Sarcoma Diagnosis and Treatment
Most sarcomas are noticed by patients as a lump or mass that grows over time, which may or may not cause pain or other symptoms. Since there are many non-cancer possibilities for “lumps and bumps,” we always recommend radiologic imaging (may include xrays, CT scans, and MRI scans). If a mass is suspicious for a cancer, the most important thing is to be evaluated by a sarcoma surgeon who will often perform a carefully planned biopsy. The results of the biopsy can be reviewed by our pathologists, and are critical for planning treatment.
Surgical removal is the main goal for most bone and soft tissue sarcomas, when it is possible to remove the tumor completely. However, is very important that a sarcoma expert performs the surgery, to make sure that there is a wide border (margin) between normal tissue and tumor tissue, and also to ensure that no contamination of healthy tissue by tumor cells occurs during the process. For sarcomas in the extremities, surgeons often can remove the cancer without amputation, which is called limb-salvage or limb-sparing surgery. Sarcoma surgeons who operate in the chest and abdomen or head and neck are also careful to remove sarcomas using similar principles. For some sarcomas, especially those in the extremities, we recommend chemotherapy and/or radiation treatment before the surgery, to help shrink the tumor and increase the chances of a complete removal.
Chemotherapy is often a part of treatment for larger or higher grade (more aggressive) sarcomas. Chemotherapy is the main treatment for sarcomas that have already spread (metastasized) through the bloodstream to the lungs or other organs. We also often use chemotherapy before or after surgery in high risk patients to help prevent metastasis. Knowing the exact type of sarcoma helps guide the use of chemotherapy. For example, chemotherapy is almost always used in Ewing’s sarcoma, rhabdomyosarcoma and osteosarcoma because of the very high risk of recurrence in distant organs even with complete removal of the sarcoma by surgery. Additionally, new targeted therapies have been shown to be very effective for certain types of sarcomas, such as GIST. Your doctors should carefully explain the risk of recurrence of your particular tumor and the potential side effects of chemotherapy to help you decide if chemotherapy is the right option for you.
Radiation therapy may also be part of the treatment plan for sarcomas. Like chemotherapy, radiation treatment can be used before or after surgery to help ensure negative margins (no tumor cells are left behind after surgery). Additionally, in sarcomas that have spread to other organs, radiation can be used to target problem areas that are not easily removed by surgery. Our radiation oncologists at Sylvester have access to the most advanced radiation techniques and machines, designed to maximize tumor kill while sparing the normal tissue surrounding the tumor site.