Sarcoma Treatment: Answers from Oncologist Carol Morris
A sarcoma is a malignant, or cancerous tumor that arises from connective tissue, such as bones, fat, cartilage and muscles. Sarcomas are rare — they make up just 1 percent of all cancers. Approximately 15,000 people in the United States are diagnosed with sarcoma every year.
Dr. Carol Morris, division chief of orthopaedic oncology and co-director of the Sarcoma Program at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, discusses sarcoma treatment options and prognosis.
What are the types of sarcoma?
There are two main types of sarcoma:
- Soft tissue sarcomas are more common and have close to 50 subtypes, including liposarcoma, synovial sarcoma, pleomorphic undifferentiated sarcoma and many others.
- Bone sarcomas, also called bone cancer, includes osteosarcoma, Ewing sarcoma, chondrosarcoma and several other subtypes.
What causes a sarcoma?
Most sarcomas have no known cause. Sarcomas can develop in children and adults for no clear reason. In some cases, sarcomas have been linked to past exposure to radiation, certain chemicals or viruses.
Are sarcomas hereditary?
Not that we know of. However, you may inherit genes that could make you more likely to get a sarcoma. For example, children with familial retinoblastoma syndrome have a gene mutation that makes them predisposed to osteosarcoma.
Where can sarcoma spread?
Like most cancers, a sarcoma may spread, or metastasize, to other parts of your body. The larger the tumor, or the higher the grade, the more likely it is to metastasize. The lungs are the most common site where sarcomas spread, although metastases have been reported in most organs, including the liver, lymph nodes and bones.
How is sarcoma treated?
When you are referred to a sarcoma specialist, whether it’s an orthopedic oncologist or a surgical oncologist, the specialist will evaluate the size and location of the tumor as well as check for metastases. At the Kimmel Cancer Center, we run a variety of tests — from MRI and CT scans to bone scans and biopsies — to make sure we get the full picture of your condition.
Each sarcoma patient’s treatment plan may be different. At Johns Hopkins, we use a multidisciplinary approach to sarcoma treatment that involves a large team of experts who work together to find the best treatment for you. In general, sarcoma treatment may include chemotherapy, radiation therapy and surgery. For example, treatment for osteosarcoma may involve nine weeks of chemotherapy, surgery to remove the tumor and rebuild the bone and another five months of chemotherapy. However, experiences may differ for different people.
Can a sarcoma come back?
Like most other cancers, a sarcoma may recur. When we perform sarcoma surgeries at Johns Hopkins, we aim for what we call a negative margin. This means cutting out the tumor and enough surrounding tissue to remove as many cancerous cells as possible. We may also use radiation treatment or chemotherapy to kill any remaining sarcoma cells.
While this approach improves survival and life expectancy, it is possible that a sarcoma could return. Some sarcomas tend to reappear in the same spot, and others grow in new locations. Typically, if a sarcoma does come back, it happens within the first two to five years after surgery.
What if a sarcoma spreads to my lungs?
If sarcoma spreads to the lungs, we try to determine if the tumors can be safely removed. If surgery is not an option, other treatments, such as biological therapy, chemotherapy and radiation therapy, may be recommended. Biological therapy uses living microorganisms to target cancer cells directly or stimulate your entire immune system. One example of biological therapy is the drug pazopanib, which was approved for treatment of soft tissue sarcomas. Radiation and chemotherapy are two other options for a sarcoma that has spread to the lungs. If these treatments are not successful, you may be eligible to participate in a clinical trial.
Does radiation prevent sarcoma recurrence?
Radiation helps prevent sarcomas from recurring in the same spot (local recurrence). When radiation is delivered during surgery, also known as intraoperative radiation therapy (IORT), it “sterilizes” the tissue around the tumor by killing cancerous cells.
What happens after a sarcoma surgery?
Once the surgery is finished, you will go through a period of recovery. It may include rehabilitation, physical therapy, occupational therapy and other care to manage the side effects of your treatment.
Even after you are back to your everyday life, you should stick to the follow-up schedule recommended by your doctor to monitor your condition. This is called surveillance. This schedule is performed every three to six months, and it typically includes a CT scan, X-ray or another test depending on the type of sarcoma.
Is there a link between diet and recurrence of sarcoma?
A healthy diet is good for you whether you have a sarcoma or not. But there is no known link between diet and sarcoma recurrence. Regardless, getting nutrients from healthy foods can help your body better manage side effects of sarcoma treatment.
Are there any new sarcoma treatments?
Personalized medicine is one emerging sarcoma treatment that may become the preferred cancer treatment approach. It means collecting data about your body and your cancer on a molecular level to match you with a drug that has the biggest impact and minimal side effects for your specific type of tumor. Imatinib is one of these drugs that targets certain types of cancers, including gastrointestinal stromal tumors (GIST), which is the most common sarcoma of the gastrointestinal tract.