3. OUTLINE
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After completion of the practice teaching the
participants will be able to :
Introduction
Definition of Sarcoma
Incidence
Types of sarcoma
Etiology
Clinical manifestation
4. Contd.
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Pathophysiology of sarcoma
Assessment and diagnostic evaluation
Medical management (Pharmacological and Non –
Pharmacological)
Surgical management
Nursing management
Complications
Health education
5. Q.1 WHAT IS CANCER ?
Q.2 WORLD CANCER DAY IS CELEBRATED ON ?
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6. INTRODUCTION
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SARCOMA –
A rare type of cancer that grow
in connective tissue like bones, nerves, muscles, and
blood vessels of the arms and legs. It causes abdominal
pain, lump, bone pain, and weight loss.
Soft tissue sarcoma forms in the tissues that connect,
support and surround other body structures.
7. DEFINITION
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Sarcoma is a type of cancer that can occur in various
locations in your body. Sarcoma is the general term for a
broad group of cancers that begin in the bones also
known as (soft tissue sarcoma).
9. INCIDENCE
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The incidence for all ages is one case per 1
million people in the United States. In patients aged 10 to
19 years, the incidence is between nine and ten cases per
1 million people.
10. TYPES OF CANCER
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Benign tumors- are slow growing tumors, well
circumscribed, and encapusulated. They produce few
symptoms . Benign primary neoplasms of
musculoskeletal system.
Malignant benign tumor – primary malignant tumor
are relatively rare and arise from connective tissues
cells or bone marrow elements (myelomas).
Metastatic tumor – more common malignant bone
tumor.the most common primary sites of tumors that
metastasize to bone are kidney.
12. ETIOLOGY
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Growth related : risk is highest for
those between 10-30yrs of age .the
risk goes down during in middle age
but rises in older age of 60’s .
Somatic alterations : TP53 AND
RB1 shows recurrent somatic
alterations in concurrent studies .
Radiation therapy for cancer-
Radiation treatment for cancer
increases the risk of developing a
sarcoma later.
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Exposure to chemicals. Certain chemicals, such as some
industrial chemicals and herbicides, can increase the risk
of sarcoma that affects the liver.
Exposure to viruses. The virus called humanherpesvirus
8 can increase the risk of a type of sarcoma called
Kaposi's sarcoma in people with weakened immune
systems.
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Germ line defect :
The tumors is identified by the tissue of origin , the
anatomic site, the behaviour the tumors(benign or
malignant ).
EMBRYONAL ECTODERM - originates Carcinoma
(skin and glands ).
ENDODERM – Mucus membrane linings of respiratory
tract , GI , GU tract.
MESODERM –sarcoma(connective tissue, muscles, bone
and fat ).
Lymphoma and leukemia are originated from
HEMATOPOETIC SYSTEM .
Contd.
18. SIGN AND SYMPTOMS
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A lump that can be felt through the skin that may or may
not be painful
Bone pain
Joint swelling and stiffness
Weight loss
Spinal metastasis resulting in cord compression and
neurologic deficits, paresthesia, paraplegia .
Abdominal pain (due to abdominal metastasis and have
poor prognosis)
19. DIAGNOSTIC EVALUATION
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Collect the history upto 3rd gen. and perform a physical
examination , may be diagnosed incidentally after
pathologic fracture.
Inspection, palpation can be done to identify the lump or
mass .
Perform ct scan , bone scans , myelography, MRI, and
chest x ray.
Obtain biochemical assay of the blood to identify TP53
and RB1 gene .
Alkaline phosphate levels are frequently elevated with
osteogenic sarcoma , serum acid phosphate levels are
elevated with metastasis in liver .
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Arteriography – to assess the soft
tissue involvement. x-ray
examination of an artery or arteries
following injection of a radiopaque
substance.{Barium sulfate and
organic iodides} are commonly used .
Improve the image contrast
(radiocontrast) and visibility of
relevant anatomic loci.
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Perform surgical biopsy for histologic identification ,
staging, based on tumor size, grade ,location and
metastasis. (TNM classification )
BIOPSY :
FINE NEEDLE ASPIRATION CYTOLOGY (FNAC )
CORE NEDDLE ASPIRATION (CNA)
24. CHEMOTHERAPY
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Chemotherapy is started before and continued after
surgery in an effort to eradicate micrometastatic lesions.
Drugs : MAID REGIMEN [ Mesna,
Adriyamycin(doxorubicin), Ifofosfamide and
Dacarbazine]
AID RGIMEN- Adriyamycin, Ifofosfamide , Mesna
25. SURGICAL MANAGEMENT
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LIMB SALVAGE : – involves resection, of affected
bone , muscle and normal muscle tissue and
reconstruction using metallic prosthesis or allografts for
bone or joint replacement and skin grafting as needed.
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Radiation is energy that is
emitted from a source and
travels through space or
some material .
Delivery of high- energy
beams when absorbed into
tissue ,produces ionization
radiation act to break the
chemical bond in DNA .
The DNA is damaged,
resulting in cell death .
TYPES OF IONIZING
RADIATION
RADIATION THERAPY
1. Electromagnetic
radiation i.e ( x -
ray , gamma ray )
2.Particulate
radiation (alpha
particles,electrons,
neutrons, protons)
3.High – energy - x
rays (photons)
29. NURSING MANAGEMENT
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ASSESSMENT
Obtain the health history of progression of
disease , presence of pain ,fever ,weight loss
and malaise .
Examine for painless mass .
Review records for evidence of pathologic
fractures .
Asses knowledge of cancer experiences with
family , others, and present coping .
30. NURSING DIAGNOSIS
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1. Acute pain related to effects of tumors .
2. Risk for injury related to altered bone structure
3. Ineffective coping related to diagnosis and treatment
options.
4. Altered Nutrition: Less Than Body Requirements related
to hypermetabolic state associated with
cancer/Consequences of chemotherapy, radiation,
surgery, e.g., anorexia,
5. Risk for Infection related to Inadequate secondary
defences and immuno suppression, e.g., bone marrow
suppression
31. NURSING INTERVENTION
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Acute pain related to effects of tumors
Use multiple approaches to reduce discomfort
Administer pain medication 30 minutes before
ambulation or other uncomfortable movement .
Support painful extrimities on pillows.
Risk for injury related to altered bone structure
Assist patients in movement with gentleness and patience
Avoid jarring patients and bed .
Supports joints when repositioning patients.
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Guard patients to avoid falls raise the side rails .
Create a hazard –free environment .
Provide patients education on safety and ambulation
Ineffective coping related to diagnosis and treatment
options.
Create a supportive environment
Answer questions and clear up misconceptions about
treatment options .
Use pshychological support services as nedded
33. PATIENT EDUCATION AND
HEALTH MAINTENANCE
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Teach about particular treatment selected .
Encourage appropriate follow up and diagnostic
testing for recurrence.
Refer for additional information and support to the
American cancer society .
34. PROGNOSIS
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Using the SEER database, statistics show that people with
a soft tissue sarcoma have an average 5-year survival rate
of 65%.
Sarcoma life expectancy depends on factors such as the
tumor’s type, size, location, rapidity of tumor cell growth,
and where it is located when first diagnosed.
The National Cancer Institute reports 5-year survival data
for cancer from the SEER (Surveillance, Epidemiology
and End Results) database, based on whether the cancer
was found when it hadn’t yet spread (localized) .
36. RECAPTUALIZATION
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1. Which one of the following soft tissue sarcomas frequently metastasizes
to lymph nodes?
A. Fibrosarcoma
B. Alveolar soft part sarcoma
C. Osteosarcoma
D. Embryonal Rhabdomyosarcoma
Answer - D
2. Which type of cancer is sarcoma ?
A. A sarcoma is same as carcinoma but is benign
B. A sarcoma is a cancer that develops from tissue like the muscle .
C. A sarcoma is a type of cancer that does not spread to other sites.
D. A sarcoma affects only children while a carcinoma affect only adults
Answer - B
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3. A sarcoma that arise from fat tissue is called –
A. Fibrosarcoma
B. Liposarcoma
C. Leimyosarcoma
D. Rhabdomyosarcoma
Answer - B
4. Osteosarcoma arise from the
A. Muscle
B. Bone
C. Blood vessels
D. Nerves
Answer - B
