Bone & Soft Tissue Sarcoma

There are no effective screening tools or ways to prevent sarcoma. While the majority of suspicious masses discovered are benign, we recommend that any questionable mass be evaluated by your primary care physician. Any unusual bone lesion should be evaluated by an orthopedic surgeon.

At initial presentation, sarcoma may be asymptomatic; symptoms may not present until the cancer has progressed. To provide a diagnosis of sarcoma, a specialist will perform a physical examination and imaging studies, such as an MRI, CT or a bone scan (if it involves the bone) to assess if the disease has spread.

A tissue diagnosis is necessary in order to determine the type or origin of tumor (for example, a tumor of muscle, bone, nerves or fat), the subtype of tumor, its aggressiveness or “grade” (for example, high grade versus intermediate or low grade) and additional tumor characteristics that assist in predicting behavior and prognosis. A precise subtype diagnosis can change the treatment approach.

Tumor tissue is first examined under the microscope by a pathologist with expertise in sarcomas. After microscopic examination, additional special studies are performed including immunophenotyping (identification of the types of proteins a tumor expresses by means of antibody reactions), molecular studies (analysis of small segments of DNA or RNA using in situ hybridization or polymerase chain reaction) and chromosome analysis. When clinically indicated, high throughput genomic sequencing can used for the purpose of both sarcoma categorization as well as potential therapeutic considerations. Once the pathologist completely analyzes the tumor, members of the multidisciplinary team can then discuss optimal treatment for the patient.

Most cases of sarcoma are sporadic (not hereditary); however, sarcoma can be associated with hereditary cancer susceptibility genes in some families. If, in addition to sarcoma, there is a personal or family history of pre-menopausal breast cancer, brain cancer, or of the childhood tumors adrenal cortical carcinoma or choroid plexus carcinoma, then genetic counseling is indicated and genetic testing is available. Hoag offers its Hereditary Cancer Program to the community – a comprehensive genetic counseling and testing program, led by certified genetic counselors and physician leadership. Contact us to see if this may be the right option for you or your family.

For more information, or to contact the Hoag Sarcoma Program Clinic, please call (949) 764-5542.

Overview

Treatment approaches for sarcoma can vary. Surgical resection, radiation therapy and chemotherapy are used either individually or in combinations based on the subtype, location, size, grade, stage of the tumor.

The main goal of surgery is to remove the tumor completely. For certain tumors, treatment may require surgeons from different disciplines to work together to successfully and safely remove the tumor. For extremity sarcomas, the second goal in the surgical treatment of sarcoma is limb salvage and preserving function and quality of life.

Each patient’s treatment plan will be different. We encourage you to speak in detail with our Sarcoma Program team members on the plan they recommend for you.

Radiation therapy is used on some patients with sarcomas. Radiation therapy can kill microscopic disease, reducing the risk of local recurrence (the cancer returning in the same location). Sometimes, radiation can shrink a tumor to facilitate surgery, such that a critical structure like a nerve or blood vessel bundle can be spared.

Radiation therapy can be utilized before or after surgery, but is determined based on a case by case basis.

Hoag Radiation Oncology offers advanced therapy to effectively treat sarcoma. One therapy that is often used at Hoag is Intensity Modulated Radiation Therapy (IMRT). IMRT improves the delivery of radiation. Studies show that this technique may improve the efficacy of treatment and can reduce the risk of side effects, such as bone fracture in extremity sarcoma. Hoag provides this therapy option utilizing one of these advanced machines: Tomotherapy, which delivers a special form of IMRT called Helical IMRT or Elekta Agility, which delivers a special form on IMRT called Volumetric Modulated Arc Therapy (VMAT).

Your team will discuss the different treatment options with you, to determine the best plan of care.

Although not utilized in all cases, chemotherapy may be of benefit in certain subtypes of sarcoma. At Hoag, our medical oncologists offer leading edge chemotherapy treatments for sarcoma. Hoag’s Sarcoma Program also has access to the latest clinical trials that will test and evaluate the efficacy of new drugs for sarcoma. These trials include targeted therapies and immunotherapy.

To learn more about Hoag Sarcoma Program, or to contact the Hoag Sarcoma Program Clinic, please call (949) 764-5542.

Clinical Nurse Navigators

Clinical Nurse Navigators are a unique asset at Hoag. Our Clinical Nurse Navigators serve as a guides for patients, answering questions and providing support through each phase of treatment.

Oncology Support Services

Oncology Support Services offers a variety of classes to support and educate patients during and after cancer. These classes and workshops are all free of charge:

One-On-One Counseling with an oncology social worker

Fitter Image Exercise Programs, including yoga, pilates and energizing cardio and toning

Workshops for Well-Being, including free flow writing, meditation, reiki and creative art classes

Other Support Programs/Teams include:

Rehabilitation Specialists – While both in the hospital and after discharge, patients will be visited by rehabilitation specialists, experienced in the care and rehab of sarcoma patients.

Palliative Care – For patients experiencing high pain or symptom burden during treatment, the Hoag palliative care team can help. Board-certified palliative care physicians, nurses and social workers are available to help manage physical and emotional symptoms alongside your sarcoma care team.

Cancer Dietitians – Special to Hoag Family Cancer Institute are two dedicated Registered Dietitians available to answer your nutritional questions and provide resources for a healthier diet before, during and after cancer treatment.

Hereditary Cancer Program – Hoag offers both genetic counseling and genetic testing for individuals concerned about hereditary cancer. Feel free to contact us to see if this service may be right for you or your family.

Internet Resources:

Not all websites are credible. Here are a few websites recommended by the Musculoskeletal Tumor society if you were interested in:

• National Cancer Institute

• American Cancer Society

• AAOS – Your Orthopaedic Connection

• The Musculoskeletal Tumor Society Bone and Cancer Foundation

• Association of Cancer Online Resources

• Desmoid Tumor Research Foundation

• MHE Research Foundation

• Orthopaedic Research and Education Foundation

• American Academy of Orthopaedic Surgeons

• The Journal of Bone and Joint Surgery

• National Institutes of Health

• Connective Tissue Oncology Society

• Lymphangiomatosis and Gorham’s Disease Alliance

• Sarcoma Alliance

• Amputee Coalition

• Leiomyosarcoma Support & Direct Research Foundation (LMSDR)

For more information on the Hoag Sarcoma Program, or to contact the Hoag Sarcoma Program Clinic, please call (949) 764-5542.