Soft tissue sarcoma in children may respond differently to treatment, and may have a better prognosis than soft tissue sarcoma in adults. (See the PDQ summary on Adult Soft Tissue Sarcoma Treatment for information on treatment in adults.)
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your child’s doctor if you think your child may be at risk.
Other risk factors include the following:
A sarcoma may appear as a painless lump under the skin, often on an arm, a leg, the chest, or the abdomen. There may be no other signs or symptoms at first. As the sarcoma gets bigger and presses on nearby organs, nerves, muscles, or blood vessels, it may cause signs or symptoms, such as pain or weakness.
Other conditions may cause the same signs and symptoms. Check with your child’s doctor if your child has any of these problems.
The following tests and procedures may be used:
An MRI of the tumor is done before the excisional biopsy. This is done to show where the original tumor formed and may be used to guide future surgery or radiation therapy.
If possible, the surgeon who will remove any tumor that is found should be involved in planning the biopsy. The placement of needles or incisions for the biopsy can affect whether the whole tumor can be removed during later surgery.
To plan the best treatment, the sample of tissue removed during the biopsy must be large enough to find out the type of soft tissue sarcoma and do other laboratory tests. Tissue samples will be taken from the primary tumor, lymph nodes, and other areas that may have cancer cells. A pathologist views the tissue under a microscope to look for cancer cells and to find out the type and grade of the tumor. The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the cells are dividing. High-grade and mid-grade tumors usually grow and spread more quickly than low-grade tumors.
Because soft tissue sarcoma can be hard to diagnose, the tissue sample should be checked by a pathologist who has experience in diagnosing soft tissue sarcoma.
One or more of the following laboratory tests may be done to study the tissue samples:
The cells of each type of sarcoma look different under a microscope. The soft tissue tumors are grouped based on the type of soft tissue cell where they first formed.
This summary is about the following types of soft tissue sarcoma:
Liposarcoma. This is a cancer of the fat cells. Liposarcoma usually forms in the fat layer just under the skin. In children and adolescents, liposarcoma is often low grade (likely to grow and spread slowly). There are several different types of liposarcoma, including:
Bone and cartilage tumors are a mix of bone cells and cartilage cells. Bone and cartilage tumors include the following types:
Fibrous (connective) tissue tumors include the following types:
Desmoid tumors sometimes occur in children with changes in the APC gene. Changes in this gene may also cause familial adenomatous polyposis (FAP). FAP is an inherited condition (passed on from parents to offspring) in which many polyps (growths on mucous membranes) form on the inside walls of the colon and rectum. Genetic counseling (a discussion with a trained professional about inherited diseases and options for gene testing) may be needed.
There are two types of fibrosarcoma in children and adolescents:
Skeletal muscle is attached to bones and helps the body move.
Pericytic tumors form in cells that wrap around blood vessels. Pericytic tumors include the following types:
Tumors of unknown cell origin (the type of cell the tumor first formed in is not known) include the following types:
Blood vessel tumors include the following types:
See the following PDQ summaries for information about types of soft tissue sarcoma not included in this summary:
The prognosis and treatment options depend on the following:
The following procedures may be used to find out if cancer has spread:
The metastatic tumor is the same type of cancer as the primary tumor. For example, if soft tissue sarcoma spreads to the lung, the cancer cells in the lung are soft tissue sarcoma cells. The disease is metastatic soft tissue sarcoma, not lung cancer.
Progressive childhood soft tissue sarcoma is cancer that continues to grow or spread during treatment.
Recurrent childhood soft tissue sarcoma is cancer that comes back after treatment. The cancer may have come back in the same place or in other parts of the body.
Different types of treatments are available for patients with childhood soft tissue sarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with soft tissue sarcoma and who specialize in certain areas of medicine. These may include a pediatric surgeon with special training in the removal of soft tissue sarcomas. The following specialists may also be included:
Surgery to completely remove the soft tissue sarcoma is done when possible. If the tumor is very large, radiation therapy or chemotherapy may be given first, to make the tumor smaller and decrease the amount of tissue that needs to be removed during surgery. This is called neoadjuvant (preoperative) therapy.
The following types of surgery may be used:
A second surgery may be needed to:
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Whether the radiation therapy is given before or after surgery to remove the cancer depends on the type and stage of the cancer being treated, if any cancer cells remain after surgery, and the expected side effects of treatment. External and internal radiation therapy are used to treat childhood soft tissue sarcoma.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug.
The way the chemotherapy is given depends on the type of soft tissue sarcoma being treated. Most types of soft tissue sarcoma do not respond to treatment with chemotherapy.
See Drugs Approved for Soft Tissue Sarcoma for more information.
Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation do.
New types of tyrosine kinase inhibitors are being studied such as:
Other types of targeted therapy are being studied in clinical trials, including the following:
See Drugs Approved for Soft Tissue Sarcoma for more information.
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of treatment is also called biotherapy or biologic therapy.
There are two types of immune checkpoint inhibitor therapy:
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working. Antiestrogens (drugs that block estrogen), such as tamoxifen, may be used to treat desmoid-type fibromatosis. Prasterone is being studied for the treatment of synovial sarcoma.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs (such as aspirin, ibuprofen, and naproxen) that are commonly used to decrease fever, swelling, pain, and redness. In the treatment of desmoid-type fibromatosis, an NSAID called sulindac may be used to help block the growth of cancer cells.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.
Gene therapy is being studied for childhood synovial sarcoma that has recurred, spread, or cannot be removed by surgery. Some of the patient's T cells (a type of white blood cell) are removed and the genes in the cells are changed in a laboratory (genetically engineered) so that they will attack specific cancer cells. They are then given back to the patient by infusion.
Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.)
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of liposarcoma may include the following:
Treatment of extraskeletal mesenchymal chondrosarcoma may include the following:
Treatment of extraskeletal osteosarcoma may include the following:
See the PDQ summary on Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment for more information about treatment of osteosarcoma.
Treatment of desmoid-type fibromatosis may include the following:
Treatment of dermatofibrosarcoma protuberans may include the following:
Treatment of inflammatory myofibroblastic tumor may include the following:
Treatment of infantile fibrosarcoma may include the following:
Treatment of adult fibrosarcoma may include the following:
Treatment of myxofibrosarcoma may include the following:
Treatment of low-grade fibromyxoid sarcoma may include the following:
Treatment of sclerosing epithelioid fibrosarcoma may include the following:
Treatment of leiomyosarcoma may include the following:
Treatment of plexiform fibrohistiocytic tumor may include the following:
Treatment of malignant peripheral nerve sheath tumor may include the following:
It is not clear whether giving radiation therapy or chemotherapy after surgery improves the tumor's response to treatment.
Malignant Triton tumors may be treated the same as rhabdomyosarcomas and include surgery, chemotherapy, or radiation therapy. It is not clear whether giving radiation therapy or chemotherapy improve the tumor's response to treatment.
Treatment of ectomesenchymoma may include the following:
Treatment of infantile hemangiopericytoma may include the following:
Treatment of infantile myofibromatosis may include the following:
Treatment of synovial sarcoma may include the following:
Treatment of epithelioid sarcoma may include the following:
Treatment of alveolar soft part sarcoma may include the following:
Treatment of clear cell sarcoma of soft tissue may include the following:
Treatment of extraskeletal myxoid chondrosarcoma may include the following:
Treatment of extra-renal (extracranial) rhabdoid tumor may include the following:
Treatment of perivascular epithelioid cell tumors may include the following:
See the PDQ summary on Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment for information about the treatment of malignant fibrous histiocytoma of bone.
Treatment of epithelioid hemangioendothelioma may include the following:
Treatment of angiosarcoma may include the following:
For treatment of specific tumor types, see the Treatment Options for Childhood Soft Tissue Sarcoma section.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
For more childhood cancer information and other general cancer resources, see the following:
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A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Soft Tissue Sarcoma Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/soft-tissue-sarcoma/patient/child-soft-tissue-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389342]
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