
<b> If all demonstrable disease is removed, then there will be scans every 3 months for a while, then 6 monthly, then yearly. See &&url . </b> 

Because LMS tumors do not always cause symptoms in early stages, and because they are not always accessible to physical exam, CT scans of chest, abdomen and pelvis are usually done every three months for two years, then every six months for another 3 years, then yearly.   Some centers do ultrasound abdomen & pelvis and chest Xray instead of the CT scans, or alternating with them.  Do not miss your scans.  Unless you have cutaneous LMS, which virtually never metastasizes, you will urgently need to be under regular surveillance.  

Remember also, that 7.5% of sarcoma patients get a second, DIFFERENT primary cancer.  Surveillance can often detect these cancers as well.
&&url PMID: 11283938  

There may never be another episode of LMS.
OR there might be a local recurrence, or a distant metastasis.

If LMS reappears, the treatment of choice is surgical. If the tumors are resected [surgically removed] or ablated, then the patient is again in remission.

If at any time, the tumors cannot be surgically resected or ablated, then there is use of chemo and/or radiation, hoping to knock the tumor back enough to MAKE it surgically resectable [this is called neoadjuvant treatment].

If many metastases occur, or cascades of metastases occur, chemotherapy is usually used to try to control the systemic disease.  Chemotherapy and radiation do not cure LMS, but sometimes they work well enough for long enough to allow a surgical solution or control where none existed before.  There is a slight chance that chemotherapy or radiation might eradicate tumors without the necessity of surgical excision, and put the patient back into remission.

If at any point LMS tumors cannot be either ablated or resected surgically, then palliative treatment is given, usually either with radiation or chemotherapy, in an effort to prolong survival time. There is still a slight chance that chemotherapy or radiation might eradicate the tumors.

There are other treatments becoming available that might be used in addition to chemotherapy, or in an adjuvant situation. Among these are Gleevec for PDGFr positive tumors, anti-hormone treatment for tumors with hormone receptors, antibody targeted viruses for tumors, replacement p53 gene therapy, vaccines, monoclonal antibodies, anti-angiogenesis treatment with targeted molecules or copper-lowering agents or metronomic dosing, targeted molecular tumoristatic agents, -- the list goes on and on. Some of these are discussed more fully on this website, for others you will have to use PubMed and ASCO searches, or find other sites. You can also join and ask on the L-M-Sarcoma mailing list &&url 

<b>Darcey's three rules:</b>
Truthfully, there are only three pieces of advice any one of us needs to receive.
a.  Get competent medical care ...in our case a sarcoma expert
b.  Question everything and listen closely to what others are trying. You never know when you will need it
c.  If a Dr tells you 'no' about a certain treatment, keep knocking on doors until someone says yes...even if they never do, you will know you have tried.
