What is sarcoma?
Sarcoma is a malignant (cancerous) tumor that can develop from fat, muscle, nerve, fibrous tissues surrounding joints, blood vessel, or deep skin tissues. Although over half develop in the arms and legs, they can develop in any part of the body. There are many types of the sarcoma. Some are malignant and some are benign.
The American Cancer Society reports that in 2006, about 9,530 new soft tissue sarcomas will be diagnosed in the United States. Of these, 5,720 cases will be diagnosed in males, and 3,810 cases will be diagnosed in females. During 2006, 3,500 Americans (1,830 males and 1,670 females) are expected to die of soft tissue sarcomas. These statistics include both adults and children.
The cause and prevention of sarcoma is unknown, but family history and exposure to chemicals are some risk factors for this cancer.
How is sarcoma diagnosed?
Symptoms:
Most patients have reported a new lump or a bump that is growing anywhere in the body, which may or may not be associated with pain. Rarely patients report abdominal pain that is getting worse, or blood in the stool or vomit.
History and Physical Exam:
Our team of cancer doctors and specialists will take a complete medical history to check for any risk factors and to ask you about symptoms, as well as any other medical conditions. A physical exam will also be performed to look for signs of sarcomas and other health problems.
Imaging Tests:
Computed tomography (CT): The CT scan is an x-ray procedure that produces detailed, cross-sectional images of the body. A CT scanner takes many pictures as it rotates around the patient. The machine will create multiple images of the part of the body that is being studied. This test can help tell the extent of the sarcoma and if your sarcoma has spread into other organs. At times a patient may receive dye through a vein to help better outline the internal structures of the body being studied.
Magnetic resonance imaging (MRI) scans: MRI scans use radio waves and strong magnets instead of x-rays. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. A contrast material might be injected, just as with CT scans. MRI scans are particularly helpful in examining the local extent of sarcomas.
Chest x-ray: This test may be done to determine whether the sarcoma has spread to lungs.
Positron emission tomography (PET) scans: PET uses glucose (a form of sugar) that contains a radioactive atom. Cancer cells of the body absorb high amounts of the radioactive sugar because of their high rate of metabolism, and a special camera can detect the radioactivity. PET is sometimes used in sarcoma patients when your doctor thinks the cancer has spread but doesn't know where.
Other imaging studies (e.g. bone scans) may be done as needed.
Biopsy:
This is the first part of the establishing the diagnosis. For a biopsy, the medical provider (usually a surgeon) removes a piece of tissue from the suspected area. The sample is sent to a laboratory where a pathologist (doctor who specializes in diagnosing cancer microscopically) looks at the tissue and determines if it is malignant and if so what type of cancer it is. The pathologist gives the sample a grade (determines the aggressiveness of the cancer). The higher the grade the more aggressive the cancer. The biopsy can be done by either with a core needle biopsy in which the provider uses a specialized needle to obtain a core of tissue or an excisional or incisional biopsy where the surgeon actually takes a larger piece of tissue in a surgical setting.
What is the treatment for sarcoma?
Depending the location, grade, type, and size of the tumor there are several treatments available for a person diagnosed with sarcoma, including sarcoma radiation therapy. You should consult your cancer doctor to discuss the appropriate treatment. These treatments include the following:
- Surgery
- Sarcoma Radiation Therapy
- Chemotherapy
- Sarcoma Brachytherapy
Surgery:
The goal of surgery is the removal of the tumor. Usually a small extra margin of nearby tissue is also taken out. Amputation was often used in the past for most patients with sarcoma found in the extremity. However, when combined with radiation, amputation can be avoided in almost all patients with sarcomas of the extremity. This type of limb-sparing surgery is what is performed most often today. Abdominal or retroperitoneal sarcomas are a little more difficult to surgically remove due to the vital organs that may be next to the mass.
Chemotherapy:
Chemotherapy uses drugs to kill cancer cells. Chemotherapy can be taken orally (by a pill) or through a needle in the vein or muscle. The medication enters the blood stream, travels through the body, and kills cancer cells throughout the body; this is sometimes called systemic therapy. Chemotherapy that is given after surgery when no cancer cells can be seen is called adjuvant chemotherapy.
The most commonly used drugs are ifosfamide and doxorubicin. Sometimes other drugs such as dacarbazine, methotrexate, vincristine, cisplatin, paclitaxel, and others are added in combination. When several drugs are used together, the combination is given a shortened name such as: MAID (combined mesna, doxorubicin [Adriamycin], ifosfamide, and dacarbazine) or AIM (doxorubicin [Adriamycin], ifosfamide, and mesna). Mesna is a drug used to protect the bladder from the severe irritation often caused by ifosfamide.
Radiation Oncology Sarcoma Treatment
Sarcoma radiation therapy (sometimes in conjunction with chemotherapy) may be given before surgery to shrink the tumor and allow complete resection. After surgery, additional (adjuvant) sarcoma radiation therapy is sometimes used to kill any cancer cells that remained after surgery and to reduce the chances of the tumor returning in the area of its origin.
Radiation Therapy:
Sarcoma radiation therapy is a form of cancer treatment that uses x-rays or other high-energy rays to kill cancer cells.
There are two ways of delivering radiation to the cancer:
- External Radiation: External beam radiation therapy (EBRT) is the most common form of radiation therapy. The treatment machine (linear accelerator) directs beams of high-energy radiation at the tumor. The machine can change position so that the beams can enter the body from any angle. External radiation therapy is usually given in daily treatments of few minutes each over several weeks, typically 5 days a week for 5 to 6 weeks.
- Internal Radiation: Internal sarcoma radiation therapy (brachytherapy) delivers a high dose of radiation to a small area by using one or more implants (radioactive sources) placed in or around the tumor. These implants can be temporary or permanent.
The radiation oncologist will select the type of therapy that is most suitable for a particular type of cancer. Radiation therapy can also be used to palliate (ease) symptoms of sarcoma when it has spread to other body organs.
The medical oncologist will select the type of therapy treatment that is most suitable for a particular type of cancer.
Sarcoma Clinic
Cleveland Clinic Sarcoma Interdisciplinary Clinic (CCSIC) is located at the Taussig Cancer Institute at Cleveland Clinic.
The mission of the CCSIC is to provide a multidisciplinary, comprehensive & compassionate approach to patients with typical or atypical malignancies in an effort to provide excellent care and to make treatment more convenient for patients.
The purpose of this clinic is to provide a setting where medical providers from different specialties can come together to create the most favorable treatment regimen for a given patient. In addition, the patient and their family can obtain expert opinions from the various specialties with just one visit to the clinic. The team includes surgeons, radiation and medical oncologists, radiologists, pathologists, social workers, nurse practitioners, physical therapists and physiatrists and other support personnel.
The vision of the CCSIC is to be the premier clinical site that provides exemplary patient care, fosters the development of new diagnostic criteria & treatments, and promotes a unified multidisciplinary approach to patients with soft tissue and bone tumors.
Sarcoma Specialists
The following are Cleveland Clinic Radiation Oncologists with a special interest in the treatment of Sarcoma:
