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Sarcoma

These are a type of malignancy, which arises from the soft tissue (muscles, tissue, ligaments) or bones. The malignancies arising from soft tissues are called soft tissue sarcomas. The malignancies arising from bone are called as Bone cancers or Osteosarcomas.

Soft Tissue Sarcomas

This malignancy arises from the soft tissue in any part of the body. Most commonly it arises from the muscles, tissues and fat from the peripheral parts of the body (limbs and surface of the body). Sometimes it arises from the smooth muscles from within the abdomen and chest. Soft tissue sarcomas usually spread locally and to the lungs. Some of them also spread to nodes.

The most common symptom of soft tissue sarcomas is lump or swelling in any part of the body. When it has spread to the lungs, the patient presents with breathing difficulty.

The confirmation of the diagnosis is through a biopsy performed by an Ortho-Oncologist (Bone Oncologist). Once the Histopathological report confirms the diagnosis, staging is required to see the extent of the tumor. The staging procedure is done using MRI scans, CT scans or PET CT scans. The findings give us the local extent of the tumor and also confirms if the tumor has spread elsewhere.

Treatment

Treatment of soft tissue sarcomas is based on the grade or aggressiveness, stage, age and general condition of the patient. Three primary modalities of treatment are Surgery, Radiation Therapy and chemotherapy (and Targeted therapy)

Surgery

Surgery is the mainstay of treatment. It could be a simple procedure like a biopsy to a complex procedure like an amputation. For early-stage and small tumors, surgery may be the only modality of treatment. Sometimes radiation and chemotherapy are given to reduce the size of the tumor before surgery, especially in higher stages. With the progress in technology, there are newer and modified surgical procedures which help in the preservation of the limbs

In the advanced stage, when the size of the tumor is more or high-grade tumors, after completion of the surgery, radiation can be given.

When the tumor has spread from the primary location to a different location, it’s called metastasis. In this condition, if there is limited metastasis, it is called as Oligometastasis. In such situations, radical surgery can be done to the metastatic site.

Radiation therapy and Brachytherapy

Radiation therapy is usually given in high-grade tumors or large tumors after completion of surgery. In these conditions, external radiation is delivered over 5 to 6 weeks. If the primary tumor is large for surgery, external radiation can be given to shrink it and then perform surgery.

Brachytherapy or internal radiation can be done during surgery by the placement of flexible catheters. This procedure is called as interstitial Brachytherapy. Brachytherapy gives very localized radiation with minimal side effects. This internal radiation is a technique that can be used alone or as a boost along with external radiation therapy.

When tumor has spread from the primary location to a different location, it’s called metastasis. In this condition, if there is limited metastasis, it is called as Oligometastasis. Stereotactic Radiation Therapy (SBRT) can be used along with chemotherapy or targeted therapy to the metastatic sites.

Radiation therapy can also be used in palliation of painful bone metastasis.

There is a technique called Extra Corporal Radiation therapy (ECRT). After the adherent tumor is removed from the bone, the bone is detached and under sterile conditions transported for radiation. Very high dose of radiation are delivered to rid the bone of any viable tumor cells. This bone is later attached back after the radiation treatment. ECRT is usually done in Ewing’s sarcomas.

Chemotherapy /Targeted therapy /Immunotherapy 

Chemotherapy is usually given in high-grade advanced stage tumors after completion of surgery and radiation. This is called as Adjuvant Chemotherapy. Sometimes if the tumor is large and inoperable, chemotherapy is given to shrink it and make it operable, called Neo-Adjuvant Chemotherapy.

In metastatic tumors, chemotherapy and targeted therapy are the primary treatment. The targeted therapy is usually called tyrosine kinase inhibitors (TKI) and is usually taken orally. 

When multiple lines of chemotherapy and targeted therapy have failed, Immunotherapy can be an option.

Osteosarcoma

Osteosarcomas is a type of cancer, which arises from bones. It usually arises at the end of long bones of feet or hands. It usually arises in the younger age group. One of the commonest symptoms is non-specific pain with a limp. Sometimes there may be a swelling.

When they approach an orthopedic oncologist, imaging is done. Imaging may include an X-ray or MRI or CT scan. Depending upon the local imaging, a biopsy is done. A qualified Orthopedic Oncologist does biopsies. On confirmation of osteosarcomas, staging is done to see the extent of spread of the tumor. This includes CT of the thorax or PET CT scan. Treatment is initiated based on the aggressiveness of the tumor, stage, age and general condition.

Treatment usually may include Surgery, Chemotherapy and radiation therapy.

Surgery is the mainstay of treatment. It involves complete removal of the tumor with sufficient margins. As far as possible, limb conservation is preferred. For early-stage low-grade tumors, surgery only might be adequate. For high- grade tumors, advanced-stage tumors and when limb salvage is not possible, high dose chemotherapy is initially given, called neoadjuvant chemotherapy. It helps to downstage the tumor and increases the possibility of limb salvage surgeries.

Role of radiation is very limited in osteosarcomas. It is usually given for palliation when the disease has spread to the spine and is causing pain and or cord compression. When surgery is not possible, radiation can be tried.

When tumor has spread from the primary location to a different location, it’s called metastasis. In this condition, if there is limited metastasis, it is called as Oligometastasis. In such situations, radical surgery can be done to the metastatic site, called metastectomy. When surgery is not possible, Stereotactic Body Radiation can be used.

Cancer Therapy India is known as the best hospital for sarcoma cancer treatment in India having the best sarcoma cancer specialist in bangalore with extensive experience in the diagnosis and treatment of virtually every kind of cancer. Cancer Therapy India have some of the best sarcoma specialist in Bangalore who are expert in using  the latest technologies and treatments to address unmet patient needs and have vast experience in providing sarcoma treatment in India.

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