Size matters for sarcomas!

Abstract

Introduction: By the time of diagnosis, sarcomas have frequently reached a large size and many patients have a long history of symptoms prior to diagnosis. The aim of this study was to assess whether size of tumour at presentation or duration of symptoms was a significant factor affecting outcome.

Patients and methods: A prospective database recording patient, tumour, treatment and outcome factors was reviewed. A total of 1460 patients with newly diagnosed sarcomas and with > 3 years of follow-up were included for analysis.

Results: The mean size of sarcomas presenting to our unit was 10.7 cm at the time of diagnosis. Bone sarcomas averaged 11.3 cm with little variation by age or diagnosis, whilst subcutaneous soft tissue sarcomas averaged 10 cm. The incidence of metastases at diagnosis increased almost linearly with increasing size and the prognosis, even for patients without metastases at diagnosis became steadily worse with increasing size for all tumours, independent of other factors. Duration of symptoms did not correlate with size but patients with symptoms > 1 year had a slightly better prognosis than those with a shorter duration.

Conclusions: The author makes a plea for greater awareness of potential malignancy in lumps and bumps, particularly those over the size of a golf ball (4.27 cm), making the point that the smaller the tumour at diagnosis the better the prognosis.

Figure 1

Size of sarcomas at presentation (n = 1490).

Figure 2

Scattergram showing size (cm) versus duration of symptoms (weeks), split by bone and soft tissue sarcomas. There was no correlation between duration of symptoms and size at presentation (R² = 0.02).

Figure 3

Box plot showing the median size of soft tissue sarcomas along with the 10th, 25th, 75th and 90th centiles represented by bars and outliers represented by dots. The results are split by age grouping in decades.

Figure 4

Incidence of metastases at presentation split by size categories (soft tissue sarcoma data).

Figure 5

Kaplan Meier survival curve showing the overall survival split by size category at presentation (patients with metastases at diagnosis not included).

Figure 6

Kaplan Meier survival curve showing survival for all sarcomas split by duration of symptoms being more or less than one year.

Figure 7

A tin of baked beans is 10.2 cm long–slightly smaller than the average size of sarcomas at diagnosis.

Figure 8

A golf ball measures 42 mm. A useful size to remember–any lump bigger than this should be considered malignant until proved otherwise.