Sarcoma: What is it, how is it diagnosed and what treatments are available?

Sarcoma are malignant tumors or cancers. They owe their name to the Greek root “sarcos”, meaning “flesh” and “oma”, meaning “tumor”. Therefore, their origin is in the supporting and filling tissues (soft tissues), such as bones, muscles, fibers and fat.

Because of this, they may behave a little differently from common cancers. For example, they have a lower tendency to invade lymphatics, perhaps because of the scarcity of lymphatics in soft tissues, their greater tendency to spread at a distance and their propensity to regrow at the site of origin.

It is common that they are located in extremities, bony pelvis, back etc, although some sarcomas develop on the muscles that exist in some organs, such as uterine sarcomas.

Diagnosis

Diagnosis is difficult at first, since they present as a painless “lump”, preferably on a limb or back. As this lump is painless, the tendency of the patient and, sometimes, of the physician who sees them for the first time, is not to give it any importance. This is not the case with sarcomas that develop in the bones, which usually cause pain.

In any case, if pain is present or the lump grows, magnetic resonance imaging is the most helpful technique, since it is the method that best allows visualization of the “soft parts”. From this point on, only the biopsy or removal of the tumor and its microscopic analysis will give us the diagnosis.

Treatment

The main treatment for both bone and soft tissue sarcomas is surgery. In the past, this surgery was very mutilating, often leading to amputations.

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Currently, treatment for bone sarcomas relies on chemotherapy and surgery, while soft tissue sarcomas are also treated with surgery, but are usually complemented with radiotherapy and, less frequently, with chemotherapy.

The indications for radiotherapy are well established. It is usually required in tumors larger than 5cm or if surgery has not been totally radical. As an alternative, radiotherapy can even be administered before surgery.

It has the advantage that tolerance to the treatment and side effects are lower, but the patient should be informed that these tumors reduce very little in size, so he/she should not be alarmed if, after treatment with radiotherapy, they maintain a similar size.

When removed, a large amount will be observed, but often the entire tumor is devitalized or destroyed and has been replaced by scar tissue, which is why its size varies little.

For advanced sarcomas, both soft tissue and bone, if surgery is impossible, only treatment to relieve symptoms is possible.