Treatment

Nonextremity Symptoms, Risk and Diagnosis

Sarcoma makes up only one percent of cancers diagnosed, but many of them come to Siteman because of our dedicated sarcoma team and clinical and research expertise.

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified. Sarcomas that originate in the trunk, as opposed to the arms or legs, may be intra-abdominal, intrathoracic or retroperitoneal in nature. They may involve both soft tissue and bone.

Symptoms of Non-Extremity Soft Tissue Sarcoma

Sarcomas arise in bone or soft tissue, including muscle, fat, blood vessels or other supporting tissues anywhere in the body. Forty percent of primary sarcomas are located in the trunk and abdomen. They also can emerge in more visible places, such as the face.

Whatever their origin, the symptoms often are similar. Patients come to their doctor with a lump or mass, sometimes visible or only found on imaging; and painful or painless. In adults, most soft-tissue masses are benign; however, it is critical to identify sarcomas as early as possible in the course of the disease. Often they have no symptoms at all until well advanced.

Risk Factors for Soft-Tissue Sarcoma

Sarcomas most often arise sporadically for reasons that are not yet understood, but occasionally they are linked to genetic factors, especially abnormalities of either the P53 or retinoblastoma gene. Some sarcomas may develop after exposure to certain herbicides, dioxin or vinyl chloride. Others occur in women with chronic lymphedema after breast cancer surgery.

Sarcomas vary in size and location, and they require different approaches to biopsy and surgery. Because an improperly performed biopsy can compromise an operation, Siteman’s experienced, multidisciplinary team meets early to plan an approach to each new case. A very thorough knowledge of anatomy is necessary to determine precisely what kinds of incisions can be made and what type of surgery will yield the best result. In fact, when referring physicians have a patient with a suspected diagnosis of bone or soft-tissue sarcoma, they may wish to refer the patient to Siteman physicians for evaluation even before the initial biopsy is performed.

Diagnosing Sarcoma

Making a diagnosis and staging sarcoma may involve different approaches. The following tests and procedures may be used:

  • Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities.
  • CT scan (CAT scan): A series of detailed pictures of areas inside the body, taken from different angles may be combined with injection or oral intake of a dye to help the organs or tissues show up more clearly.
  • MRI (magnetic resonance imaging): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
  • Biopsy: Tissue from the tumor is taken either by core biopsy or fine needle aspiration biopsy, so the pathologist can examine it under a microscope to confirm the presence of sarcoma.

Staging of Soft-Tissue Sarcoma

Once adult soft tissue sarcoma is found, a doctor needs to know the stage of the disease to plan treatment. For soft tissue sarcoma, stages are I-IV and recurrent, depending on the extent of the cancer and the quality of the cancer cells. The following stages are used for adult soft tissue sarcoma:

Stage I: The cancer is a low-grade tumor that may be any size. The cancer has not spread to lymph nodes or other parts of the body.

Stage II: The cancer is either near the surface or deep and is 5 centimeters or smaller in size, but it has not spread to lymph nodes or other parts of the body.

Stage III: The cancer is deep and is more than 5 centimeters in size, but it has not spread to lymph nodes or other parts of the body.

Stage IV: The cancer may have spread to lymph nodes in the area or may have spread to other parts of the body, such as the lungs, head, or neck.

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the tissues where it first started, or it may come back in another part of the body.

Staging is very useful in determining the correct treatment.

Prognosis

The prognosis (chance of recovery) and choice of treatment depend on the following:

  • Size and stage of the cancer (how far the cancer has spread).
  • The patient’s age and general health.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Sarcoma is best controlled before it has spread and can be removed by surgery. Clinical trials are a good option for getting the latest treatment. For sarcoma that has metastasized, the standard of care is clinical trials.