Have you noticed a new lump somewhere on your body that doesn't hurt, but it's a little scary? Or have you been experiencing pain in your arms or legs for no apparent reason for a long time? Sometimes we don't pay much attention to these things, but in rare cases, these can be symptoms of a type of cancer called 'Sarcoma' . Many people get a little worried when they hear this name, because it's a little rare. So, today we'll talk about Sarcoma, what it means, how it develops, what are the symptoms, and whether there is treatment, in a simple way that you can understand.
What exactly is Sarcoma?
Simply put, Sarcoma is a malignant tumor, that is, cancer, that develops in the bones or soft tissues of our body. Now you may be wondering what this soft tissue is for. Soft tissues are the things that support other structures in our body. For example:
- Muscles (flesh)
- Fat
- Tendons (tissues that connect muscles to bones)
- Cartilage (soft tissue found in places like joints)
- Ligaments (tissues that connect bones together)
- Blood vessels (blood veins)
- Nerves
This type of cancer called sarcoma is actually very rare. If we take the total number of cancers that occur in adults, sarcoma is a small amount, about 1%. However, about 15% of cancers that occur in children can be sarcoma. In a country like America, about 16,000 new cases of sarcoma are reported every year. Of these, about 4,000 are sarcomas that develop in the bones, and about 13,000 are sarcomas that develop in the soft tissues.
Where does sarcoma most commonly occur?
Just think, this sarcoma can develop anywhere on our body, from our head to our toes. However, there are a few places where it is most commonly seen:
- About 40 percent (40%) of them occur in our feet (legs, ankles, feet).
- About 15 percent (15%) involve the hands (shoulders, arms, wrists, fingers).
- About 30 percent (30%) are in areas like our torso, chest, abdomen, and pelvis.
- About fifteen percent (15%) involve the head and neck.
What are the types of Sarcoma?
Sarcoma is not just one type. It is a broad term for a large group of cancers that develop in the bones and soft tissues. In fact, more than 70 subtypes of sarcoma have been identified. It's very complicated, isn't it? Let's look at the two main types.
1. Bone Sarcomas
This is a cancer that starts directly in the bones (`primary bone sarcoma`). More than a third of this type of sarcoma is diagnosed in people under the age of 35. It can also be seen in children.
Some of the main types of bone sarcoma are:
- Osteosarcoma (this is the most common type)
- Chondrosarcoma
- Chordoma
- Ewing's sarcoma
- Fibrosarcoma
Important: Not all cancers that develop in the bones are bone sarcoma. Sometimes, cancer cells that have started elsewhere in the body (such as the lungs, breast, or thyroid) can travel through the bloodstream and spread to the bones. This is called metastatic bone cancer . This is different from primary bone cancer.
2. Soft Tissue Sarcomas
These start in our muscles or other connective tissues in the body. Unlike bone sarcoma, soft tissue sarcoma is most common in adults. However, some types, such as rhabdomyosarcoma, are more common in children.
There are several types of soft tissue sarcoma:
- Angiosarcoma
- Desmoplastic small round cell tumors
- Gastrointestinal stromal tumor (GIST)
- Leiomyosarcoma
- Liposarcoma
- Malignant peripheral nerve sheath tumor
- Malignant schwannoma
- Myxofibrosarcoma
- Synovial sarcoma
- Undifferentiated pleomorphic sarcoma
Look at how many different types there are! The nature and treatment methods of each of these may be slightly different.
Who is at higher risk of developing sarcoma?
Sarcoma can affect both children and adults. Soft tissue sarcoma is more common in adults. Bone sarcoma, on the other hand, is more common in children, young adults, and people over the age of 65. Some studies have shown that bone sarcoma is slightly more common in men and in people who are black or Hispanic.
Why does this sarcoma develop? What is the cause?
This is actually the problem that many people have. Sarcoma develops when certain changes occur in the genetic information (DNA) of immature bone cells or soft tissue cells in our body, and those cells become cancer cells. Then these cancer cells start dividing rapidly and uncontrollably. Eventually, these cells join together to form a tumor. This tumor gradually grows and can damage and invade surrounding healthy tissues.
If left untreated, cancer cells can travel through our bloodstream or lymphatic system to distant parts of the body and cause cancer in new places. This is called metastasis , or the spread of cancer. Treating cancers that have spread this way is very challenging.
As with other types of cancer, researchers have not yet found a definitive reason why a healthy cell suddenly becomes a sarcoma cell.
What are the risk factors for developing sarcoma?
Although there is no direct cause, some risk factors have been identified that may increase the risk of developing sarcoma. They are:
- Exposure to certain chemicals: Long-term exposure to things like arsenic, some chemicals used to make plastics (e.g. vinyl chloride monomer), herbicides (e.g. phenoxyacetic acid), and wood preservatives (e.g. chlorophenols).
- Radiation: Exposure to high doses of radiation as a previous treatment for another cancer.
- Lymphedema: Long-term swelling of the arms or legs.
- Some genetic conditions: Some genetic conditions and chromosome changes are inherited. Examples include Gardner syndrome, Werner syndrome, von Hippel-Lindau disease, Gorlin syndrome, tuberous sclerosis, Li-Fraumeni syndrome, retinoblastoma, and neurofibromatosis type 1. These are very rare conditions.
Having these risk factors does not mean you will definitely develop sarcoma. However, it is important to be aware of them.
What are the symptoms of Sarcoma? How do you recognize it?
The symptoms of sarcoma vary greatly depending on where the cancer is located. For example, some sarcomas may not show any symptoms at first. Others may feel like a painless lump under the skin. However, pain only begins to occur when the lump grows and presses on nearby nerves and organs.
On the other hand, some sarcomas can cause long-lasting pain and swelling in the bones of an arm or leg . This pain can be especially severe at night . This can make it difficult to move your arm or leg and perform daily tasks.
Some common symptoms that can be seen are:
- A new lump or swelling (this may or may not be painful).
- Unexplained pain in an arm, leg, stomach, or pelvis.
- Difficulty moving an arm or leg (e.g., limping, limited movement).
- Weight loss without reason.
- Back pain (especially if the cancer is in the spine).
Remember, these symptoms can also be seen in many other diseases. So, don't be afraid to assume that it's sarcoma just because you have a sign like this. However, it's wise to see a doctor and get advice.
How to accurately diagnose sarcoma? (Diagnosis)
If you have symptoms like this, your doctor will first ask you about your symptoms and perform a physical examination. Then, they will need to do some special tests to confirm whether you have sarcoma and what type it is. The most crucial test is a biopsy.
A biopsy involves taking a small piece of tissue from the tumor and sending it to a lab. There, a specialist called a pathologist examines the tissue under a microscope to see if it contains cancer cells and, if so, what type of sarcoma it is. This information will help determine the best treatment for you.
Some other tests are:
- X-ray: This can take pictures of bones and soft tissues.
- CT scan (Computed Tomography scan): This takes a series of X-rays and creates cross-sectional views of the inside of the body.
- MRI (Magnetic Resonance Imaging): This uses a large magnet, radio waves, and a computer to make clear, detailed pictures of the inside of the body. If something unusual is seen on an X-ray, you may be asked to have an MRI.
- Bone scan: In this, a small amount of radioactive material is injected into the body to help detect abnormalities in the bones (such as bone sarcoma).
- PET scan (Positron Emission Tomography scan): This uses a special type of glucose. Because rapidly dividing cells, such as cancer cells, use a lot of glucose, this scan can show areas of the body where glucose levels are abnormally high (where tumors may be present).
How are the stages of sarcoma determined?
Determining the stage of a cancer is very important. It helps to understand the severity of the cancer and the best treatment options. Most sarcomas are classified according to the TNM classification system :
- T (Tumor): This refers to the size and location of the primary cancerous tumor.
- N (Nodes): This refers to whether the cancer has spread to nearby lymph nodes .
- M (Metastasis): This refers to whether the cancer has spread (metastasized) to other distant organs in the body.
In addition, doctors also determine the grade (G) of the cancer. This refers to how similar or different the cancer cells are from normal cells. In general, the more similar the cancer cells are to normal cells, the better the prognosis.
Using all this information, doctors determine the stage of sarcoma (a number from 1 to 4). The higher the number, the more the cancer has grown locally or has spread throughout the body.
The criteria for determining the stage may be slightly different for each type of sarcoma. So, be open with your doctor about the stage of your cancer and how it will affect your treatment and future recovery.
What are the treatments for Sarcoma?
When treating sarcoma, it is not just one doctor, but a team of specialists who work together. This team may include surgeons, radiologists, geneticists, medical oncologists, radiation oncologists, pathologists, pediatricians (for childhood cancers), psychologists, and social workers.
The treatment you receive will depend on many factors, including:
- Sarcoma type.
- The size and location of the tumor.
- Your general health.
- Whether the sarcoma is newly diagnosed or has previously developed and returned (recurrent).
Some of the main treatment methods are:
1. Surgery
In this, doctors try to remove all the cancer cells while preserving as much healthy tissue as possible. The tumor is removed with a negative margin of healthy tissue around the tumor (`wide local excision`). This attempts to remove very small, microscopic cancer cells without leaving any.
Sometimes, the affected area must be reconstructed. In limb salvage surgery, the tumor is removed and, if necessary, the joint is rebuilt with metal replacements. Sometimes, bone from another part of the body or another graft can be used to replace the removed bone. However, in some cases, the safest and best option is to remove the affected limb (amputation). This is a very difficult decision.
2. Radiation Therapy
In this, high-energy X-rays are used to destroy cancer cells. The goal is to minimize damage to healthy cells. Radiation therapy can be given either internally (put inside the body) or externally (delivered from outside the body by a machine). Today's advanced technology allows the radiation beam to be directed precisely at the cancer, sparing the surrounding healthy tissue.
Radiation therapy given internally , also called brachytherapy , can be used for sarcomas that have not spread. It can be given either during surgery (intra-operative radiotherapy) or through plastic tubes (catheters) after surgery (interstitial brachytherapy).
Radiation therapy is also used in cases where the cancer has spread (metastatic disease).
3. Chemotherapy
This uses drugs that kill rapidly dividing cancer cells or slow their growth. These drugs can be given intravenously or as pills taken by mouth. They are given to shrink the tumor before surgery or to kill any remaining cancer cells after surgery. Sometimes, chemotherapy is given along with radiation therapy.
4. Targeted Therapy
This is a very specific treatment. It uses drugs that target specific weaknesses in cancer cells without harming healthy cells. However, this treatment only works on the types of cancer cells that have those targeted weaknesses. Your doctor may recommend it as a single treatment or in combination with other treatments.
5. Immunotherapy / Biologic Therapy
This involves strengthening our body's own immune system , helping it recognize and fight cancer cells. Cancer cells can hide from our immune system, or stop it from working. This is why cancer cells grow inside the body. Immunotherapy works by disabling these defense mechanisms of cancer cells and helping our body fight cancer itself.
6. Thermal Ablation
Sometimes, sarcomas can be destroyed by heating or freezing them . This is done by an interventional radiologist, who uses a scan (such as a CT scan) to precisely locate the tumor and insert a special instrument (a probe).
7. Palliative Care
This is not a treatment that cures cancer. But it is very important. This is specialized medical care for people with serious illnesses like cancer. The palliative care team includes doctors, nurses, social workers, and nutritionists. They help relieve symptoms, manage side effects of treatment , and help you deal with the stress and problems that come with a cancer diagnosis, and help you maintain your quality of life.
8. Clinical Trials
Your doctor may also recommend that you participate in a clinical trial . These are studies that test the safety and effectiveness of new cancer treatments. New treatments for sarcoma are always in the research phase. Depending on your diagnosis, this type of trial may be an option for you.
What is life like with Sarcoma? (Survival Rate)
This is a question that many people ask. In soft tissue sarcoma, the five-year survival rate is about 81% if the cancer has not spread to other parts of the body (metastasized). However, in cases of metastatic cancer, this figure is about 15%. In osteosarcoma, the most common type of bone sarcoma, the five-year survival rate is about 77% if the cancer has not spread, and in cases of metastatic cancer, it is about 26%.
However, don't base your prognosis on these numbers alone. Your outcome will depend on many factors, including the type of sarcoma you have, where it's located, your general health, and how you respond to treatment. Your doctor is the best person to know the exact details for your situation.
What are the best times to see a doctor?
If you have a new lump – whether it's painful or not – especially if it's the size of a golf ball (about 5 centimeters), see a doctor right away. Also, if you or your child have bone pain without any injury , and it doesn't get better on its own, seek medical advice.
Finally, things to remember (Take-Home Message)
Sarcoma is not a single type of cancer. It is a group of different types of tumors that can develop in our bones or soft tissues. Symptoms vary depending on where the tumor is located. If you are diagnosed with sarcoma, remember that your treatment options and the future course of the disease depend on many factors. Your doctor can explain all of this to you.
Don't panic, but be careful. If you notice anything unusual, talk to a doctor about it. The sooner it is detected, the more likely it is that treatment will be successful.
` Sarcoma, cancer, bone cancer, soft tissue cancer, cancer symptoms, cancer treatment, Sarcoma
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