Liposarcoma Symptoms and Treatment

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Cancer 101: Cancer Explained

A diagnosis of liposarcoma and its treatment made Mayor Rob Ford, the controversial former mayor of Toronto, decide to take his name out of the running for the election for Toronto's mayor in 2014. The disease caused his death on Tues., Mar. 22, 2016. His disease and death at age 46 has stimulated further interest in liposarcoma, especially pleomorphic liposarcoma, a relatively rare cancer that is difficult to treat because the tumors are usually found or diagnosed when the disease is advanced.

Liposarcoma causes

Liposarcoma cancer cells are similar to fat cells but are thought to develop from deeper fat tissues instead of superficial fat cells beneath the skin or mucous membranes. Although liposarcomas may develop almost anywhere in the body, most develop in the abdomen and limbs. Liposarcomas are rare; they represent less than 1% of all newly diagnosed cancers. Although it is not known what triggers the development of liposarcomas, they are usually noted after trauma when a "hard lump" develops and remains.

Liposarcoma vs. lipoma

Liposarcomas do not develop from common lipomas, which are benign tumors of fat cells.

Liposarcoma symptoms and signs

Many liposarcoma patients do not feel sick initially so the patients seek help only late in the disease process when other symptoms arise. Symptoms depend on the location of the tumor and the extent to which it has spread in the body. Symptoms and signs that may occur later in the disease can include

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Diagnosis of liposarcoma

Many patients with liposarcoma will complain of a mass that they can feel; the mass can be soft and fleshy or even firm to palpation. The diagnosis usually requires standard X-rays that will help show whether or not any bony elements are involved; however, an MRI is usually obtained and may help suggest a diagnosis that must be confirmed by a biopsy. For many individuals, a chest CT is done because the chest is the most common site of metastasis (spread) of liposarcomas.

Liposarcoma types

There are five subtypes of liposarcoma now recognized by WHO (World Health Organization):

  • The most common type is termed well-differentiated liposarcoma (about 50% of sarcomas).
  • The next type is termed myxoid (resembling mucus).
  • Round cell liposarcoma is an intermediate grade of fat-cell cancers that includes round-cell variants and is the most common type of liposarcoma in children and teens.
  • A rare type is termed pleomorphic (meaning the cancer cells look different in size and shape) liposarcoma and makes up only about 5%-10% of liposarcomas; this type can be very aggressive.
  • The last type is termed combined, mixed-type, or dedifferentiated liposarcoma, which is a high-grade sarcoma with an increased risk of metastasis.

Liposarcoma stages

Once the tumor has been typed, it is usually staged to determine the extent of spread of the tumor at the time of diagnosis. The stages range from IA, IB, IIA, IIB, to III, with III representing the most extensive cancer with metastatic spread.

Liposarcoma treatment

The treatment of liposarcoma is mainly surgical, with the goal to remove the tumor entirely and prevent its recurrence (achieving a cure) by removing all of the tumor cells. In the past, amputation was the surgical option for these tumors in the limbs; currently, tumors that occur in limbs only require about 5% of patients to undergo amputation. Tumor removal by surgery in other areas of the body is the treatment of choice for liposarcomas. However, many patients are treated by a combination of surgery and radiation therapy. In fact, some patients are given radiation therapy before surgery to shrink the tumor.

Chemotherapy in the treatment of liposarcoma is controversial, and experts in the field consider the question of chemotherapy for liposarcoma to be best addressed on a case-by-case basis; some investigators consider chemotherapy of liposarcomas to be experimental. Because liposarcomas are relatively rare, your doctor should be a specialist with experience treating sarcomas.

Chemotherapy has been done (for example, using anthracycline drugs) without great success. For unresectable (cannot be treated by surgery) or metastatic liposarcomas, trabectedin (Yondelis) and eribulin mesylate (Halaven) were recently approved by the U.S. Food and Drug Administration (FDA) to treat the disease in patients who had received a prior anthracycline-based chemotherapy regimen, as both these drugs showed an improvement in progression-free survival as compared to other drugs.

Liposarcoma prognosis and survival rate

The prognosis of liposarcomas varies with the type and location of the tumors. Extremity tumors that are appropriately treated have a good prognosis as do the well-differentiated types and myxoid type tumors. However, round-cell and poorly differentiated cell types have a poor prognosis with a survival rate of about 50% over five years.

As stated previously, if any mass or lump is noticed near or at a site of trauma, or if you develop any of the late symptoms of a liposarcoma described above, you should contact your doctor immediately. Many conditions other than malignant tumors can cause a mass or lump, and it is important to find out the cause so that appropriate treatment can be given.

REFERENCE:

Schwartz, Robert A. "Liposarcoma." Medscape.com. Feb. 4, 2016. <http://emedicine.medscape.com/article/1102007-overview>.


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Reviewed on 4/7/2017

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