How are sarcomas treated?
Sarcomas are treated by specialists, depending on where the sarcoma is located. In larger medical centers, sarcomas are treated by a team of caregivers, including surgeons, radiologists, medical oncologists (cancer specialists), radiation oncologists, pathologists, pediatric specialists (for cancers in children), psychologists and social workers.
The most common forms of treatment for sarcoma are surgery, radiation and chemotherapy.
Most tumors are removed by surgery. This treatment is often combined with radiation therapy to help prevent the sarcoma from returning.
In removing a tumor with surgery, the goal is to minimize the risks of a sarcoma returning in the same location or spreading. In order to do this, the surgeon will remove the tumor with a wide local excision, while leaving a margin of healthy (“negative”) tissue at the edges — meaning all the tumor is removed without leaving any obvious or microscopic disease. The goal is to preserve as much normal anatomy as possible. Sometimes, artificial implants or bone taken from another part of the body or donor tissue can be used to replace the bone that was removed during surgery.
While removing the tumor completely is vital, rebuilding the area is just as important. Limb salvage (saving/preserving an arm or a leg) in complex tumor situations can come in many forms, and includes such techniques as using metal replacements for joint reconstruction, donor bone to reconstruct bone defects, or even bone taken from another part of the body to replace the bone that was removed during surgery.
Despite increasing abilities to perform limb salvage, sometimes the safest or best option is to amputate the affected limb, which can be a very difficult decision.
Radiation therapy is a form of cancer treatment that uses high energy X-rays to kill cancer cells while minimizing damage to healthy cells. Radiation therapy can either be internal (placed in the body) or external (delivered by a machine outside the body). High-dose radiation is delivered to the areas at risk, while doses to normal tissues are minimized in order to reduce the risk of side effects.
In certain cases that have not spread, another kind of radiation, called brachytherapy, can be used. Brachytherapy can be delivered in two ways: intra-operative radiotherapy (during surgery), and interstitial brachytherapy, which is delivered through a series of catheters (plastic tubes) after surgery. Radiation can also be used for patients with sarcoma that has spread (metastatic disease).
Side effects of radiation therapy include:
- Nausea and vomiting
- Changes to the skin
- Irritation of the bladder
- Edema (swelling) in the legs
Chemotherapy is the use of medications to kill or to slow the growth of rapidly multiplying cancer cells. These medications are often given intravenously (through a needle into a blood vessel) and can have major side effects. Chemotherapy is often given before surgery to shrink the tumor.
Side effects of chemotherapy include:
- Nausea and vomiting
- Hair loss
- Loss of appetite
- Low blood count
- Mouth sores
Sometimes benign bone tumors (e.g., osteoid osteoma) or sarcomas can be heated or frozen to destroy the mass. An interventional radiologist does this procedure using guided imaging (for example, placing the probe to freeze tissue using a CT scan).