Introduction
Sarcomas are cancers that arise in soft tissues, such as muscles of all the organs (leiomyosarcomas), lining of the blood vessels (angiosarcomas), fatty tissue (liposarcomas), fibrous tissue (fibrosarcoma) that support muscles and blood vessels, and supporting tissue (malignant fibrous histiocytoma) of all organs. Most are fast growing cancers. Bone cancer also belongs to the sarcoma group of cancers.
How common is Sarcoma?
These are relatively rare cancers. Between 1968 and 1992 there were approximately 700 to 800 cases of soft tissue sarcomas reported in Singapore. During that same period there were about 250 bone cancers reported. One subtype of bone cancer called osteosarcoma or osteogenic sarcoma is the most common bone cancer in childhood. Most cases are seen in teenage boys. The other sarcomas occur at any age.
Risks and Causes
For most patients, no risk factors have been identified.
Patients with familial diseases such as neurofibromatosis who have multiple benign enlargements of nerve sheaths have a higher risk of one of these enlarged nerve sheaths turning cancerous.
Patients with prior radiotherapy for breast cancer or lymphoma have a slightly higher chance of developing a sarcoma within the previously radiated area. This may take up to 10 years to occur, if at all.
SymptomsMany patients first consult a doctor because of a lump or mass on the trunk, leg or arm. The lump may or may not be painful. The sarcoma is diagnosed when biopsy (removal of piece of tissue) of a lump on the arm, leg or trunk is examined under a microscope by the pathologist (doctor who specialises in examining issue under a microscope). Bone cancers are more common in the shoulder and knee areas compared to other areas of the body.
When the cancer is advanced there may be weight loss, loss of appetite, or prolonged fever. Other symptoms are referable to the site of the sarcoma, such as feeling of fullness on eating, indigestion, and gastric pain when a stomach sarcoma is present and bleeding from the vagina when a uterus sarcoma is present.
Diagnosis
Most sarcomas are diagnosed when biopsy (removal of piece of tissue) of a lump on the arm, leg or trunk is examined under a microscope by the pathologist (doctor who specialises in examining issue under a microscope).
Once a sarcoma is diagnosed, other tests such as magnetic resonance scanning (MRI) of the site of cancer to delineate extent of the cancer and if it is operable, computerised scans (CT) of the lungs and liver to determine if the cancer has spread, are usually arranged.
Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of sarcoma may be. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with sarcoma is excellent.
Patients with smaller sarcomas do better than patients with large sarcomas. Patients with early stage, slow growing sarcoma do better compared to patients with fast growing or more advanced stage sarcoma.
TreatmentPatients who have sarcoma localised to the organ of origin have surgical removal of the entire cancer and a rim of surrounding normal tissue where possible. In some patients, additional radiotherapy to the site of cancer is required after surgery to prevent cancer recurrence at the same site. This is especially so if the cancer was large to begin with.
Radiotherapy to arms and legs is associated with redness of the skin and hair loss over the area radiated. Radiotherapy to the head and neck region is associated with temporary redness of the skin, loss of appetite, loss of salivation and dryness of the mouth. There may be some hair loss also. Radiotherapy to the stomach region is associated with temporary nausea and vomiting, loss of appetite, and occasional gastric pain.
The role of chemotherapy in patients with early stage soft tissue sarcoma after surgery is controversial. Patients with osteogenic sarcoma usually require chemotherapy to prevent cancer recurrence after surgery. This chemotherapy is given into hand veins and may cause nausea and vomiting, temporary hair loss, lowering of the blood counts and occasional numbness of the fingers and toes.
In patients with advanced stage sarcoma, chemotherapy can slow the course of the cancer. Associated side effects of chemotherapy are temporary complete hair loss, nausea and vomiting, ringing of the ears, numbness of the fingers and toes, and loss of appetite.
Frequently Asked Questions
My 12-year old nephew has a painful shoulder lump. This occurred after a fall. We have been seeing the Chinese physician but there is no improvement. What should we do?
He should seek urgent medical attention. Plain x-ray of the lump may be able to tell if there is possible cancer present. If the x-ray is highly suspicious of cancer, a biopsy will be arranged by the surgeon to confirm the type of cancer.