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.

Hoag’s Precision Medicine Program combines genomics and genetics to diagnose, treat, and prevent diseases. Using the latest advances in genomic technologies, targeted therapies and research, our precision medicine program brings together a multidisciplinary team, including a robust genetic counseling group of experts, to provide patients with the latest in innovation and technology.

Meet the Precision Medicine Team.

Being diagnosed with cancer can feel overwhelming at times. Many patients and their families need help with coping and can benefit from supportive counseling. Oncology Clinical Social Workers are available to provide emotional and practical support during all stages of cancer including diagnosis, treatment and post-treatment survivorship.

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Hoag Family Cancer Institute dietitians work closely with patients’ physicians, nurses, therapists, and social workers to ensure complete care.

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