Frequently Asked Questions
1. Is sarcoma cancer?
2. Are all sarcomas the same?
3. What kind of people get sarcomas?
4. What determines whether I have a "good" or "bad" sarcoma?
5. What is meant by "grade" for sarcomas?
6. Where can sarcomas spread?
7. If I have a sarcoma, am I going to die?
8. What are the important questions about sarcomas to ask my doctor before treatment?
9. Is amputation ever needed for sarcoma?
10. Will I need chemotherapy?
11. Will I need radiation therapy?
12. Are there different forms of radiation therapy?
13. When will I know if I am cured?
14. Why is sarcoma so rare?
15. Does sarcoma run in families?
16. Can sarcomas be caused by chemicals?
17. Why am I told that sarcoma is hard to diagnose?
18. Can injury cause sarcoma?
19. Who should treat me?
20. How can my family help me?
21. What is limb salvage surgery (LSS)?
22. What is a pathological fracture?
23. Is metastatic cancer always terminal?
Answer #1. Yes. Sarcoma is a malignant tumor of the musculoskeletal system.
Answer #2. No. Soft-tissue sarcoma covers a wide range of tumors. Some are more aggressive than others. Different metastatic patterns are observed. Similarly, skeletal sarcomas behave differently. Some are treated with chemotherapy and surgery, others with surgery alone.
Answer #3. Sarcomas affect everybody, from the very youngest to the very oldest. Different kinds of sarcomas occur at different ages. We do not know of any particular personality type that is at more risk of sarcoma than others.
Answer #4. You will hear a lot about the "risk factors" for sarcoma. These are mainly: Where is the tumor?How big is it? Has it already spread?What are the special characteristics of the tumor that can only be determined after biopsy (sampling) of the tumor?
Answer #5. Grade is a descriptive term provided by the pathologist upon examining the tissue. Grade is a measure of how aggressive the tumor is. Low-grade tumors usually stay confined to one place. High-grade tumors have the capacity (usually seen in up to half of high-grade tumors) to spread elsewhere.
Answer #6. It depends on where they start. In high-grade soft tissue tumors of the limbs, the most common site of spread is to the lung. Soft tissue sarcomas inside the abdomen can spread to the liver.
Answer #7. The majority of patients with sarcomas can be cured.
Answer #8. Perhaps the most important question to ask the doctor is, "How many sarcomas do you treat?" to make sure that you are talking to a doctor who understands and has a lot of experience with the management of sarcomas. Because the disease is so rare, many doctors will attempt to treat one or two sarcomas per year. A sarcoma specialist manages many sarcoma patients each week.
Answer #9. Yes, but less and less often today. Twenty years ago, amputation was virtually the only form of treatment for patients with sarcoma of the limbs. It is now required in approximately 10% of patients.
Answer #10. Chemotherapy may be given before an operation for high risk sarcomas. It is also may be given after a tumor has been identified as having spread. High risk malignancies are those which have a high chance to spread to other body sites.
Answer #11. Radiation therapy is commonly given to limit the risk of a local recurrence at the same place where the sarcoma was removed.
Answer #12. Yes. Brachytherapy is the local application of radiation therapy through small tubes placed under the skin at the time of surgery. It usually lasts for about four or five days. External beam radiation therapy is usually given over four to six weeks for a few minutes a day, five days out of seven.
Answer #13. In the majority of patients, if the disease will recur, this will happen in the first two years. However, patients with sarcoma are usually followed for a minimum of ten years, as some patients can have a very late recurrence of their tumor.
Answer #14. We really do not know.
Answer #15. Sarcoma can occur in families, but that, too, is very rare. Usually there is some predisposing disease that is known to lead to an increased frequency of sarcoma. If your doctor is familiar with sarcoma, he or she will be familiar with those diseases.
Answer #16. We believe that, on rare occasions, sarcomas can be caused by environmental exposure at high levels to some chemicals. This, too, however, is very rare.
Answer #17. Because sarcoma is rare, very few doctors ever see a sarcoma in their lifetime. They do,however, often see benign lumps and bumps, which makes them unlikely to think of sarcoma.
Answer #18. We believe this is very rare. However, sometimes patients first notice a sarcoma when they bump their leg or their arm and subsequently notice a lump.
Answer #19. The most important thing is that you see a doctor who is familiar with sarcoma. Whether that doctor is a surgical oncologist, an orthopaedic oncologist, a radiation oncologist, or a medical oncologist is probably less important than that the doctor is familiar with the disease. A doctor familiar with sarcoma can point you in the right direction for treatment.
Answer #20. As in the treatment of any cancer, the support of family and friends can be crucial. Do not be frightened to ask your friends and family to help. Often, the simplest thing is the most helpful:help me find the right doctor, please drive me to the hospital so I don't have to find parking, please look after my children/pets while I am out.
Answer #21. A special operative procedure that removes cancer in bone/soft tissue without amputation. Sparing the extremity creates a bone/soft tissue defect. Thus, LSS has two parts: 1) removing the cancer, and 2) reconstructing the defect.
Answer #22. A sarcoma or metastatic carcinoma growing inside a bone mechanically weakens the bone structure such that it breaks (fractures) and is painful. Tumor resection and skeletal stabilization are required to relieve symptoms and restore function.
Answer #23. No. Combined chemotherapy, radiation, and surgery can halt tumor progression. An individual can live many productive years with a tumor in a static growth pattern.
