A guide to sarcomas

A sarcoma is a cancerous tumour that is derived from certain cells, called mesenchymal cells, that are found all over the body: in the bones, cartilage, blood vessels, muscles, fat, nerves, and connective tissues. Here to tell us all about sarcomas is distinguished surgeon Mr Samuel Ford.

What is sarcoma?

Sarcomas are formed when young bone or soft tissue cells develop into cancer cells and begin to grow erratically. Eventually, they clump together, becoming a tumour that will grow or spread (metastasise) if not addressed. There are several – over 70 – types of sarcomas, which are categorised as either soft tissue sarcomas or bone sarcomas, such as:

• Bone sarcomas
  • Osteosarcoma
  • Chondrosarcoma
  • Chordoma
  • Ewing’s sarcoma
• Soft tissue sarcomas
  • Angiosarcoma
  • Liposarcoma
  • Malignant schwannoma
  • Synovial sarcoma

Who is at risk of sarcoma?

Sarcoma cancers are not common, with around 5,300 cases diagnosed in the UK each year. People who have had exposure to high amounts of radiation, such as people who have had radiotherapy treatment for cancer previously, are at risk of developing sarcomas. Exposure to other abrasive substances, like arsenic and wood preservatives, is also a risk factor.

Soft tissue sarcomas are most common in people over the age of 65, whereas bone sarcoma is not as uncommon in younger people, with many cases being diagnosed in children.

What are the signs of sarcoma?

Sarcomas occurs most commonly in the lower limbs, and most rarely in the head and neck, but can appear anywhere in the body.

The main indication of a tumour is a new lump forming on the body, feeling rooted deep beneath the skin. It will likely not hurt initially, but as time goes on it will become painful and grow bigger. A bone sarcoma will feel like pain in the bones (like an ache that happens during growth spurts), or a swelling at the joints, and the bone may be prone to breakage. If the lump is near the stomach, it can be accompanied by abdominal pain, and if it is near the lungs, it may be accompanied by a cough. Patients may experience unexpected weight loss, night sweats, and a high temperature.

How is sarcoma diagnosed?

Imaging tests are used to make a diagnosis. X-rays, CT scans, and MRIs are the most common imaging tests, as they are a good way to see the condition of, and the damage done to, the bones and soft tissues of the body. A biopsy may be conducted to analyse a tissue or bone sample for cancer cells.

For bone sarcomas specifically, a bone scan can give detailed information about the inside of the bones by monitoring the activity of a small amount of radiation that is injected into the veins.

When the sarcoma diagnosis is confirmed, it will be assigned a stage based on how far it has spread, often written in Roman numerals. Stages I and II are when the cancer has not spread beyond its origin, and is still fairly straightforward to treat, but in stages III and IV will have spread and will require aggressive treatment and will be difficult to cure.

How is sarcoma treated?

Sarcoma can be treated with surgery if found early enough and hasn’t progressed beyond stage II. The cancer cells, and some healthy cells around it, will be excised so that there will be no remaining cancer and no chance for a tumour to regrow. In cases of sarcoma where it has taken over a limb, the doctors may recommend amputating the limb to halt the spread, though they will do their best to salvage the limb and may replace the bone or joint with a donor from elsewhere in the body or with a prosthesis made of ceramic, metal, and plastic.

If surgery is not possible, then there are alternative treatments that can be utilised in place of surgery, or in tandem with surgery.

Radiotherapy uses high-energy X-rays to kill cancerous cells while avoiding healthy cells. The course of therapy may last a few weeks, with short daily sessions to control the cancer. It may be also employed before surgery, to shrink the tumours, or after as a way to reduce the risk of the cancer reoccurring.

Chemotherapy, which uses toxic chemicals called cytotoxins which are intravenously or orally administered to also target and kill cancerous cells, can also be used in similar ways to radiotherapy treatments. It can even be used in conjunction with radiotherapy for extra potency. It is not often used for soft tissue sarcomas but can be effective against bone sarcomas.

These treatments can come with some considerate side effects, such as hair and weight loss, nausea and fatigue, and irritation of the skin.

If you are looking into sarcoma removal, consult with Mr Samuel Ford via his Top Doctors profile.