Sarcoma is a very rare type of cancer that develops in the connective tissue of the body, such as fat, deep skin tissues, muscles, blood vessels, nerves, bones, and cartilage. Of the three cancer types, sarcoma is the least common compared to the other two forms – carcinomas (organs and glandular tissue) and hematologic (leukemias and lymphomas). Sarcomas are divided into two large classifications of soft tissue and bone sarcomas and then further sub-classified by a tumor’s cell origin.
Approximately 14,000 new cases of sarcomas are diagnosed each year in the United States impacting both children and adults. In fact, sarcoma comprises 15 percent of cancer diagnoses in children 20 and under. Most sarcomas occur in the extremities, but they can actually occur at almost any location of the body. Certain genetic disorders, radiation, and chemical exposure may increase the risk for the development of a sarcoma, but a vast majority of tumors arise without a clear underlying cause.
Treatment requires a coordinated, multi-disciplinary approach at a sophisticated medical center by a team with extensive resources in the treatment of these relatively rare, but important cancers. Dr. Daniel C. Allison and his dedicated sarcoma team at Cedars-Sinai Medical Center are exceptionally qualified and experienced in the diagnosis and treatment of this complex disease. Dr. Allison is one of the few orthopedic oncologists in the nation with the specialized knowledge and expertise in early detection and treatment of sarcoma.
Soft tissue sarcoma at an early stage rarely causes any symptoms and tumors can grow quite large before they are felt. The first symptom is usually a painless lump. As the tumor grows and begins to press against nearby nerves and muscles, pain or soreness can occur.
Symptoms of bone cancer can vary depending on the size and location of the tumor. Pain is the most common symptom caused by tumors forming around joints and causing swelling and tenderness. Bone fractures caused by weaken from tumors are another common symptom. Some individuals could also experience weight loss, fatigue or anemia.
The accurate diagnosis of any malignant tumor requires a sample of tissue, also known as a biopsy. This biopsy can be performed through a small needle (fine needle aspiration), a larger needle (core needle biopsy), or a surgical incision (incisional biopsy). Most sarcomas are performed through a core needle or a surgical incision.
In our study (the only orthopedic oncology level one prospective study published in the entire world in 2010), we found the incisional biopsy to be significantly more accurate in diagnosis and more reliable in guiding the appropriate treatment than the other two methods. This is the technique we most often employ. Because of the high rate of interference with treatment associated with untrained surgeons, biopsies should be performed or guided by a surgeon trained in orthopedic cancer and preferably by the surgeon who will be performing the definitive treatment surgery.
Staging looks at the factors of tumor grade (degree of cellular activity and aggressiveness), anatomic extent of the tumor, and presence of tumor spread (to the lungs, other bones, and lymph nodes).
Staging sarcomas typically require:
- Extensive physical examination
- CT scan of the chest
A bone scan is a standard diagnostic for bone sarcomas and often may require additional studies, such as a bone marrow biopsy in the case of Ewing’s sarcoma. PET/CT scanning is emerging as a test to assess all three aspects of staging (grade, size, and metastasis), but is not a perfect study and not yet the standard of care.
The overall treatment plan depends on the grade (activity) and type of sarcoma. Treatment usually requires surgery often combined with additional radiation therapy or chemotherapy. Types of tumors and their typical treatments include:
- Low grade tumors – usually surgery alone, sometimes supplemented with radiation.
- Intermediate grade tumors – combination of surgery and radiation.
- High grade tumors – surgery and radiation therapy, with or without additional chemotherapy.
Patients are followed for at least five years after surgical resection to monitor appropriate healing, optimization of function, local recurrence of the tumor or systemic spread. Dr. Allison monitors outcomes with periodic history and physical exams, MRI’s, and CT scans of the chest.
Contact the Orthopedic Oncology Specialist
Sarcomas can weaken bones and damage soft tissue requiring the specialized expertise of Dr. Daniel Allison and his dedicated sarcoma team. Dr. Allison is a renowned orthopedic oncologist who has extensive expertise in diagnosing and treating sarcoma patients. He is the ideal physician to coordinate the type of multi-disciplinary treatment plan sarcomas require. Call today to schedule a personal consultation at (310) 730-8008.