Question 1#

All of the following are true about soft tissue sarcoma EXCEPT:

A. Most common site is trunk and retroperitoneum

Incidence rates are declining for most cancer sites, but they are increasing among both men and women for melanoma of the skin, cancers of the liver and thyroid. Incidence rates are decreasing for all four major cancer sites except for breast cancer in women.

Question 2#

Which of the following is NOT associated with the development of sarcoma?

A. Radiation exposure

External radiation therapy is a rare but well-established risk factor for soft tissue sarcoma that may be associated with radiation-induced mutations of the p53 gene. Exposure to herbicides, such as phenoxyacetic acids and to wood preservatives containing chlorophenols, has been linked to an increased risk of soft tissue sarcoma. In 1948, Stewart and Treves first described the association between chronic lymphedema after axillary dissection and subsequent lymphangiosarcoma. Although patients with sarcoma often report a history of trauma, no causal relationship has been established. More often, a minor injury calls attention to a pre-existing tumor.

Question 3#

Internationale Contre le Cancer (AJCC/UICC) sarcoma staging system?

A. Tumor size

The seventh edition of the American Joint Committee on Cancer (AJCC) staging system for soft tissue sarcomas is based on histologic grade of aggressiveness, tumor size and depth, and the presence of nodal or distant metastases. Histologic grade is the most important prognostic factor for patients with soft tissue sarcoma. The features that define grade are cellularity, differentiation (good, moderate, or poor/anaplastic), pleomorphism, necrosis (absent, <50%, or ≥50%), and number of mitoses per high-power field (<10, 10-19, or ≥20).

Question 4#

All of the following are known molecular pathogenic events in sarcoma EXCEPT:

A. Chromosomal translocations

In general, sarcomas resulting from identifiable molecular events tend to occur in younger patients with histology suggesting a clear line of differentiation. The identifiable molecular events include point mutations, translocations causing overexpression of an autocrine grow factor, and oncogenic fusion transcription factor producing a cellular environment prone to malignant transformation. In contrast, sarcomas without identifiable genetic changes or expression profile signatures tend to occur in older patients and exhibit pleomorphic cytology and p53 dysfunction.

Question 5#

For a T2G3NOMO sarcoma (stage II), treatment typically consists of:

A. Surgery alone

Recommendations for the management of soft tissue masses:

1. Soft tissue tumors that are enlarging or greater than 3 cm should be evaluated with radiologic imaging (ultrasonography or computed tomography [CT] ), and a tissue diagnosis should be made using core needle biopsy.
2. Once a sarcoma diagnosis is established, obtain imaging (magnetic resonance imaging for extremity lesions and CT for other anatomic locations) and evaluate for metastatic disease with chest CT for intermediate- or high-grade (grade 2 or 3) or large (T2) tumors.
3. A wide local excision with 1 - to 2-cm margins is adequate therapy for low-grade lesions and Tl tumors.
4. Radiation therapy plays a critical role in the management oflarge (T2), intermediate- or high-grade tumors. 
5. Patients with locally advanced high-grade sarcomas or distant metastases should be evaluated for chemotherapy.
6. An aggressive surgical approach should be taken in the treatment of patients with an isolated local recurrence or resectable distant metastases.