A diet rich in cruciferous vegetables such as broccoli, brussels sprouts, cabbage, cauliflower, kale, bok choy, horseradish, arugula, turnips, collard greens and radishes, and whole grains may help prevent/reduce the risk, or improve the symptoms and treatment outcomes of a rare cancer called liposarcoma, a soft tissue sarcoma originating in the fat cells. However, consuming glutamine supplements, following high fat diets with foods containing saturated fats or trans-fats and those that cause obesity such as red meat, processed meat, processed foods, sugary beverages and fried crisps, may increase the tumor size, aggravate the symptoms or the risk of liposarcoma (soft tissue sarcoma). Eating a healthy diet with the right foods in the right proportions, being physically active and doing regular exercises are inevitable to stay away from soft tissue sarcoma such as liposarcoma.
What is Sarcoma?
Rare cancers are those cancers that usually affect less than 6 per 1,00,000 people in the population. Sarcomas belong to the rarest forms of cancer. Sarcomas may originate from smooth muscle cells, fat cells, synovial tissues, the connective tissues of the body such as muscle, bone, nerves, cartilage, tendons, blood vessels and the fatty and fibrous tissues. Sarcomas account for approximately 0.7% of all cancers with around 13,130 new cases diagnosed in 2020 in the soft tissues. The overall 5-year survival rate for sarcoma is 65%. (American Cancer Society)
What is Soft Tissue Sarcoma?
There are over 60 different types of soft tissue sarcoma, a rare cancer which may start from any part of our body such as muscles, tendons, blood vessels, nerves, fat or deep skin tissues. Some examples of soft tissue sarcomas are:
- Leiomyosarcoma – originates in smooth muscle cells
- Malignant fibrous histiocytoma (MFH) or Undifferentiated Pleomorphic Sarcoma (UPS) – usually found in the arms or legs, but may also start in other parts of the body
- Liposarcoma – originates in fat cells.
- Rhabdomyosarcoma – originates in the skeletal or voluntary muscles of the body; common in children
- Angiosarcoma – originates in blood or lymph vessels.
- Fibrosarcoma – originates in fibrous tissues, usually in the arms, legs, chest, or back.
- Myxofibrosarcoma – originates in the extremities of elderly patients
- Ewing sarcoma – originates in bones or in the soft tissue around the bones.
- Chondrosarcoma – usually originates in the bones, but may also occur in the soft tissue near bones.
- Synovial sarcoma – originates in synovial tissues that surround joints.
- Gastrointestinal stromal sarcoma – originates in the digestive system.
- Desmoid tumor – noncancerous growths that occur in the connective tissue.
In this blog we will elaborate on one of these soft tissue sarcomas, called the Liposarcoma, with details on its causes, signs and symptoms, treatments and the studies related to the association of diet (foods and supplements) and Liposarcoma.
What is Liposarcoma?
Liposarcoma is a rare type of cancer that develops in fat cells found in the soft tissues of the body. Liposarcoma accounts for up to 15-20% of all soft tissue sarcomas, with 82%-86% cases identified among whites. (Suzanne Bock et al, Int J Environ Res Public Health., 2020)
Liposarcoma can originate in any part of the body, however, it is usually formed in abdomen, legs – especially the thighs, or arms. Liposarcoma mostly occurs in the fat layer just below the skin or in the soft tissues such as muscles, tendons, fat, and nerves.
Liposarcoma is also known as lipomatous tumor. It usually does not cause pain. Liposarcoma often affects men more than women and tends to show up in people who are aged between 50 and 65.
What are the Different Types of Liposarcoma?
Before finalizing the treatment for Liposarcoma, it is important to find out the exact type of the Liposarcoma, in order to design the best treatment for the patient. Following are the three main types of liposarcoma.
Well-differentiated liposarcoma : It is the most common type of Liposarcoma. It grows slowly and usually does not spread to other parts of the body.
Myxoid liposarcoma : It is the second most common type of liposarcoma. It accounts for about 30% to 35% of all liposarcomas. Myxoid liposarcoma tends to grow slowly, but as compared to well-differentiated liposarcoma, it can grow faster and is more likely to spread to other parts of the body. Round cell liposarcoma is a more aggressive form of myxoid liposarcoma.
Pleomorphic liposarcoma : This type of liposarcoma is extremely rare. It often spreads very quickly. It accounts for less than 5 percent of all types of liposarcoma and is more common in older adults.
What are the Treatments for Liposarcoma?
There are different treatment regimens for Liposarcoma, including surgery, radiotherapy, chemotherapy and targeted therapy. Depending on the stage of this soft tissue sarcoma, the treatment will vary.
Surgery or surgery followed by radiation is the most common treatment regimen for liposarcoma. As a first step, tumor is often removed surgically along with a wide margin of healthy cells. Radiation helps destroy the remaining cancer cells left. However, when the tumor is in the areas such as the head, neck, or abdomen, it might be difficult to remove the entire tumor with enough normal tissue around it. For the treatment of these liposarcoma, radiotherapy is done, with or without chemotherapy, before surgery. Radiotherapy helps to try to shrink the tumor.
Chemotherapy targets fast growing cells and hence it might not be very effective in the low grade liposarcomas which grow extremely slowly.
How does Liposarcoma occur?
It is not very clear what exactly causes liposarcoma. Liposarcoma is usually attributed to a change in some of the genes that are normally present in fat cells. Some of the key factors that may lead to the development of these soft tissue sarcomas are:
- Radiation given to treat other cancers such as breast cancer or lymphoma
- Disorders caused by mutations that an individual might have inherited from a parent, which are linked to a high risk of getting certain cancers; certain genetic syndromes such as neurofibromatosis and Li-Fraumeni syndrome
- Environmental exposure; exposure to certain chemicals
- Damaged lymph system (through radiation)
Individuals with a strong family history of soft tissue sarcomas such as Liposarcoma or who have a history of other cancers should consider consulting a doctor to decide whether they should undergo genetic testing to detect any mutated genes and plan the next steps. Diagnosing these cancers is a challenge as there are many non-cancerous conditions which may appear like soft tissue sarcomas with similar signs and symptoms.
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What are the Signs and Symptoms of Liposarcoma?
Approximately 40% of sarcomas may originate in the belly and half of the soft tissue sarcomas may originate in an arm or leg.
Following are some of the signs and symptoms of Liposarcoma one should look out for. (American Cancer Society)
- A growing lump of tissue under the skin
- Weakness of the affected limb
- Pain or swelling in the affected limb
- Persistent, severe abdominal pain
- Blood in stool or vomit
- Abdominal swelling
- Black tarry stools due to bleeding in the bowel or stomach
The signs and symptoms vary depending on the part of the body where the liposarcoma originates. The first 3 symptoms may be caused when liposarcoma occurs in the arms and legs, while the rest of the symptoms may be caused when it occurs in the abdomen.
Consult a doctor if you experience at least one of these symptoms of liposarcoma. Though many of these symptoms may be often related to other health issues and not liposarcoma, it is very important to get it checked by your doctor.
What is the Role of Diet/Foods in Liposarcoma?
Choosing the right foods to include in the cancer patients’ diet or for healthy individuals who are at risk of cancer may help to prevent/reduce the risk or support the treatment of cancer, may it be soft tissue sarcoma such as liposarcoma, or any other type of cancers. At the same time, following a diet with the wrong selection of foods and supplements, unhealthy eating habits and lifestyle may lead to the development of these rare soft tissue sarcomas. Based on preclinical studies and observational studies in humans, here are examples of some foods which have been shown to be good or bad, when it comes to liposarcoma.
1. Cruciferous Vegetables containing Sulforaphane may be beneficial
In a study done by the researchers from the Chiba University, Chubu University and National Cancer Center Research Institute in Japan based on microarray data from 88 soft tissue sarcoma patients, they found that the survival rates for those patients who were positive for a gene called MIF-1 (macrophage migration inhibitory factor), an inflammatory cytokine, were lower than those patients who were negative for MIF-1 (Hiro Takahashi et al, Biochem J., 2009). Hence, they concluded that those agents that can inhibit MIF-1 may be a potential therapeutic compound for treating soft tissue sarcomas.
Furthermore, in other experimental studies, it was found that Sulforaphane, a key bioactive compound seen in cruciferous vegetables such as broccoli, brussels sprouts, cabbage, cauliflower, kale, bok choy, horseradish, arugula, turnips, collard greens and radishes, has the potential to inhibit or inactivate the gene MIF-1 (Janet V Cross et al, Biochem J., 2009; Hiroyuki Suganuma et al, Biochem Biophys Res Commun., 2011). When the cruciferous vegetables are chewed, cut or cooked, the plant cells are damaged and glucoraphanin, a glucosinolate present in these vegetables, comes in contact with an enzyme called myrosinase and gets transformed into sulforaphane.
Hence, consuming a diet rich in cruciferous vegetables is healthy and may help to prevent or support treating soft tissue sarcoma such as liposarcoma.
2. Whole Grains containing Dietary Fiber may be beneficial
Whole grains are nothing but the unrefined grains which simply means that their bran and germ are not removed by milling. Hence, the nutrients are not lost via processing and are better sources of dietary fibers and nutrients including selenium, potassium and magnesium. Being an excellent source of dietary fibers and also due to their high nutritional value, whole grains are considered healthy.
In a case-control study conducted in Northern Italy between 1983 and 1992 by the researchers from the Instituto di Ricerche Farmacologiche Mario Negri in Italy, they evaluated the association between the frequency of intake of different foods, lymphoid neoplasms, and soft tissue sarcoma. The study included a total of 158 patients with Hodgkin’s disease, 429 patients with non-Hodgkin’s lymphoma, 141 patients with multiple myelomas, 101 cases of soft tissue sarcomas, and 1157 controls. (A Tavani et al, Nutr Cancer., 1997)
The study found that regular intake of whole-grain foods significantly reduced the risk of non-Hodgkin’s lymphoma and soft tissue sarcoma. Hence, include whole grain foods rather than polished grains in your diet to prevent soft tissue sarcoma such as liposarcoma.
3. Black Seed (Nigella Sativa) and Saffron may have Anti-Sarcoma Effect
In a previous pre-clinical study done by the researchers from Amala Cancer Research Centre in Kerala, India, they evaluated whether Nigella sativa/Black seed and Saffron can inhibit the action of 20-methylcholanthrene (MCA)-induced soft tissue sarcomas, by studying the effect of Black seed and Saffron on MCA-induced soft tissue sarcomas in albino mice. The study found that the intraperitoneal administration of Black seed and saffron after administration of MCA, restricted the tumor incidence to 33.3% and 10%, respectively, when compared with 100% in MCA-treated controls. Hence, black seed and saffron may have the potential to reduce the risk of soft tissue sarcoma such as liposarcoma. (M J Salomi et al, Nutr Cancer., 1991)
4. Soy-Food Derived Multi-Amino Acid Supplement may have Anti-Sarcoma Effect
In a pre-clinical study done by the researchers from Taiwan in 2016, they evaluated the effects of using soy-derived multiple amino acids’ oral supplements on the therapeutic efficacy of a low-dose drug CTX in mice with implanted sarcoma cells. The study found that a low dose of CTX when combined with the oral soy-derived multiple amino acid supplement had a potent anti-tumor effect. (Chien-An Yao et al, Nutrients., 2016)
Taking moderate amounts of soy foods rich in key active compounds such as genistein and daidzein with anti-inflammatory and antioxidant effects, should not do any harm. Some examples of soy foods are Soybeans, Tofu, Tempeh, Edamame, Soy yogurt and Soy milk.
5. Glutamine Supplements should be avoided: Targeting Glutamine Metabolism may Slow down Sarcoma Growth
Glutamine is an important nutrient for highly proliferative cells. A recent paper published in 2020 by the researchers from the University of Pennsylvania and Children’s Hospital of Philadelphia in the United States, based on experimental studies, highlighted that glutamine metabolism is associated with the pathogenesis of sarcoma. The in vitro studies found that glutamine deprivation inhibited the growth and viability of different soft tissue sarcoma cell types, including Undifferentiated Pleomorphic Sarcoma (UPS), fibrosarcoma, leiomyosarcoma, and a few subtypes of Liposarcoma, though not all subtypes. Hence targeting glutamine metabolism may slow down the growth of sarcoma. (Pearl Lee et al, Nat Commun., 2020)
Based on these findings, one should avoid consuming glutamine supplements if diagnosed with soft tissue sarcoma such as liposarcoma.
6. Obesity is associated with Larger Soft-Tissue Sarcomas
Researchers from the University of Arkansas for Medical Sciences and Texas A&M University carried out a study to evaluate the association between obesity and soft-tissue sarcoma outcomes and published their findings in the Journal of Surgical Oncology in 2018. The study included a total of 85 nonobese (with a BMI< 30 kg/m2) and 54 obese individuals (with a BMI≥ 30 kg/m2). (Corey Montgomery et al, J Surg Oncol., 2018)
The researchers found that, when compared to the non-obese patients, there was 50% larger average tumor diameter, 1.7-fold higher overall complication rates, a significantly higher rate of complex wound closures and more complications after the surgical treatment in patients who were obese. However, they didn’t find any significant difference in the incidence of cancer spread or survival between the obese or non-obese patients.
Hence, avoid those foods and unhealthy eating habits that can lead to obesity to stay away from larger soft tissue sarcoma. Regular intake of the following foods may increase the chances of obesity:
- Red meat and Processed Meat
- Fried Crisps and Chips
- Sweetened or Sugary beverages
- Ultra-Processed Foods
- Fast Food
Being physically active and doing regular exercises are also important to stay away from obesity and live healthy. Always remember that, when we consume more than what the body burns, the weight goes up. Hence, eat healthy foods in the right proportions and do regular physical activities to prevent soft tissue sarcoma cancers such as liposarcoma!
7. High Fat Diets should be avoided to Prevent Liposarcoma (Soft Tissue Sarcoma)
In a preclinical study done by the researchers from the Graduate School of the Chinese Academy of Sciences in Shanghai, China, it was found that there was spontaneous formation of liposarcoma, a soft tissue sarcoma in the adipose tissues of a transgenic mouse model with overexpression of IL-22, a cytokine that modulates inflammatory response in tissues such as epithelium and liver. (Zheng Wang et al, PLoS One., 2011).
Based on this animal study, it seems like a high fat diet should be avoided to prevent/reduce the risk of the soft tissue sarcoma- Liposarcoma.
A high fat diet, especially, a diet rich in trans-fats or unsaturated fats is known to be harmful to our health as it leads to obesity. Foods such as fried crisps/chips, red meat, processed meat and processed foods are rich in saturated or bad fats and should be avoided from the diet to prevent liposarcoma.
Based on these experimental and observational studies, a diet rich in healthy foods such as cruciferous vegetables and whole grains seems to be beneficial to prevent/reduce the risk or improve the symptoms and treatment outcomes of a rare soft tissue sarcoma – liposarcoma. Soy, black seed and saffron may also have the potential to reduce the risk or aggression of the liposarcoma symptoms. However, consumption of glutamine supplements, high fat diets, foods containing saturated fats or trans-fats and those that cause obesity such as red meat, processed meat, processed foods and fried crisps may result in increased tumor size, aggravated symptoms or increased risk of liposarcoma (soft tissue sarcoma). Patients with poorly controlled diabetes may also be associated with large, malignant, and retroperitoneal (behind the abdominal cavity) lipomatous tumors such as liposarcoma. In short, consuming a healthy diet with emphasis on plant sources such as cruciferous vegetables and whole grains, maintaining a healthy weight, adopting a physically active lifestyle and doing regular exercises are inevitable to prevent the soft-tissue sarcoma liposarcoma.
Integrative cancer care needs to move towards personalization of supportive nutrition based on the type of liposarcoma, ongoing treatment and other factors such as lifestyle. This isn’t really explored and may significantly help with improving the treatment outcomes and quality of life of the patients.
“What should I eat?” is the most frequently asked question to cancer dieticians and physicians. The right answer depends upon cancer type, underlying genomics, current treatments, any allergies, lifestyle information, and factors like BMI.
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Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer. Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.