What is liposarcoma?

Liposarcoma is a rare form of cancer that develops in your body’s soft and fatty tissues.¹ It can grow anywhere around the body, but the most common locations are your abdomen, your limbs and behind your knee joints.¹ Liposarcoma can affect anyone at any age, but the average age of diagnosis is around 50 years old.¹

People with liposarcoma often show no symptoms. However, when signs are present, they may include:¹

• Development of a lump on your body, which may not be painful at first, but it can become sore
• Pain and tenderness around the lump
• Nausea and vomiting
• Pain, numbness, tingling and weakness in your limbs
• Varicose veins
• Fatigue
• Weight loss

If a doctor thinks that you might have liposarcoma, they will order medical tests to determine which subtype of liposarcoma you have. The World Health Organisation (WHO) divides liposarcoma into three different subtypes of tumour.^1,2 This includes well-differentiated and de-differentiated liposarcoma, myxoid liposarcoma, and pleomorphic liposarcoma.^2,3

Well-differentiated and de-differentiated liposarcoma 

Well-differentiated liposarcoma is the most common type of liposarcoma.³ It is a low-grade tumour, which means that the cells look relatively normal under a microscope and that they grow slowly.³ Because of this, they are less likely to spread (metastasise) and have a low recurrence rate.³ These tumours are mainly found in the abdomen and limbs.³

De-differentiated liposarcoma occurs when a well-differentiated liposarcoma becomes a high-grade tumour.³ They become more aggressive and more severe much quicker than well-differentiated liposarcomas.³ They are more likely to spread and are more dangerous to your health.³

Myxoid liposarcoma

Myxoid liposarcoma makes up more than one-third of liposarcomas, making it the second most common liposarcoma subtype.³ It is characterised by a distinct structure when investigated under a microscope.³ It is more likely to spread than de-differentiated liposarcoma, with a preference for spreading to soft tissue and bone.³ The round cell type of myxoid liposarcoma is more severe than myxoid liposarcoma alone.³

Pleomorphic liposarcoma

Pleomorphic liposarcoma is the rarest, but most aggressive subtype of liposarcoma.³ It is a high-grade tumour associated with high rates of recurrence.⁴

A doctor will use information regarding the subtype of liposarcoma to create a treatment plan.^5,6 The treatment often includes surgery to remove the tumour and sometimes radiation or chemotherapy to ensure that all of the surrounding cancer cells are killed.^1,5,6 A multidisciplinary team of specialised doctors, surgeons and nurses will work together to oversee your treatment and recovery to ensure that it goes as smoothly and effectively as possible.^1,5

What does “local recurrence” mean?

Local recurrence is when a cancer returns at the same location after treatment.⁷ It can happen even when tumour removal surgery, radiation or chemotherapy have been successful.⁸ Liposarcomas can have a high rate of local recurrence.¹

Recurrence of liposarcoma is an important factor for doctors to consider, as it unfortunately means that you would require further treatment. It is more likely to occur in the first few years following treatment for liposarcoma.^1,6

Recurrence risk can be calculated by doctors using various factors such as liposarcoma subtype, tumour grade, tumour depth, tumour size and age.^1,5,6 This will usually help doctors to decide how often you should be monitored after surgery (post-operative monitoring) and treatment.^5,6

Monitoring is important since it allows doctors to detect possible recurrences early and therefore put treatment plans in place as quickly as possible.⁵ It also allows doctors to look for any possible complications or adverse effects from surgery to ensure that you have the best possible outcomes after treatment.⁵ This gives you and your healthcare team peace of mind.

What does monitoring look like?

Doctors base the post-operative monitoring plan on a set of guidelines.^5,6 These plans usually look different from person to person since doctors also incorporate your unique risk of local recurrence into their decision, as opposed to using a ‘one size fits all’ approach.⁹ These plans include regular follow-ups.⁵ A follow-up is usually an appointment with a doctor or expert who specialises in cancers and liposarcoma^5,10. This allows a doctor to check up on your condition post-surgery and give you any relevant further information. It also provides you with the opportunity to ask any questions or raise any concerns that you may have.^10,11 During follow-ups, you may also be required to undergo some tests to check for any local recurrence. These tests include physical exams and imaging tests.^5,11

Physical exams

These exams are performed by an expert to check for any lumps, changes or abnormalities at the original area where your liposarcoma was found.^5,11 They usually involve visual and physical assessments by a doctor, and listening to your internal body sounds using a stethoscope to check that your organs are working properly.¹² Physical examinations are not normally used to diagnose or treat conditions, but are helpful for doctors to determine their next steps.¹²  

Imaging tests

These tests create a picture of the inside of your body that can be used by a doctor to look for any internal abnormalities. In these tests, signals are created, which are then processed into an image by the computer. To check for recurrent liposarcoma, doctors will usually use Magnetic Resonance Imaging (MRI) scans and Computed Tomography (CT) scans.^6,13

MRI scans, or magnetic resonance imaging scans, use strong magnetic fields and radio waves to produce detailed images of the inside of your body.¹⁴ During this test, you lie on a flat bed that is moved inside a large tube containing powerful magnets known as an MRI scanner.¹⁴ It can be used to examine almost any part of the body, including the regions where liposarcoma is likely to develop.¹⁴ The scanner is controlled using a computer by a professional radiographer who has had extensive training to carry out this procedure.¹⁴ They perform the procedure in a separate room to protect themselves from the magnetic field that it produces.¹⁴ Despite this, the radiographer can still see you and communicate with you during the scan using an intercom.¹⁴ The scanner may produce loud noises, but you can request earplugs or headphones.¹⁴ During the scan, you must stay as still as possible and follow any instructions given to you by the radiographer.¹⁴ MRI scans usually last 15 to 90 minutes; this varies depending on which area of your body is being scanned and how many images are being taken.¹⁴ 

CT scans, or computerised tomography scans, are also used to take detailed images of the inside of your body.¹⁵ X-ray beams are used, which are pointed at you and are quickly rotated around your body to produce signals that can be processed by a computer.¹⁶ The computer can then generate multiple images of your body, in which abnormalities can be detected.¹⁶ During a CT scan, you lie down on a flat bed which passes through the part of the CT scanner known as a gantry.¹⁶ The gantry contains the X-ray tube and other components needed for imaging.¹⁶ Similar to an MRI scan, CT scanners are also operated by a radiographer from another room.¹⁵ The radiographer will still be able to communicate with you throughout the scan using an intercom.¹⁵ You must stay as still as possible during the scan and follow any instructions given to you by the radiographer. CT scans usually last 10 to 20 minutes, depending on which area of your body is being scanned and how many images of are being taken.¹⁵ 

How often does monitoring occur?

How often you receive these tests depends on your risk of recurrence and other factors like age.⁶ The ESMO guidelines recommend that those with high risk should follow up every three to four months in the first two to three years after surgery.⁶ After that, they should be checked two times a year up until the fifth year after surgery, and then once a year after that.⁶ People with low risk of recurrence should go for a follow-up every 6 months for the first 5 years after surgery, then once a year after those first five years.⁶

What to watch for independently

Self-examination is also important, as recurrences can still happen a long time after your initial diagnosis.¹¹ You should still be vigilant at home and check for:

• New lumps or swelling near the original sites
• Pain, discomfort, or other new symptoms

It would also be helpful to keep a symptom diary or take photos of the area to track your condition and discuss with your doctor.

Summary

Post-operative monitoring is an important part of recovery. It is not something to be concerned or anxious about, but instead a good approach to ensure that local recurrence or complications are detected early. Monitoring may include physical examinations and imaging tests, with a focus on the original area where liposarcoma was found. Other than the tests performed by health professionals, self-examinations at home would also be useful in the long term. Monitoring methods suggested by doctors are usually tailored to you depending on several factors to minimise any risks and hence ease your mind.