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Soft tissue sarcoma
Any soft-tissue lump larger than 5 cm, deep to the fascia, growing or painful is a sarcoma until proven otherwise; MRI and core needle biopsy are done at a specialist centre before any surgery, and treatment is wide excision with clear margins, usually with radiotherapy.
Why it matters in the exam
The exam mainly tests the correct first step: a large deep lump in an adult's thigh is not "a lipoma until proven otherwise". After MRI a core needle biopsy is done, along the line of the future incision, by the team that will operate — an excisional biopsy or an unplanned "simple lump excision" can seed cells and destroy the chance of limb preservation.
Candidates are also asked about spread: sarcomas spread mainly by blood, so the common metastases are to the lungs and a chest CT is done for staging; nodal spread is rare, except for a few types (rhabdomyosarcoma, epithelioid, synovial and clear cell). Limb treatment is wide excision with limb preservation, and radiotherapy is added for large or high-grade tumours (before or after surgery). A retroperitoneal sarcoma — usually a liposarcoma — is removed en bloc with adjacent organs. GIST and desmoid tumours are treated differently.
Key points
- Warning signs: over 5 cm, deep to the fascia, growing, painful.
- MRI, then core needle biopsy by the operating team.
- Metastases mainly to the lungs — chest CT.
- Wide excision with clear margins and limb preservation, usually with radiotherapy.
- Nodal spread is rare, except for a few types.
Summary table
| Topic | Details | Exam note |
|---|---|---|
| Warning signs | Over 5 cm, deep to the fascia, growing, painful | Each one requires work-up at a specialist centre |
| Imaging | MRI for a limb lump; CT for the abdomen and retroperitoneum; chest CT for staging | Metastases mainly to the lungs |
| Biopsy | Core needle, along the future incision line, by the operating team | Not an excisional biopsy of a suspicious lump |
| Limb treatment | Wide excision with clear margins and limb preservation; radiotherapy for large or high-grade tumours | "Accidental" excision — wide re-excision |
| Retroperitoneum | Usually liposarcoma; large abdominal mass | En bloc resection with adjacent organs as needed |
| Nodal spread | Rare | Except rhabdomyo-, epithelioid, synovial and clear cell sarcoma |
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Sources
- ESMO–EURACAN–GENTURIS Clinical Practice Guidelines: Soft tissue and visceral sarcomas, 2021 — Diagnosis, biopsy and multimodal treatment
- NCCN Clinical Practice Guidelines in Oncology: Soft Tissue Sarcoma, 2025 — Extremity and retroperitoneal sarcoma
- Sabiston Textbook of Surgery, 21st edition (2022) — Soft Tissue Sarcoma
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.