Sarcoma

Sarcomas are tumors that grow in bone and/or soft tissue nearly anywhere on your body. There are more than 70 different known kinds of sarcomas, including:

Bone sarcomas

Sarcomas that start growing in bones include:

• Osteosarcoma.
• Chondrosarcoma.
• Chordomas.
• Ewing sarcoma.
• Fibrosarcoma.

Soft tissue sarcomas

Soft tissue sarcomas include:

• Angiosarcoma.
• Clear cell sarcoma.
• Desmoplastic small round cell tumors.
• Epithelioid sarcoma.
• Epithelioid hemangioendothelioma.
• Gastrointestinal stromal tumor (GIST).
• Giant cell tumors.
• Leiomyosarcoma.
• Liposarcoma.
• Malignant peripheral nerve sheath tumor.
• Malignant schwannomas.
• Malignant soft tissue tumors.
• Myxofibrosarcoma.
• Rhabdomyosarcoma.
• Synovial sarcoma.
• Undifferentiated pleomorphic sarcoma.

What to expect at your first visit

We know you might feel a little nervous when you come in for your first appointment. And you probably have a lot on your mind. That’s why we’ll start with a conversation. We’ll talk about:

• What kind of symptoms you have.
• When you first noticed them.
• If they’ve gotten worse.
• How they’ve affected your daily life.

We’ll also go over your medical history and give you a physical exam so we can check your overall health.

Next, your provider may order some imaging tests to get a closer look at your tumor from the inside, like:

• X-rays.
• CT scan.
• MRI.
• Bone scan.
• PET scan.

We may also want to do a biopsy to see for sure that what you have is a sarcoma. Your provider will take a sample of tumor tissue and send it to our lab, where pathologists will look at it under a microscope. We can also do next generation sequencing (NGS), which lets us look for flaws in the tumors at the genetic level. This helps us understand what kind of tumor it is, what stage it is and what treatment options may work best for your specific diagnosis.

Second Opinions

When you learn you may have cancer, you need to feel confident you’ve chosen the right care team. You want providers that listen to your concerns, answer your questions and, most importantly, give you expert and compassionate care. That’s why we encourage second opinions, either in-person or virtually. A virtual visit is an excellent option if it’s hard to get in to see our providers in person or if you don’t live nearby.

Our sarcoma team will talk with you, explain treatment options and offer their expertise. And because we know that cancer doesn’t wait, we always try to schedule your appointment with us as soon as possible. A second opinion can give you peace of mind — because you know you’re in the most capable and compassionate hands.

When you choose Cleveland Clinic, you’ll get a handpicked team of different providers from different specialties. They work together to make sure you get the treatment that matches your specific needs. Your team could include:

• General surgery.
• Gynecologic oncology.
• Head and Neck Surgery.
• Intracranial neurosurgery.
• Medical oncologists.
• Occupational therapists.
• Palliative care specialists.
• Pathologists.
• Pediatric oncologists.
• Plastic surgery.
• Psychologist/Psychiatrist.
• Physical therapists.
• Radiation oncologists (cancer specialists that treat you with radiation therapy).
• Radiologists.
• Surgical oncologists (cancer specialists that perform surgeries).
• Social workers.
• Thoracic surgery.
• Urology.

Once we confirm your diagnosis, we’ll work with you to plan your treatment, which depends on:

• The kind of sarcoma you have.
• How big the tumor is.
• Where the tumor is in your body.
• Your general health.

Taking all of these things into account, your provider may recommend:

Surgery

Your provider will likely recommend surgery to remove visible tumors. Our specialists will always try to save your limb (arm or leg) — whenever it’s safe to do so — with limb-sparing (limb salvage) surgery.

Often, we can successfully remove the cancer and a rim of healthy tissue (margin) and rebuild the limb with bone from another part of your body or with a metal replacement joint. This technique has helped more than 90% of our patients save their limbs and lower the risk that the cancer comes back (recurrence).

For complex conditions, a team of surgical specialists will use technology to help create better accuracy for margins and create custom solutions to rebuild the area where we took out the cancer.

If we can’t save your limb, we partner with a nationally recognized orthotics and prosthetics team and use the most innovative techniques, like:

• Targeted muscle reinnervation (TMR): We’ll reconnect cut nerves to nearby healthy nerves in nearby muscles. This procedure can help lessen painful neuromas and phantom limb pain after surgery.
• Osseointegration: We’ll attach a socket to your remaining limb and put the prosthesis into this socket. Or we may decide to attach a strong metal rod to your healthy bone instead. The prosthesis connects to the metal rod and lets it move more naturally.

Systemic (whole body) treatments

These treatments kill cancer cells throughout your body with medications that travel through your bloodstream. They include:

• Chemotherapy.
• Targeted therapy.
• Immunotherapy.

Radiation therapy

Radiation therapy uses high-energy radiation (usually X-rays), to kill cancer cells in specific areas. We try to avoid damaging healthy cells. You may have internal radiation placed inside your body (brachytherapy) or externally with a machine delivering the treatment.

Radiation therapy may include one to several weeks of daily treatments.

Hypofractionated radiation therapy

Cleveland Clinic offers an innovative treatment called hypofractionated radiation therapy for bone and soft tissue sarcomas. We’ll deliver highly concentrated doses of radiation to treat tumors in a few days instead of up to six weeks. With this approach, you can have radiation and surgery to remove the tumor in as little as one week without affecting the cancer outcome. This therapy isn’t for everyone. Your provider will let you know if it’s an option for you.

Cryo- and thermal ablation

Sometimes we can destroy a sarcoma by freezing or heating it. We use guided imaging (like a CT scan) for ablation therapy. This helps us place a probe that heats up or gets colder inside the tumor.

Recovering From Sarcoma Treatment at Cleveland Clinic

During and after treatment, we’ll help you manage your symptoms and any treatment side effects. Our ongoing follow-up care also includes regular imaging and blood tests to check for signs of new cancer. And, if needed, our physical and occupational therapists can help you push past stiffness, weakness and swelling as you recover.

Taking the Next Step

When you learn you have cancer, you’ll want experienced, caring healthcare providers on your side. Cleveland Clinic’s highly skilled sarcoma team is ready to help. We’ll find the right treatment that matches your unique needs and give you personalized, compassionate care throughout your cancer journey and beyond.