Leiomyosarcoma Treatment by Metastatic Site
Metastatic Site Treatment
You may already understand that Leiomyosarcoma, LMS, is a form of cancer that appears in the body’s soft tissue, particularly the involuntary muscles. Because this includes all of the blood vessels in the body, it makes it an unpredictable disease that can appear almost anywhere, and which can metastasize in an equally unpredictable manner.
In this article we are going to consider the treatment of LMS once it has metastasized, and how your medical team will treat your condition as systemic issue rather than a local one. There is always a different way of handling systemic illness from a single local tumor, even with something as challenging as LMS. Fortunately, as the experts point out, although, “…The site of the metastasis can be almost anywhere… there are more frequent and less frequent sites of metastatic occurrence.”
LMS experts know that the uterus, trunk of the body, and the limbs are common places. They also know that the liver, lungs, brain and occasionally the bones may be vulnerable to metastatic spread. When it is a primary tumor, surgery is the chosen procedure, and when it is systemic, surgery or ablative treatment is also the norm.
However, one very important factor in the treatment of LMS, in general, is that it is often quite resistant to radiation or chemotherapy, and the most effective treatment is surgical removal or local ablative methods (such as cryosurgery, embolization, hyperthermia, and so on). Most patients are referred to an experienced oncological surgeon rather than general surgeons simply because the work is more complex and due to the fact that wider margins are the norm.
Generally, a patient’s ultimate prognosis is often viewed as being determined by the surgeon who did the initial removal of the LMS tumor. And it is why a specialist or someone whose surgical specialty is related to the location of the LMS tumor(s) is essential. They will understand the need for the use of the widest margins, rather than conservative approaches that can leave dangerous cells behind.
When discussing LMS as a local condition (usually described as the primary tumor), surgeons will have to take margins into consideration. There are “clear” margins and “positive” margins. The clear margins are the large and cancer free areas around a tumor or near the surgically removed tissue. Surgical removal of LMS tumors requires surgeons to create very wide margins because the tumors tend to create “tendrils” that invade healthy tissue.
Positive margins exist when some of the LMS tumor cells remain at the edges of removed tissue. This will necessitate the use of chemotherapy or radiation treatments in order to inhibit spread or destroy the remaining cells.
Metastasis is when a disease spreads. When your LMS is being graded and staged, it is going to be explored for any spread. You will get a more severe staging if it is clear that the condition has metastasized to any other area of the body. To treat LMS that is metastatic, your medical team will first determine if there are many or a few metastatic sites.
When there are a few, the most common approach is the surgical removal of the tumor using the same wider margins. If surgery is not an option, ablation (often followed by chemo or radio therapies) is the norm. When there are many metastatic sites, the condition is viewed as systemic rather than local, and chemotherapy or molecular therapies are the preferred approach.
Metastic Site Breakthroughs
The good news is that there are many aggressive and new treatments for metastatic sites and systemic LMS. In addition to advancements in ablative treatments, there are various chemical therapies being tested and developed as well as new surgical methods. They do vary based on your specific metastatic site, and so choosing an oncological surgeon with a sub specialty in the organs or systems affected (i.e. a lung specialist versus a gynecological, etc.) is a very wise way to get the best treatment.
Leiomyosarcoma.org. General Approach to Treatment of Leiomyosarcoma. 2015. http://www.leiomyosarcoma.info/general.htm