| Soft Tissue Sarcomas in Cats and Dogs |
Source: Withrow Stephen J, and David M. Vail. Small Animal Clinical Oncology. St Louis: Saunders Elsevier, 2007. How is the diagnosis made? Soft tissue sarcomas can be challenging to distinguish from each other as well as from other types of tumors due to the overlapping features and patterns. In human medicine, new tools became available (eg immunocytochemistry, tissue microarrays) that have helped pathologists to better diagnose soft tissue sarcomas but their application in veterinary medicine is still rather limited. Prior to initiating any type of treatment, it is important to gather as much information as possible regarding the tumor's tissue origin, size, site, histologic grade (level of aggressiveness) and whether it has spread to other organs. Fine-needle aspirates are recommended to exclude other possible causes of suspected mass (eg abscesses, cysts, or mast cell tumors), however, cytologic evaluation by itself is usually not sufficient to reach a definitive diagnosis, and a biopsy prior to initiating any type of treatment should be done. There are a variety of different biopsy techniques that can be used but excisional biopsy is usually not recommended since surgery is typically performed after confirming diagnosis, and multiple surgical attempts have a negative impact on survival for soft tissue sarcomas. Additional tests are performed in order to evaluate how advanced the disease is. The tests will depend on the type of soft tissue sarcoma but generally involve blood and serum biochemical tests, chest X-rays and imaging. Blood tests are usually normal for most pets but there are some exceptions. For example, blood abnormalities are commonly detected in dogs with disseminated histiocytic sarcoma and hypoglycemia (low sugar) has been reported in dogs with intra-abdominal leiomyomas and leiomyosarcomas (tumors of smooth muscle). Imaging studies of the local tumor are usually done prior to planning the surgical removal of the tumor and/or radiation therapy, especially in animals with suspected intra-abdominal soft tissue sarcomas. Advanced imaging techniques such as CT (computed tomography) and MRI (magnetic resonance imaging) are especially useful due to their high level of resolution and detail. Other imaging methods can involve X-rays, ultrasound, angiography, and nuclear scintigraphy. Evaluation of metastasis Diagnostic tests that evaluate whether the tumors have spread to other organs include chest X-rays (to test for lung metastasis), abdominal ultrasound (to check for metastasis in the spleen, liver) and fine-needle aspirates/biopsy of regional lymph nodes (to check for lymph node metastasis). At the very minimum, chest X-rays should be performed prior to initiating treatment since soft tissue sarcomas commonly spread to the lungs. Lymph node metastasis is not common for typical soft tissue sarcoma but their biopsy/cytology should be assessed in animals whose lymph nodes appear abnormal and/or whose specific tumor type is suspected to have a high metastatic potential. Below are examples of soft tissue sarcomas seen in pets. Does cancer cause pain in cats and dogs? Pain is common in pets with cancer, with some tumors causing more pain than others. In addition to pain caused by the actual tumors, pets will also experience pain associated with cancer treatments such as surgery, radiation therapy or chemotherapy. Untreated pain decreases the pet's quality of life, and prolongs recovery from the illness, treatment or injury. It is, therefore, essential that veterinary teams that are taking care of pets with cancer should also play a vital role in educating pet owners about recognizing and managing pain in their pets. The best way to manage cancer pain in pets is to prevent it, a term referred to as preemptive pain management. This strategy anticipates pain ahead of time and administers pain medication before the pet actually experiences pain, thus ensuring the pet's maximum comfort. To learn more about how to recognize pain in pets with cancer and what cancer pain management options are available for your pet, please visit the Cancer Pain Management section. Is nutritional support important for pets with cancer? Cancer cachexia (a term referring to progressive severe weight loss) is frequently observed in pets with cancer. Pets with cancer lose weight partly because of lack of appetite and partly because of cancer-induced altered metabolism. Some of the causes for decreased appetite are related to the cancer itself (for example, tumors may physically interfere with food chewing, swallowing, and digestion process) and some may be related to the side effects of cancer treatment (for example, some chemotherapy drugs cause nausea and vomiting, and radiation therapy can cause mouth inflammation). Proper nutrition while undergoing cancer treatment is essential to maintain your pet's strength, improve survival times, quality of life and maximize response to therapy. Adequate nutritional support was shown to decrease the duration of hospitalization, reduce post-surgery complications and enhance the healing process. Additionally, pets with cancer need to be fed diets specifically designed to provide maximum benefit and nutritional support for the patient. To learn more, please visit the Cancer Nutrition section. What are the treatment options? Local tumor control is the most important consideration in the management of soft tissue sarcomas due to their locally aggressive behavior. Surgical removal of the tumor is the main treatment of choice and radiation therapy is typically applied in cases where the entire tumor could not be surgically removed. Specific treatment options will depend on the tumor subtype, location, size, and how advanced the disease is. To learn more about treatment and/or prognosis for a specific soft tissue sarcoma subtype, please click on the subtype of interest in the above table. Surgery Soft tissue sarcomas aggressively invade adjacent tissues, necessitating the need for an aggressive surgery to prevent local tumor recurrence (coming back). The first surgery provides the best opportunity for local tumor control. If the tumor cannot be completely removed, radiation therapy is used to kill any remaining cancer cells, and provides an attractive alternative to limb amputation for a limb affected with soft tissue sarcoma. Radiation therapy should be started a minimum of 7 days after the surgery to minimize the risk of radiation-induced complications within the surgical wound. Radiation therapy Radiation therapy can be used in combination with surgery to attempt cure or at least provide long-term control of the tumor but it can also be used by itself for palliative reasons (provide pain relief associated with soft tissue sarcoma but not cure). Current results indicate that radiation treatment is the best treatment option for tumors that could not be completely surgically removed. Radiation therapy prior to surgery is becoming more common in veterinary oncology and is thought to provide certain advantages: 1) the area subjected to radiation is smaller since after surgery, the entire surgical site must be irradiated. 2) it shrinks the size of the tumor, making the following surgery easier. Human studies showed that there was no difference in survival in patients who received radiation prior to surgery compared to those after surgery, however, wound complications were significantly more frequent in pre-surgery radiation. Higher doses of radiation have a better chance of killing the cancer cells but will also increase the chance of complications. Some studies suggest that combining radiation with hyperthermia can better control the local tumor but the difficulty of heating large tumors limits the utility of this approach Chemotherapy The benefit of chemotherapy in the treatment of soft tissue sarcomas is unknown, however, there are clinical situations in which chemotherapy after surgery should be considered: dogs with grade III soft tissue sarcoma, metastatic disease, intra- abdominal soft tissue sarcoma, and tumor types known to have a higher rate of metastasis. Drugs such as doxorubicin with or without cyclophosphamide have shown most promise with 23% of dogs responding. Finding a qualified veterinary oncologist To locate a qualified veterinary oncologist in your area who can discuss with you appropriate cancer treatment plan for your pet's cancer condition, please visit the "Locate a veterinary oncologist" section. Are there any clinical trials investigating new treatments for soft tissue sarcoma in cats or dogs? There are several clinical trials ongoing for dogs with soft tissue sarcomas, which are partially funded by the institutions. To learn more about these trials, please visit the Clinical Trials for Soft Tissue Sarcoma in Dogs section. Additionally, there are several clinical trials available for cats and dogs with any tumor type for which your pet may qualify. To learn more these trials (which are partially or fully funded by the institutions), please visit the Dog Clinical Trials (any tumor type) or Cat Clinical Trials (any tumor type) section. To learn more about veterinary clinical trials in general, please visit the Pet Clinical Trials section. What is the prognosis? The prognosis for soft tissue sarcoma is good. Local control of the tumor is very challenging and local tumor recurrence rates after surgery (with or without radiation) range from 7% to 32%. Poor prognostic factors for local tumor recurrence include large tumor size, incomplete surgical removal and high histologic tumor grade (high grade corresponds with aggressive tumor behavior). Management of recurrent soft tissue sarcomas is usually more difficult than the original tumor, emphasizing the need for an aggressive treatment of the initial tumor. Because the median time for tumor recurrence is 368 days, the pets should undergo long term follow up and frequent check ups. The metastatic rate for soft tissue sarcomas varies from 8% to 17% with a median time to metastasis of 1 year, depending on the tumor's properties. The median survival time for dogs with soft tissue sarcoma is 1416 days with surgical treatment and 2270 days with surgical and radiation treatment. Overall, up to 33% of dogs eventually die of tumor related causes. Additional online resources
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Last updated 2/19/2017
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| What are soft tissue sarcomas? Soft tissue sarcomas is a general term that refers to a group of tumors that form in tissues of mesenchymal origin such as the connective tissue (eg fat, smooth muscle, blood vessels, lymph vessels, skeletal muscle, etc). They tend to have similar histologic appearance and biological behavior, and can be either benign (noncancerous) or malignant (cancerous). Soft tissue sarcomas can arise in any part of the body although skin and subcutaneous (the layer of tissue directly underlying the skin) tumors are the most commonly observed. The following table classifies the known soft tissue sarcomas, their origin and potential for metastasis (spread to other organs). How common are these tumors? These tissues represent 15% of all skin tumors and 7% of all subcutaneous tumors in cats and dogs. Most soft tissue sarcomas are solitary tumors in middle to older aged pets and tend to be over-represented in large breed dogs. |
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