Understanding soft tissue sarcoma

This post was written by Christopher Johnson, DO, PPG – Oncology.

Sarcomas are rare cancers that originate from connective tissue. As opposed to more well-known cancers, like lung, breast, colon and prostate cancer, which arise from organs, sarcomas are cancers that start within muscle, bone, fat or nerves.

There are more than 50 subtypes of soft tissue sarcomas, all of which have unique characteristics and behavior. There are only about 15,000 new cases of sarcoma a year in the United States, and as a result, sarcoma does not receive as much publicity or research funding compared to more common cancers.

Soft tissue sarcomas affect all ages, from children to the elderly. Sarcomas can arise in any anatomic location, but deep within the extremities, trunk and pelvis are the most common locations. Unlike carcinomas that spread through the lymphatic system, sarcomas have a predilection to spread through the blood and most commonly metastasize to the lung. 

Sarcomas can have a wide variety of behaviors from low-grade tumors that rarely spread, to very aggressive tumors that are challenging to control. Due to the rarity of these cancers and the expertise needed to treat them, it’s important for patients to receive their care at an experienced center that has a team dedicated to the treatment of sarcomas.

Causes

While most sarcomas occur sporadically and have no known cause, certain types of sarcoma are more commonly seen in certain age groups. For example, rhabdomyosarcoma (a soft tissue sarcoma of skeletal muscle), is commonly seen in children, while undifferentiated pleomorphic sarcoma is the most common sarcoma seen in adults.

There are certain syndromes that predispose patients to develop sarcoma, such as neurofibromatosis and Li Fraumeni syndrome. The Sarcoma and Musculoskeletal Tumor Care Team at the Parkview Cancer Institute utilizes a High-Risk Clinic to develop protocols to monitor such patients to allow for early detection of sarcoma if it is to develop. Unfortunately, researchers have not discovered any ways to prevent the development of soft tissue sarcomas.

Symptoms

Soft tissue sarcomas present as a soft tissue mass that can arise anywhere in the body. The most common location is in the extremities, followed by the trunk and pelvis. The tumor can range in size from a few centimeters to more than 40 cm, consuming an entire limb.

The most common way a sarcoma presents is a painless enlarging mass deep within an extremity. Any soft tissue mass that is larger than a golf ball or is increasing in size warrants advanced imaging, typically an MRI, so that the provider can better visualize the mass. If imaging shows there is any concern for sarcoma, the patient should be seen at a sarcoma center to obtain a biopsy. The Sarcoma and Musculoskeletal Tumor Care Team utilizes a multidisciplinary approach to perform biopsies of sarcoma and in appropriate clinical scenarios, patients may undergo a same-day biopsy in the sarcoma clinic.

Treatment

It is very important for patients to receive treatment at a dedicated sarcoma center. Soft tissue sarcomas are generally treated with radiation and limb-salvage surgical excision of the tumor. In some clinical scenarios, chemotherapy may be administered.

Utilizing proper treatment can allow for local control of sarcoma in approximately 85% of cases. Unfortunately, if sarcoma is spread, it becomes more challenging to control. With Parkview Cancer Institute’s Sarcoma and Musculoskeletal Tumor Care Team, all patients are treated in a multidisciplinary fashion. Patients are seen in the same office visit by orthopedic oncology (an orthopedic surgeon with subspecialized training in sarcoma surgery), sarcoma medical oncology and sarcoma radiation oncology. All cases undergo review at a weekly sarcoma conference attended by orthopedic oncology, medical oncology, radiation oncology, genetics, pathology, musculoskeletal radiology, sarcoma nurse navigation and a dedicated research team, to ensure that all patients receive proper care according to national guidelines.

Patients are continually assessed for availability of clinical trials by our dedicated research team. In addition, patients are guided through their treatment by a dedicated sarcoma nurse navigator. Patients who have completed treatment are seen at our survivorship clinic to minimize the adverse effects of cancer treatment, using a holistic approach.

To learn more about this condition and Parkview’s approach to treating sarcoma, visit us online or call 260-484-3030.

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