelines that classify the subtypes of sarcoma. These subtypes are as follows:
Subtypes of bone sarcoma Osteosarcoma Chondrosarcoma Poorly differentiated round/spindle cell tumors (includes Ewing sarcoma) Hemangioendothelioma Angiosarcoma Fibrosarcoma/myofibrosarcoma Chordoma Adamantinoma Other: Liposarcoma Leiomyosarcoma Malignant peripheral nerve sheath tumor Rhabdomyosarcoma Synovial sarcoma Malignant solitary fibrous tumor.
Subtypes of soft-tissue sarcoma Liposarcoma (includes the following varieties: atypical lipomatous tumor/well-differentiated liposarcoma, dedifferentiated liposarcoma, myxoid sarcoma, pleomorphic liposarcoma, and myxoid pleomorphic liposarcoma Atypical lipomatous tumor Dermatofibrosarcoma protuberans (includes pigmented varieties) Dermatofibrosarcoma protuberans, fibrosarcomatous Giant cell fibroblastoma Malignant solitary fibrous tumor Inflammatory myofibroblastic tumor Low-grade myofibroblastic sarcoma Fibrosarcoma (includes adult and sclerosing epithelioid varieties) Myxofibrosarcoma (formerly myxoid malignant fibrous histiocytoma) Low-grade fibromyxoid sarcoma Giant cell tumor of soft tissues Leiomyosarcoma Malignant glomus tumor Rhabdomyosarcoma (includes the following varieties: embryonal, alveolar, pleomorphic, and spindle cell/sclerosing) Hemangioendothelioma (includes the following varieties: retiform, pseudomyogenic, and epithelioid) Angiosarcoma of soft tissue Extraskeletal osteosarcoma Gastrointestinal stromal tumor, malignant (GIST) Malignant peripheral nerve sheath tumor (includes epithelioid variety) Malignant Triton tumor Malignant granular cell tumor Malignant ossifying fibromyxoid tumor Stromal sarcoma not otherwise specified Myoepithelial carcinoma Malignant phosphaturic mesenchymal tumor Skin sarcomas Synovial sarcoma (includes the following varieties: spindle cell, biphasic, and not otherwise specified) Epithelioid sarcoma Alveolar soft part sarcoma Clear cell sarcoma of soft tissue Extraskeletal myxoid chondrosarcoma Extraskeletal Ewing sarcoma Interdigitating dendritic cell sarcoma Desmoplastic small round cell tumor Extrarenal rhabdoid tumor Perivascular epithelioid cell tumor, not otherwise specified Intimal sarcoma Undifferentiated spindle cell sarcoma Undifferentiated pleomorphic sarcoma Undifferentiated round cell sarcoma Undifferentiated epithelioid sarcoma Undifferentiated sarcoma, not otherwise specified.
Signs and symptoms Symptoms of bone sarcomas typically include bone pain, especially at night, and swelling around the site of the tumor. Symptoms of soft-tissue sarcomas vary, but they often present as firm, oftentimes painless lumps or nodules. Gastrointestinal stromal tumors (GIST, a subtype of soft-tissue sarcoma) often are asymptomatic, but can be associated with vague complaints of abdominal pain, bleeding into the intestines, a feeling of fullness, or other signs of intestinal obstruction.
Cause
Causes and risk factors The cause of most bone sarcomas is not known, but several factors are associated with an increased risk of developing bone sarcoma. Previous exposure to ionizing radiation (such as prior radiation therapy) is one such risk factor. Therapeutic radiation is associated with sarcoma after 10 to 20 years. Exposure to alkylating agents, such as those found in certain cancer chemotherapeutic medicines, also increases the risk of bone sarcoma. Certain inherited genetic syndromes, including Li-Fraumeni syndrome, inherited RB1 gene mutations, and Paget's disease of bone are associated with an increased risk of developing bone sarcomas. Most soft-tissue sarcomas arise from what doctors call "sporadic" (or random) genetic mutations within an affected person's cells. Nevertheless, there are certain risk factors associated with an increased risk of developing soft-tissue sarcoma. Previous exposure to ionizing radiation is one such risk factor. Exposure to vinyl chloride (e.g., such as the fumes encountered in the production of polyvinyl chloride (PVC)), arsenic and Thorotrast all are associated with an increased risk of angiosarcoma. Lymphedema, such as that resulting from certain types of breast cancer treatment, also is a risk factor for development of angiosarcoma. As with bone sarcomas, certain inherited genetic syndromes also are associated with an increased risk of developing soft-tissue sarcoma, including Li-Fraumeni syndrome, familial adenomatous polyposis, neurofibromatosis type 1, and heritable RB1 gene mutations. Kaposi sarcoma is caused by Kaposi sarcoma-associated herpesvirus (HHV-8).
Mechanisms The mechanisms by which healthy cells transform into cancer cells are described in detail elsewhere (see Cancer main page; Carcinogenesis main page). The precise molecular changes that result in sarcoma are not always known, but certain types of sarcomas are associated with particular genetic mutations. Examples include:
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