Diagnosis & Treatment for Sarcoma
The experts at University Hospitals Seidman Cancer Center offer advanced care to patients diagnosed with soft-tissue sarcoma and bone sarcoma. Our team consists of nationally recognized orthopedic oncologists, surgical oncologists, radiation oncologists, pathologists, pediatrics, and medical oncologists, who aim to deliver advanced, personalized care to each patient to treat the disease successfully.
The diagnosis of sarcoma can be challenging and requires a skilled interventional radiologist and an experienced sarcoma pathologist. A number of modalities are needed not only to diagnose sarcoma but also to identify the correct subtype.
A sarcoma diagnosis usually involves:
- A medical history and a physical exam performed by a sarcoma specialist
- Imaging studies, such as X-rays, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), or PET scans: Our state-of-the-art imaging equipment provides clear and precise imaging that guides our experts to identify the exact location and extent of cancer.
- A biopsy involves a minor procedure where a needle is inserted into the tumor body to obtain a tissue sample, which is then examined in the lab. Our team of musculoskeletal radiologists performs an imaging-guided biopsy, which is examined by our experienced sarcoma-pathologists. In addition to this, we also have the capability to test for a number of mutations through our own platform for Next-Generation Sequencing. The presence of these mutations can widen the potential options for treatment.
At University Hospitals, we have dedicated team musculoskeletal radiologists and interventional radiologists who have the necessary expertise in obtaining tissue samples, which are then examined by our experienced sarcoma pathologists.
Treatments for Sarcoma
The treatment for patients diagnosed with sarcoma can be challenging and requires a multidisciplinary approach. The treatment is divided into local treatment and systemic treatment. Local treatment usually entails performing a surgical resection with or without radiation therapy. Systemic treatment involved administering medications to control cancer.
Surgical resection is the principal treatment for any soft-tissue and bone sarcoma. The goal is to remove cancer completely with a margin of healthy tissue around it, which is also called as R0 (R-zero) resection. Radiation therapy is used in conjunction with surgery to preserve the limb function (limb-sparing surgery) and maintain quality of life. Amputation of the affected limb, which was the standard of care in the past, is seldom performed today.
The surgeons at UH Seidman Cancer Center are accomplished in novel techniques and are some of the most respected in the field. Our surgical team is also skilled in reconstructive techniques if necessary, in order to help optimize limb function and help ensure continued quality of life. They regularly team up with other surgical sub-specialties like plastic surgery, genitourinary surgery and colorectal surgery to optimize the outcome of surgery and provide the best care possible.
- Radiation Therapy
Radiation therapy is a form of treatment where a focused beam of radiation consisting of either x-ray, gamma rays, or photons are used to destroy cancer cells. In patients diagnosed with sarcoma, it is often used in conjunction with surgery to prevent amputation and preserve the limb. Research has consistently shown excellent long-term control of the tumor in the extremity with the use of radiation therapy in combination with surgery. Radiation can be delivered either before the surgery (pre-operative or neoadjuvant radiation), after the surgery (post-operative or adjuvant surgery) or during the surgery (intraoperative radiation therapy), depending on the presentation. The decision to pursue radiation therapy is made in our multidisciplinary tumor board.
Here at UH Seidman Cancer Center, we have experienced and nationally recognized radiation oncologists who specialize in patients with sarcoma. At UH, we provide state-of-the-art radiation therapy technology to our patients, including:
- Intraoperative electron radiation therapy (IOERT): This innovative radiation therapy is administered in the operating room, during surgery. It can decrease the risk of complications and recurrence. IORT is available at only a handful of hospitals nationwide.
- Proton therapy: UH is the only cancer center in Northeast Ohio to offer proton therapy, an innovative form of radiation therapy that precisely targets a tumor while minimizing damage to surrounding, healthy tissue.
Please always make sure to discuss the pros and cons of any treatment recommended for you. Our team is very considerate and compassionate towards our patients and are willing to answer all your questions.
- Systemic Treatment
Systemic treatment entails using medications to control the growth of cancer cells. There are three kinds of systemic treatments available for patients diagnosed with sarcoma:
Chemotherapy: These are medications that are usually administered through the intravenous route. The role of chemotherapy has been very well established in patients diagnosed with soft-tissue sarcoma and bone sarcoma. A number of different agents can be used either before or after surgery. Most of the times, chemotherapy for soft-tissue sarcoma is only used when the cancer starts spreading in the body. The timing of chemotherapy is highly variable and depends entirely on the kind of sarcoma. Your doctor will discuss with you the pros and cons of each agent.
Targeted therapy: Targeted agents are drugs designed to ‘target’ a particular receptor or a mutation in your tumor. They can either be pills or an intravenous drug.
Immunotherapy: These drugs target the cancer cell and make it more visible to your immune system. The efficacy of immunotherapy in patients with sarcoma is still being evaluated in clinical trials.
- Clinical Trials
Participation in clinical trials can be an important treatment option for individuals with sarcoma. Patients may be eligible to participate in a trial during treatment at UH Seidman Cancer Center. Participation is voluntary and dependent on the specifics of the individual’s diagnosis. It is best for patients to discuss options with their care team to get all the information needed to make an informed decision.
University Hospitals Rainbow Babies & Children's Hospital is involved in a number of clinical trials aimed at improving the care of children with sarcoma. These include drug trials and studies that are comparing the effectiveness of multiple treatments for a variety of sarcomas. UH Seidman Cancer Center has a number of Phase I clinical trials that are enrolling patients from multiple tumor types.
- Supportive and Integrative Medicine
In addition to our advanced treatments, UH offers supportive oncology and integrative health services that focus on managing pain and promoting overall well-being during cancer treatment and recovery. Supportive oncology services include social work, nutrition services, spiritual care, symptom management, mental health services, and much more. Additionally, integrative health services are available as a vital resource for helping patients maintain quality of life while undergoing sarcoma treatment. Integrative health services include:
- Sarcoma Treatment for Children
Sarcoma accounts for 15 percent of all pediatric cancers. The Angie Fowler Adolescent & Young Adult Cancer Institute at University Hospitals Rainbow Babies & Children’s Hospital is specially staffed and equipped to treat children with all types of cancer, including sarcoma.
Each pediatric patient has a team of specialists working on planning the most effective treatment. The team works cooperatively, combining decades of experience and expertise across many disciplines. The Pediatric Tumor Board meets to devise a strategy for each patient's unique challenges. Treatment options include the most up-to-date chemotherapy protocols and advanced clinical trials in search of novel solutions.
The multidisciplinary sarcoma team at UH Seidman Cancer Center is made up of surgeons, radiologists, oncologists, nurses, and support staff who work together to coordinate your care. Each patient receives a treatment plan developed by a panel of physicians from a variety of specialties. These physicians comprise the Sarcoma Tumor Board. The team includes:
- Orthopedic oncologists: Orthopedics trained surgeons specializing in bone cancer and the soft tissues of the extremities
- Surgical oncologists: Surgeons specializing in cancer surgery
- Thoracic surgeons: Surgeons specializing in the chest and lung surgery
- Plastic and reconstructive surgeons: Surgeons specializing in soft tissue restoration
- Radiation oncologists: Doctors experienced in using radiation
- Medical oncologists: Doctors specializing in cancer treatment using chemotherapy, targeted therapy or immunotherapy
- Pathologists: Doctors who specialize in examining biopsy specimens
- Pediatric oncologists: Pediatricians who specialize in taking care of children with cancer
- Musculoskeletal radiologists: Radiologists who specialize in reading imaging scans of patients with skeletal issues.
Care for people diagnosed with sarcoma continues long after active treatment has ended. Your health care team will continue to check that cancer has not come back, manage any side effects, and monitor your overall health. Your follow-up care will include regular physical examinations and tests, including but not limited to CT scans, MRI and blood tests. Doctors want to keep track of your recovery in the months and years ahead. For patients treated for a sarcoma occurring in an extremity, we offer a rehabilitation program after completion of treatment that can help the patient regain or maintain limb function, range of motion and strength. On the pediatrics side, we have a robust survivorship program at University Hospitals, Rainbow Babies & Children’s that includes a long term follow up of pediatric cancer survivors.