What Are the Normal Soft Tissues?

The human body is made up of individual“cells”, of which there are many various kinds. Initially, when the father’s sperm and mother’s egg join to form a fertilized egg, each cell in the fledgling human “embryo” is exactly the same. As the embryo’s cells divide, the genetic material within them, called“DNA”, instructs certain cells to “specialize”– that is become heart cells, lung cells, bone cells, brain cells, etc. This process of “specialization” is called “differentiation”, and accounts for the wide variety of cells making up adults. The early embryo separates cells into 3 basic distinctions– cells for making skin, brain and nerves (ectoderm), cells for making the organs (endoderm), and cells cells for making bone, flesh and blood (mesoderm). However, ultimately the “mesoderm” cells are found in all parts of the growing human. Certain specialized cells are programed to form “tissues”, which are a collection of cells for a certain purpose. Examples of tissues include skin, muscle, fat, bone, blood and cartilage. The tissues are joined in complex patterns to form“organs”, which contain many types of cells. For instance, the ear is an organ which contains bone (the “ossicles”), muscle fibers, nerves, fat, cartilage and skin, all precisely organized. Organs are further arranged into “organ systems” . The ear must be properly connected to another organ, the brain, to function. Other examples of organ systems include the skeletal, digestive, urinary, and reproductive systems. Still, as complex as the systems become, they still are made of single cells as the smallest unit of “life”.

The mature human body contains organs, bones, flesh, and blood, and we said that each of these complex structures are formed from simpler tissues. The“soft tissues” of the body are basically it’s flesh — formed of muscles, fat, cartilage, and fibrous tissues. These tissues are not only found as the“middle layer” (mesoderm) between the skin and bone, but are also a part of many internal organs, such as the stomach, bladder, and uterus, and bone. Thus, a disease of the “soft tissues” can actually arise almost anywhere in the body! This is because these basic tissues are the building blocks of nearly all a human’s “parts”. While the bone is initially from the mesoderm flesh (it starts out as cartilage), as it becomes calcified it is no longer considered a “soft tissue” (after all it is hard!). Thus, diseases, including cancer, of bone a classified separately from “soft tissue” diseases, even though the same tissues may be involved . Skin is also classified separately since it arises from a different area of the developing embyro (ectoderm), along with the nerves and brain.

Thus, the basic soft tissues making flesh in the adult are the muscle, fat, fibrous tissues (“sinews”), cartilage, and blood vessles. To understand disease of these, we must look at them on their cellular level. There are actually three types of muscle cells in the body, several types of fibrous cell, but only one type of fat and cartilage cell. The blood vessles are made up of layers of various types of cells. For muscle cells, there are “intercalated” heart cells (not discussed here) “striated” skeletal muscle cells, and“smooth” organ muscle cells.

You can see the range of crucial soft tissues in the body, and understanding the above prefixes allows one to categorize the diseases that arise from these “mesechy mal” cells. It is not uncommon for more that one type of cell to be involved with a disease process, so sometimes the names are conjoined together to describe the cells seen under the microscope. Examples include “Chondrofibro”, “Osteochondro” and “Lipofibro”; they are all “mesenchymal” (middle embryo layer) diseases.

What is Soft Tissue Cancer?

The “mesenchymal” or “soft tissues”, like all tissues, are made up of individual cells. Normally, cells within the forming body divide and grow very rapidly in the womb, in early childhood, and through puberty. In adulthood, new cells are only formed to replace those which have died from injury, old age or disease. The division of cells to produce new ones is under tight control by the “genes” within each cell. These genes are made up of DNA, and if it becomes damaged, that cell may start dividing out of control.Soft Tissue Cancer starts in a single cell which has become abnormal. This cells produces millions, and eventually billions, of copies of itself. The copies are called“clones” . These clones fail to function as normal body tissue, but instead divert resources from healthy cells to fuel their own growth. When there are about 1 billion cells, they form a clump, or “tumor” 1/2 inch across. A “tumor” merely means a swelling, it can be caused by infection, inflammation, cancer or whatever. If a tumor can only grow in it’s local area (even very large) but does not have the capacity to spread to distant body areas, it is called“benign” and isnot cancer. If, however, the tumor has the ability to spread to distant body areas, it is called “malignant” andthis is cancer. The actual process of spread is called“metastasis”, and can occur to any area of the body.

For benign Soft Tissue tumors, they are commonly given the suffix “oma” . The most common types of benign tumor are “Lipoma (from fat), “Leiomyoma (from smooth muscle) and “Fibroma (from fibrous tissue). These benign tumors may grow very large, but they will never“metastasize” (spread distantly) and so are not considered “cancer”. Simply removing them surgically should be curative, and if surgery is not practical then radiation therapy will often shrink them. Unless they are disturbing body function or cosmetic appearance, they often require NO THERAPY.

For malignant Soft Tissue tumors, they are commonly given the suffix“sarcoma” .This means a cancer that has arisen from the mesenchymal tissue, as opposed to “carcinomas”, which develop from the body’s lining tissues and organs. Any tumor that is called a “sarcoma” is cancerous, but not all cancerous mesenchymal tumors end with “sarcoma” . However, the common ones do, and include “Liposarcoma” (from fat cells), “Rhabdomyosarcoma” (from skeletal muscle cells), “Leiomyosarcoma” (from smooth muscle cells), “Fibrosarcoma” (from fibrous cells) and “Chondrosarcoma” (from cartilage cells). “Osteosarcoma” is the most common bone cancer, but is not considered a“Soft Tissue Sarcoma” and is discussed as a “Primary Bone Tumor”.

Other, rarer types of Soft Tissue Sarcoma (which may or may not have the word “sarcoma” in them) include “Angiosarcoma” (divided into Hemangiosarcoma and Lymphangiosarcoma– from blood or lymph vessels),“Hemangiopericytoma” (also from a blood vessel cell), “Mesothelioma ” (from abdominal or lung linings),“Synovial Sarcoma” (from joint linings), “Neurofibrosarcoma” (from nerve sheaths),“Kaposi’s Sarcoma (origin uncertain) and “Malignant Fibrous Histioctyoma” (from fibrous tissue). Some of the above are more aggressive than others, but they are all cancer!

How Common is Soft Tissue Sarcoma?

Each year in there about 8,000 new cases of “Soft Tissue Sarcoma” in the United States, which cause approximately 2,500 deaths per year. Thus, they represent ~1% of all new cancers. Soft Tissue Sarcoma is about 3 times more common than Bone Sarcoma. There are two “peaks” of most common patient age, one in childhood at 10 years old and the other in 40 year old adults. Thus Sarcomas are unlike the other major type of cancer, “Carcinomas” (e.g. breast, lung, prostate, colo-rectal) which all tend to get more likely as we age. Males and Females are overall equally affected by Sarcomas. In children, the most common type of Soft Tissue Sarcoma is “Rhabdomyosarcoma” (from skeletal muscle cells), which occur mostly in the Head and Neck areas. In adults, the most common type is now“Fibrosarcoma” or“Malignant Fibrous Histiocytoma”, which tends to occur in the trunk or extremities. In contrast to childhood cases, the least common area for adult sarcomas is in the Head and Neck area. Overall, the number of new cases of Soft Tissue Sarcoma has remained stable for the past 3 decades.

The common underlying factor is damage to “DNA” which causes the affected cell to become “transformed” — that is lose control over it’s division. Cancer is ultimately a disease of the DNA! The DNA is packed into thousands of “genes”, which are themselves located upon the 48 “chromosomes” (46 general plus 2 sex chromosomes) that all healthy humans have in every cell. The chromosomes become visible under an ordinary light microscope when cells divide, and nearly every case of Sarcoma shows chromosome damage. This damage usually includes pieces missing from chromosomes (“deletions”), or even parts of one chromosome getting stuck onto another (“translocations”). Overall, anything which can damage DNA, the fundamental genetic material, will increase the risk of a cell turning cancerous. This damage may be“latent”, meaning a cancer may arise many years or decades after the damage occurs.

Can Sarcomas Be Prevented?
There is no sure way to prevent sarcomas. It is always a good idea to avoid unnecessary exposure to potential carcinogens and avoid unwarranted X-rays. This is especially true for patients with family susceptibility to cancers, or who actually have genetic diseases. If a worrisome sign or symptom arises (see below) it should be evaluated promptly, and not ascribed to some benign process without proof. Eating a diet with enough vitamin C (“Ascorbic Acid”) is important for proper maintainance and healing of soft tissues. Vitamin C deficiency results in a breakdown of the soft tissues (“scurvy”), since it is essential for crosslinking their crucial collagen proteins. However, taking too much can also be harmful by causing the blood to become too acidic (“ascorbic acidemia”). A standard supplement multi-vitamin is well advised.

The human muscular system is incredibly engineered, providing for body support, movement, and the storage of sugar energy in the form of glycogen. There are 3 basic types of muscle in the body: Skeletal Muscle for voluntary movement, Smooth Muscle for involuntary processes like digestion, and Cardiac Muscle in the heart. Normally the muscles are a very trouble-free system, maintained by simple activity and exercise. Rarely, however, cancers called “sarcomas” arise from muscle. Smooth muscle gives rise to “myosarcoma”, and skeletal muscle to “rhabdomyosarcoma”.

It is crucial to get prompt diagnosis and proper treatment for a muscle cancer problem. This can make the difference between keeping or losing a limb, or even between life and death. Fortunately, recent advancements in therapy make limb loss less likely, and cure more like, than ever before. Understanding your options for a Muscle Cancer problem will give you the peace of mind of knowing you have done everything possible to help ensure a happy outcome.

CancerAnswers’ material explains, in plain English, the definition, types, frequency, risk factors, symptoms, evaluation, historic and latest effective treatment for Muscle Cancers. We tell you everything you must know to make the right choices today to deal with a Muscle Cancer problem.



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November 2008


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