Sarcomas account for 1% of all cancer cases
At iTAcC we consider the diagnosis and sub-classification of sarcomas requires a multidisciplinary medical team
We recommend the characterization of these tumors by employing complex molecular determinations with the highest demands for their interpretation
Sarcomas are tumors that originate from the tissues that support the weight of the internal organs of our body. Since these tissues are varied, the classification of different types of sarcomas is broad and with very diverse clinical evolutions that also help us to classify them. This disease can roughly be divided into two groups: soft tissue sarcomas and bone sarcomas.
Sarcomas account for 1% of all cancer cases. Cases are diagnosed primarily between the ages of 10 and 60 and depending on their type. Bone sarcomas occurring in children are known as osteosarcomas and chondrosarcomas in adults. Soft tissue sarcomas occur most frequently in the neck area during childhood and in the extremities during adulthood.
We consider that the diagnosis of this pathology and its sub-classification requires a well-structured multidisciplinary medical team in addition to a pathology department with the capability to perform complex molecular determinations with the highest demand for interpretation. This classification makes little difference in the management and in many cases, the treatment of these diseases. Treatment will widely vary only in very specific situations. This depends on the sarcoma subtype in comparison to others, such as gastrointestinal stromal sarcoma (GIST), Ewing sarcoma or Kaposi’s sarcoma.
Diagnosis is based on the basic premises at iTAcC with an exploration of signs and symptoms during the consultation with the physician. This will establish a clinical suspicion and direct the diagnostic protocol which consists of:
- Complete blood analysis including blood count, biochemistry, renal function, alkaline phosphatase, GGT and LDH levels.
- Simple x-ray: it is the first complementary test to be performed and provides diagnostic information based on radiological findings as well as indicating what the next diagnostic step to be taken is.
- Computerized tomography (CT) is useful for evaluating retroperitoneal tumors or those of the head and neck. It should also be done in order to rule out pulmonary metastases in patients with a previously diagnosed sarcoma.
- The MRI provides information about the neurovascular and skeletal relation to the tumor in the event of a possible surgical resection.
Further testing may be required in specific instances such as:
- Arteriography: it may be helpful in some cases for the planning of interventions.
- Bone scan in patients with osteosarcomas when bone spread is suspected at other levels.
- PET / CT: it may be useful and necessary in certain clinical situations that will be defined by the multidisciplinary team responsible for evaluating the case.
The diagnosis treatment requires the participation of a multidisciplinary team of orthopedic surgeons, general surgeons, thoracic surgeons, medical oncologists and radiation oncologists.
Surgery is the essential pillar of treatment. Having a team of expert surgeons experienced in the oncological resection of this disease is extremely important. Surgery must be correct with clear margins even if the amputation of a limb is required (a situation that is only necessary in 20% of cases). The resection in itself which includes the pseudo-capsule surrounding these tumors, still poses a risk of local recurrence in as high 80 % of cases.
A local-regional dissection of the sentinel lymph node may be necessary because it drains the area where the tumor is located. The resection of pulmonary metastases, when accessible and small is available in certain situations.
Radiation therapy is necessary in tumors with affected borders in order to reduce the risk of local recurrence in the area from which the tumor was removed. It is also highly regarded when limb amputation is required or in cases of Kaposi sarcoma when patients are unable to tolerate topical dermatological treatments.
Chemotherapy and biologic therapies occupy a role in special situations such as limb sarcomas, sarcomas with metastases in organs other than the one which had been diagnosed, small cell sarcomas with a capacity for high speed proliferation or GIST.
iTAcC has the means to monitor and control the progress of patients who have had a sarcoma in order to rule out the possibility of disease recurrence.
A follow up is done as in all oncological activity at our center in a personalized manner with the cooperation of physicians who have been involved in the diagnosis and treatment of each case.