Soft tissue sarcoma
Soft tissue sarcomas can affect any part of the body; they develop in supporting or connective tissue such as the muscle, nerves, fatty tissue, and blood vessels. The most frequent location is on the limbs (mostly the legs), which account for about half of all the diagnosed cases.
Soft tissue sarcomas can also develop within the abdomen in specific organs like the stomach or intestines (known as GIST). Some soft tissue sarcomas are described as “retroperitoneal” which means that the sarcoma lies behind the tissue membrane which lines the abdomen and encloses many of the bodies vital organs – stomach, intestines, kidney, liver etc.
The first step in treating sarcoma is an accurate diagnosis. (See diagnosing sarcoma). It is becoming less common than it once was for surgery to be undertaken before a full diagnosis is achieved but it can still happen. In some cases of abdominal/retroperitoneal sarcomas the sarcoma may not be identified until after it is removed because a biopsy is not always taken. Surgeons who specialize in treating these tumours believe that radical surgery gives the best outcomes for patients, and that radical surgery is most effective when it is the first surgery. This means that special care must be taken when reviewing scans and planning the surgery.
Surgery is the most common form of initial treatment. The surgeon will look to achieve a clear border (margin) of disease-free tissue around the lump when they cut it out. These margins will be checked in the pathology laboratory. A clear margin of a few millimetres on every side of the tumour is the objective. If gaining clear margins is difficult, then it is probable that a course of radiotherapy will be proposed following surgery. This is known as adjuvant radiotherapy.
There are times when large soft tissue tumours in awkward locations can make removing the cancer difficult. In these cases, although no longer common, patients and surgeons may need to consider amputation as one of the options to remove the tumour in a leg or arm to remove every visible trace of the disease. Limb salvage techniques are improving all the time for patients who have to consider this decision.
The aim is to ensure that the patient is free of any evidence of the disease when initial treatment finishes.
Specialist treatment centres
There is plenty of evidence that treatment at a specialist treatment centre delivers the best results for patients. Increasingly treatment is being provided at specialist centres and when National Institute of Health and Clinical Excellence (NICE) guidance is fully implemented all surgery should be under the supervision of an accredited sarcoma specialist multi-disciplinary team (MDT).
A sarcoma MDT meets each week and discusses each patient currently being treated. The members of the team will include surgeons, clinical and medical oncologists, radiologist, pathologist, nurses and allied healthcare professionals involved in providing care and treatment for sarcoma patients. Sarcoma specialist MDTs are usually at the large teaching hospitals, specialist orthopaedic hospitals, or at specialist cancer hospitals.
Note: if you are being treated privately, your treatment and care may not be managed by a sarcoma multi-disciplinary team (MDT). If your private doctor is not a member of the sarcoma MDT, it may be beneficial to transfer to the NHS and into the care of a specialist sarcoma MDT. This would give you the benefit of ongoing reviews of progress by experts from all the relevant disciplines. Private health cover could still be used for some elements of your care eg, to avoid delays in scans or to receive treatments such as radiotherapy.
Monitoring after initial treatment
Unfortunately, sarcomas do tend to come back (recur) so careful monitoring is important, particularly in the first two years following surgery so that any further problems can be picked up.
Monitoring will include a clinical examination, a chest x-ray (and in some circumstances CT scans), and other simple tests, usually three/four monthly for a period, then six monthly, then annually.
Clinical follow-up should always be under a specialist multi-disciplinary team even if tests or scans are undertaken locally.
For more information on soft tissue sarcoma recurrence, click here.