Considerations for Location

After diagnosis, occasionally, a sarcoma patient will be referred to a general oncologist who does not specialize in sarcomas. Many patients must weigh the comfort and convenience of dealing exclusively with a local oncologist versus the potential benefits of traveling to receive treatment at a high-volume sarcoma center. It is almost always in your best interest to see a sarcoma specialist, and it can help to seek a second opinion at a sarcoma center when making this decision. 

Sarcomas are rare and complex enough that most oncologists are not bothered when their patients seek second opinions and can be quite supportive. Physicians in sarcoma centers are accustomed to providing second opinions, and they understand that some patients will seek their advice and then choose to receive treatment elsewhere. In fact, distant sarcoma specialists may be willing to work with your local oncologist to oversee treatment or to provide insights and assistance during treatment.

Most specialists have received excellent oncology training and have developed varying levels of expertise in sarcoma. Most cases of soft tissue sarcoma need to be managed by many specialists, including a radiologist, surgeon, medical oncologist and radiation oncologist. Teams can also include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Factors for Treatment

When you start to talk about treatment options, it’s very important that you take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for sarcomas because there are different treatment options. Make sure to learn as much as you can and understand the information being given to you.

In general, the treatment options you’re given will depend on:

• The type of cancer
• The stage of the cancer
• Other tests that might be done on the tumor to give more information about it (for example, biomarkers or hormone receptors)
• Other tests that might be needed to give more information (for example, blood tests, x-rays or other image tests, or genetic testing)
• Your overall health
• Any other medical problems you might have
• Your personal preferences

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Types of Treatment for Sarcoma

Surgery

Surgery is the main treatment for most soft tissue sarcomas. Depending on the size and location of the tumour, you may have one or more of the following types of surgery:

• Wide local excision removes the cancer along with some normal tissue around it. It is used to treat soft tissue sarcoma that is only in the area where it started (localized). It may also be used for soft tissue sarcoma that has come back in the area where it started (local recurrence).
• Limb-sparing surgery removes a tumour from an arm or a leg (a limb) without removing the whole arm or leg. It is used to treat soft tissue sarcoma that is only in an arm or a leg and hasn’t spread anywhere else in the body.
• Mohs surgery removes the cancer in layers, little by little, until no cancer remains. It may be used for soft tissue sarcoma that can be seen near the surface of the skin.
• Reconstructive surgery repairs the skin and nearby area after the tumour is removed. When a large area has been removed to make sure the cancer is completely gone, the doctor rebuilds the area using a piece of tissue from another part of the body.
• Amputation removes all or part of a limb. It is not usually done for soft tissue sarcoma. Amputation may be needed if the cancer has grown into certain nerves, blood vessels and muscles so the limb won’t work properly or if there will be many long-term problems after surgery.
• Lymph node dissection removes a group of lymph nodes from the body. It may be done for soft tissue sarcoma that has spread to nearby lymph nodes.
  

Radiation Therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells. External radiation therapy may be given before or after surgery. It is most often used for high-grade soft tissue sarcomas to lower the risk of the cancer coming back where it started.

Chemotherapy

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is most often used to treat advanced soft tissue sarcoma. It can also be used to lower the risk of the cancer coming back. The most common chemotherapy drug used is doxorubicin (Adriamycin).

Targeted Therapy

Targeted therapy uses drugs to target specific molecules (such as proteins) on or inside cancer cells to stop the growth and spread of cancer and limit harm to normal cells. It is usually used in people with advanced soft tissue sarcoma. A targeted therapy drug that may be used is pazopanib (Votrient).

Follow-up Care

Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially in the first 5 years after treatment has finished. These visits allow your healthcare team to monitor your progress and recovery from treatment.

- Tip: Explore Clinical Trials: When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options.

Treatment Options For Sarcoma by Stage

When considering the treatment plan, doctors will often divide sarcomas into 2 categories: curable and treatable. Curable sarcomas can be completely removed from the body, with the goal of preventing it from coming back. Treatable sarcomas cannot be totally removed from the body but can be controlled with treatments. In many cases, stage I to stage III sarcoma is curable and stage IV, or metastatic, sarcoma is treatable.

Stage I sarcoma

At this early stage, sarcoma can often be completely removed with surgery. Treatment with radiation therapy before and/or after surgery may be recommended.

Stage II sarcoma

Stage II sarcoma is often high grade and can grow and spread quickly. Treatments at this stage include surgery plus radiation therapy. If the tumor is hard to reach, radiation therapy may be used first to shrink the tumor. This is called neoadjuvant treatment. Or, if the tumor can be removed with surgery, radiation therapy may be used afterward to reduce the risk of the cancer coming back. This is called adjuvant treatment.

Stage III sarcoma

Stage III sarcoma is also high grade and larger. Treatment will involve a combination of surgery and radiation therapy. Chemotherapy may also be added to the treatment plan. Radiation therapy, chemotherapy, or both may be given before and/or after surgery to shrink tumors and lower the risk of the cancer coming back.

Metastatic (stage IV) sarcoma

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion at a sarcoma specialty center before starting treatment, so you are comfortable with your chosen treatment plan.

For most people, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, possibly through a support group.

Sources:

https://www.cancer.org/treatment/treatments-and-side-effects/planning-managing/making-decisions.html

https://www.cancer.net/cancer-types/sarcoma-soft-tissue/types-treatment

https://www.cancer.ca/en/cancer-information/cancer-type/soft-tissue-sarcoma/treatment/?region=on

http://sarcomahelp.org/newly-diagnosed.html#tpm1_2