A sarcoma is a cancerous tumor of the bone or soft tissue. Soft tissues are the tissues that connect, support, or surround the body's organs and structures. They include muscle, tendon, synovial tissue (around joints), fat, blood vessels, lymph vessels, and nerves. Sarcomas are divided into two main groups – bone sarcomas and soft tissue sarcomas. They are further sub-classified according to the type of cell found in the tumor. They all share certain microscopic characteristics and have similar symptoms.
Sarcoma Overview and Symptoms
Types of sarcoma include:
- Osteosarcoma - a cancerous tumor of bone
- Chondrosarcoma - cancer of cartilage
- Pleomorphic sarcoma - a group of cancerous soft-tissue or bone tumors
- Liposarcoma - cancer of fatty tissue
- Leiomyosarcoma - cancer of smooth muscle tissue or in the muscle wall of a blood vessel
- Synovial sarcoma - soft tissue cancer (sarcoma) often near a joint, but seldom in a joint
- Ewing's sarcoma - a cancerous bone or soft tissue tumor that often strikes children and young adults
People with soft tissue sarcomas often have no symptoms until the tumor grows to a large size and can be felt. However, when symptoms are present, they may include:
- Pain in the affected area
- Inflammation and swelling in the affected area
- Inability to move limbs properly in the affected area
If a lump or swelling indicate the possibility of sarcoma, doctors usually will suggest imaging tests:
- CT Scan – also called computed tomography (CT) scan
- magnetic resonance imaging (MRI)
- positron emission tomography (PET) scan
If the imaging tests show the presence of a tumor, doctors will perform a biopsy to determine whether it is a benign (non-cancerous) or malignant (cancerous) tumor. Biopsy can be done through either a needle or surgical incision.
- Image-guided needle biopsy – Musculoskeletal radiology physicians, guided by CT or ultrasound, insert a needle into the tumor to take a small core sample of cells for analysis. A surgeon is also present to help guide the needle's path. This outpatient procedure uses a local anesthetic to numb the area.
- Open biopsy – A surgeon uses a scalpel (surgical knife) to make a small incision and take a wedge of tumor for analysis. This is usually an outpatient procedure, but performed in the operating room with general anesthesia, so you are asleep.
Usually biopsy procedures are not carried out at the initial visit, but arranged for at a later date once all the information and imaging studies have been gathered.
Staging is the process of determining whether the sarcoma has spread and if so, where. More imaging studies may be necessary. A surgical oncologist may also need to do an outpatient procedure called a sentinel node biopsy. Tumors with a tendency to involve lymph nodes require this type of biopsy. The surgical oncologist injects an area of the tumor with "dye," which is picked up in the lymph nodes. The lymph node(s) that are both the first to absorb the dye and absorb the largest amount are removed and examined to determine if they contain any tumor cells. (If so, the surgeon will remove these lymph nodes during the same or subsequent operation to remove the tumor, to be sure all traces of cancer are gone.)
Sarcoma TreatmentThe type of treatment you receive is based on whether the sarcoma is low or high grade (low-grade tumors grow more slowly with a more favorable outlook), and whether the tumor is localized or metastasized. A localized tumor is confined to one area and is more easily treated. Cancer that has metastasized has spread to other tissue or areas, which requires more aggressive treatment.
Surgeons remove (or excise) the tumor. Our orthopedic oncology team of experts is internationally recognized for expertise in limb-salvage reconstructive surgery when removing the tumor to avoid amputation, preserve appearance, and promote the greatest degree of mobility. Limb preservation is based on your age and health, and tumor size and location.
In limb-sparing surgery, once the tumor is removed, surgeons reconstruct any bone defects with bone graft, bone cement and/or metal replacements. They reconstruct any tissue defects usually with local tissue. Revolutionary advances in limb-sparing surgery and in limb prostheses if amputation is the best course of treatment, help preserve mobility and function, and sustain a quality of life that was until now not often possible.
Radiation is the first treatment course if you have a localized (confined) high-grade (more advanced) soft tissue sarcoma. In some cases, you may need low-dose chemotherapy at the same time, in order to shrink the tumor before surgeons can remove it. Most often, following radiation and chemotherapy, surgeons can perform limb-sparing surgery to remove the tumor.
Orthopedic oncology surgeons reconstruct soft tissue defects with local tissue, or with muscle flaps, with help from a plastic surgeon. If the tumor is very large, and sitting next to a nerve or blood vessel, for instance, it may be necessary to follow surgery with a boost of radiation from CyberKnife, to remove any traces of cancerous tissue. CyberKnife is precisely targeted radiation therapy, focused on the residual cancer cells, with minimal exposure to surrounding healthy tissue. You may also need physical therapy and rehabilitation to restore range of motion and function to the affected limb.
If you have a localized (confined) high-grade (more aggressive) bone sarcoma, your treatment course is likely to include:
- Chemotherapy before surgery
- Limb-sparing surgery with metal bone and joint replacements, and allografts (donated bone graft), and reconstruction of soft tissue defects that may require muscle flaps, with assistance from a plastic surgeon
- Additional chemotherapy after surgery, which may be the same or different from the chemotherapy you received before surgery
- Physical therapy to restore range of motion and function to the affected limb
Metastases are cancer cells that have spread from an original or primary site to one or more locations or organs elsewhere in the body. Metastatic sarcoma means your cancer has spread from a primary site (such as the tumor in your arm or leg) to another area, usually the lung or lymph notes. If you are diagnosed with metastatic sarcoma, you will likely receive some combination of chemotherapy, radiation, and surgery, depending on the tumor and the areas of involvement.
Bone is the most common site of metastasis from cancer of the breast, prostate and lung. If you are diagnosed with metastatic carcinoma to the bone, physicians will assess your risk of fracture and if that is high, may recommend prophylactic (preventive) fixation of the bone with rods or plates and screws. Treatment is also likely to include:
- Chemotherapy and hormone therapy
- Interaction with other cancer care teams to treat your primary cancer
- Rehabilitation to improve function
Sarcoma ProgramThe Sarcoma Program in the Cancer Center at Beth Israel Deaconess Medical Center is internationally recognized for its team of experts, advanced treatment options, and personalized care.