Date:
Patient:
Reason for Visit:
Initial evaluation for suspected soft tissue sarcoma
Follow-up for established soft tissue sarcoma
Assessment of treatment response or disease progression
Management plan discussion
History:
Presenting Illness: (For initial evaluation)
Location, size, and duration of the mass
Pain (present/absent), character of pain (dull, aching, sharp)
Rapid growth of the mass
Changes in skin overlying the mass (redness, ulceration)
Past history of trauma or radiation therapy to the area
Past Medical History (PMH):
Underlying medical conditions (e.g., neurofibromatosis, Li-Fraumeni syndrome) that may increase risk
Previous surgeries or procedures (relevant to the area)
Allergies to medications
Social History:
Occupation (potential exposure to carcinogens)
Smoking history (risk factor for angiosarcoma)
Physical Exam:
General: Assess vital signs (temperature, blood pressure) and overall health.
Mass: Evaluate location, size, consistency (firm, mobile, fixed), tenderness, presence of overlying skin changes.
Lymph Nodes: Palpate regional lymph nodes for enlargement or tenderness.
Diagnostic Tests (may be ordered depending on clinical suspicion):
Imaging Studies:
Ultrasound – initial imaging modality to assess the mass and surrounding tissues.
MRI scan with contrast – most definitive imaging study for soft tissue sarcomas, providing details on size, location, and involvement of surrounding structures.
CT scan (may be used in some cases)
Biopsy: Tissue sample obtained by core needle biopsy, incisional biopsy, or excisional biopsy for definitive diagnosis.
Fine-needle aspiration (FNA) biopsy (less common): May be performed in some cases to obtain a quick diagnosis, but definitive diagnosis requires core biopsy or excision.
Assessment:
Clinical suspicion of soft tissue sarcoma: Based on history, physical exam findings, and imaging studies.
Confirmation of diagnosis: Requires histopathological examination of a biopsy specimen, including grading (low, intermediate, high) and specific sarcoma subtype.
Staging (if diagnosis confirmed): Determines the extent of cancer spread (localized, regional, or distant metastasis). Staging is crucial for treatment planning and prognosis. This may involve additional imaging studies like PET scan or chest X-ray.
Plan:
Treatment approach depends on several factors:
Stage and grade of the sarcoma
Size and location of the tumor
Patient’s overall health and performance status
Surgery: The primary treatment for most localized soft tissue sarcomas, aiming for complete removal with adequate margins.
Adjuvant therapy (after surgery):
Radiation therapy – to destroy remaining cancer cells in the area.
Chemotherapy – may be used for high-grade or advanced sarcomas.
Neoadjuvant therapy (before surgery): In some cases, chemotherapy or radiation therapy may be used to shrink the tumor before surgery.
Other modalities: For advanced or unresectable sarcomas, targeted therapies or immunotherapy may be considered.
Pain management: Important throughout the treatment course to improve quality of life.
Follow-up:
Regular follow-up appointments to monitor for recurrence and manage any side effects of treatment.
Imaging studies (MRI scans) to assess for disease progression.
Additional treatment decisions based on follow-up findings.
Patient education: Provide information about soft tissue sarcomas, their diagnosis, treatment options, potential side effects, and importance of follow-up.
Discuss potential long-term effects of treatment and strategies for managing them.
Encourage open communication about any concerns or questions.
Provide resources for support groups or educational materials.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of soft tissue sarcoma.