Sarcoma: Types, Symptoms, and Treatment

In this blog, where we're diving into the world of sarcoma treatment. It's a journey filled with complexities, but we're here to guide you through it. Together, we'll explore the ins and outs of surgery, radiation therapy, chemotherapy, and targeted therapy, shedding light on this rare form of cancer. Join us as we share insights, foster hope, and make the path ahead a bit clearer.

Sarcoma

Sarcoma is a type of cancer that develops in the connective tissues of the body, including muscles, bones, tendons, and cartilage. Unlike more common cancers, sarcomas are relatively rare. While sarcomas account for only a small percentage of all cancer diagnoses, they can occur in both children and adults. Their rarity can sometimes make diagnosis and treatment more challenging.

Types of Sarcoma

There are over 150 different types of sarcoma, each with its own unique characteristics.

• Undifferentiated Pleomorphic Sarcoma (UPS): A type of sarcoma that can occur in any part of the body, typically in older adults.
• Leiomyosarcoma: Arises in smooth muscle tissue, often found in the uterus, gastrointestinal tract, or blood vessels.
• Liposarcoma: Develops in fat tissue, commonly in the limbs or abdomen.
• Synovial Sarcoma: Often occurs near large joints, such as the knee, and can affect tendons or ligaments.
• Rhabdomyosarcoma: Most common in children and adolescents, originating from skeletal muscle cells.

Who Does Sarcoma Affect?

Sarcoma can affect individuals of all ages, from children to older adults. However, certain types of sarcoma are more prevalent in specific age groups:

1. Children and Adolescents:

• Certain types of sarcoma, such as rhabdomyosarcoma and Ewing sarcoma, are more common in children and adolescents. These typically arise in bones or soft tissues and can affect areas like the arms, legs, or pelvis.

• Osteosarcoma, a type of bone sarcoma, is more commonly found in young adults and adolescents, often affecting the long bones of the arms and legs.

• Soft tissue sarcomas like leiomyosarcoma and liposarcoma are more frequently diagnosed in adults, particularly in middle-aged and older individuals. These tumours can arise in various soft tissues throughout the body.

• Some types of sarcoma, such as undifferentiated pleomorphic sarcoma (UPS), can occur more frequently in older adults. UPS can develop in various soft tissues and often presents in the limbs or trunk.

Symptoms and Signs

The symptoms and signs of sarcoma can vary depending on the location and type of sarcoma. Here are some general symptoms that may indicate the presence of sarcoma:

1. Localized Symptoms:

• Swelling or Lump: A noticeable lump or swelling that may grow over time. This can be painless or accompanied by discomfort.
• Pain: Persistent pain at the site of the tumor, which may worsen at night or with physical activity.
• Limited Mobility: Difficulty moving or using affected muscles or joints, especially if the tumour is near bones or joints.

• Fatigue: General tiredness or weakness that is not alleviated by rest.
• Weight Loss: Unintended weight loss, is often associated with more advanced cases of sarcoma.
• Fever: Occasionally, a fever may develop, but this is less common.

• Bone Sarcomas: Bone pain, often worsening at night or with activity. Swelling or tenderness at the site.
• Soft Tissue Sarcomas: Depending on the location (such as limbs, trunk, abdomen), symptoms may include pain, swelling, or difficulty with movement or function of nearby organs or structures.

• Neurological Symptoms: If sarcoma affects nerves or the brain, symptoms may include numbness, weakness, or changes in sensation.
• Respiratory Symptoms: If sarcoma affects the lungs, symptoms may include coughing, chest pain, or difficulty breathing.

It's important to note that these symptoms can be caused by many conditions other than sarcoma. However, if you notice any persistent or concerning symptoms, especially a new lump or swelling that doesn't go away, it's essential to consult a healthcare professional for further evaluation and diagnosis. Early detection can significantly impact treatment outcomes for sarcoma.

Causes of Sarcoma

• Genetic Factors
  • Some sarcomas have a hereditary component, with certain genetic mutations increasing susceptibility.
  • Understanding family medical history can provide insights into genetic risk factors.
• Radiation Exposure
  • Exposure to ionizing radiation, whether from medical treatments or environmental sources, is a known risk factor.
  • Individuals who have undergone radiation therapy for previous cancers may be at increased risk.
• Environmental Factors
  • While specific environmental factors contributing to sarcoma development are not well-defined, exposure to certain chemicals may play a role.
  • Occupational exposure to certain substances has been associated with an increased risk in some cases.

Diagnosis of Sarcoma

1. Imaging Tests (MRI, CT Scans)

• MRI (Magnetic Resonance Imaging):
  • Utilizes magnetic fields and radio waves to create detailed images of soft tissues.
  • Useful in determining the location, size, and extent of the sarcoma.
• CT Scans (Computed Tomography):
  • Combines X-rays and computer technology to produce cross-sectional images.
  • It helps visualize bones and detect abnormalities in soft tissues.

2. Biopsy:

• The definitive diagnostic procedure for sarcoma involves the removal of a small tissue sample (biopsy) from the suspected tumour.
• Types:
  • Needle Biopsy:
    • A thin needle is used to extract a tissue sample for examination.
    • Less invasive and often used for tumours deep within the body.
  • Open Biopsy:
    • Involves a surgical procedure to directly remove a tissue sample.
    • Provides a larger sample for a more detailed analysis.

3. Molecular Testing

• Purpose:
  • Molecular testing examines the genetic and molecular characteristics of the tumour cells.
• Benefits:
  • Aids in identifying specific genetic mutations or alterations.
  • Helps determine the most effective treatment options, especially with targeted therapies.
• Techniques:
  • Polymerase Chain Reaction (PCR):
    • Amplifies specific DNA sequences for analysis.
  • Sequencing:
    • Determines the order of nucleotides in DNA, revealing genetic abnormalities.

Treatment of Sarcoma

1. Surgery

Surgery is the main treatment for sarcomas that haven't spread. It involves removing the tumour.

Approach:

• Wide Local Excision:
  • This means taking out not only the tumour but also a bit of the healthy tissue around it. This helps lower the chance of the cancer coming back.
• Limb-Sparing Surgery:
  • Sometimes, even with tumours near important structures like bones or joints, surgeons can remove the cancer while preserving the limb's function and appearance.
• Amputation:
  • In cases where it's not possible to save the limb, amputation, or removing the affected limb, might be needed.

2. Radiation Therapy

Radiation therapy uses high-energy rays to target and kill cancer cells.

Applications:

• Adjuvant Radiation:
  • After surgery, radiation can be used to make sure any remaining cancer cells are eliminated.
• Neoadjuvant Radiation:
  • Given before surgery to shrink the tumour, making it easier to remove.
• Palliative Radiation:
  • This helps with symptoms and controls the growth of tumours, especially when complete removal isn't possible.

3. Chemotherapy

Chemotherapy uses drugs to stop or slow down the growth of cancer cells.

Application:

• Systemic Chemotherapy:
  • These drugs travel throughout the body, targeting cancer cells wherever they might be.
• Adjuvant Chemotherapy:
  • After surgery, it's used to get rid of any remaining cancer cells.
• Neoadjuvant Chemotherapy:
  • Given before surgery to shrink tumours and make them easier to remove.

4. Targeted Therapy

Targeted therapy focuses on specific molecules involved in cancer cell growth and survival.

Advantages:

• Precision:
  • It precisely targets cancer cells, reducing harm to healthy cells.
• Reduced Side Effects:
  • Compared to traditional chemotherapy, targeted therapy often causes fewer side effects.

• It's tailored to the unique genetic and molecular characteristics of the tumour.

Risk Factors of Sarcoma

• Genetic Syndromes
  • Specific genetic syndromes, such as Li-Fraumeni syndrome, hereditary retinoblastoma, and neurofibromatosis, substantially elevate the risk of sarcoma development.
  • In these syndromes, individuals inherit mutated genes that predispose them to various cancers, including sarcomas.
• Previous Radiation Therapy
  • The risk of sarcoma increases in individuals who have undergone radiation therapy, particularly if the radiation field includes connective tissues.
  • Radiation-induced sarcomas may manifest years after the initial treatment and necessitate careful monitoring.
• Chemical Exposure
  • Occupational exposure to certain chemicals, such as vinyl chloride and dioxin, has been linked to an increased risk of developing soft tissue sarcomas.
  • Understanding and mitigating workplace exposures are crucial for preventing sarcoma in at-risk populations.

Complications of Sarcoma

• Metastasis
  • Sarcomas are notorious for their potential to metastasize, spreading to distant organs and tissues.
  • The likelihood of metastasis varies depending on the sarcoma type and stage, impacting treatment approaches and prognosis.
• Impaired Function of Affected Area
  • The growth of sarcomas in or near vital structures can lead to functional impairment.
  • For example, a sarcoma near a joint may restrict movement, and tumours affecting nerves may cause sensory or motor deficits.
• Secondary Cancers
  • Treatment-induced secondary cancers can arise as a consequence of radiation or chemotherapy.
  • Balancing the benefits of treatment with the potential risks, including secondary cancers, is a critical aspect of sarcoma management.

Prevention of Sarcoma

• Genetic Counseling
  • Genetic counselling provides individuals and families with information about their risk of hereditary cancers, facilitating informed decision-making and personalized surveillance.
• Avoidance of Known Risk Factors
  • Minimizing exposure to environmental carcinogens, such as industrial chemicals, is essential in preventing sarcoma.
  • Individuals with known genetic predispositions may consider lifestyle modifications to reduce risk.
• Regular Check-ups and Screenings
  • Regular monitoring, including imaging studies and clinical examinations, is vital for early detection.
  • High-risk individuals, such as those with a family history or genetic predisposition, may benefit from more frequent and specialized screenings.

As we wrap up this exploration into sarcoma treatment, it's our hope that this journey has been both enlightening and empowering. Navigating the world of surgery, radiation therapy, chemotherapy, and targeted therapy is no small feat, but understanding these paths can bring a sense of control and optimism. You're not alone in this journey. Stay informed, stay hopeful, and take each step with the knowledge that there's a community here to support you. Here's to brighter days ahead and a future filled with hope and healing.