September 9, 2021 by Peter B. Laird
Sarcoma Awareness Month Spotlights Rare but Often Treatable Cancer
Unless you or someone you know has been diagnosed with it, odds are you probably don’t know too much about sarcoma. It’s an extremely rare type of cancer, according to the American Cancer Society, accounting for just one percent of all adult cancers and 15 percent of all pediatric cancers.
As part of National Sarcoma Awareness Month, Resource editors spoke with Cecilia Belzarena, M.D., an orthopedic surgical oncologist with Miami Cancer Institute, which is part of Baptist Health. Dr. Belzarena specializes in the surgical treatment of musculoskeletal tumors, including benign and malignant bone and soft tissue tumors, and is also a pediatric orthopedic surgeon.
Resource: What exactly is Sarcoma?
Dr. Belzarena: Sarcoma is a type of cancer that arises most often from soft tissues or bones. The most common soft tissues where we tend to find sarcomas are fat, muscle, nerves and blood vessels. There are several different subtypes of sarcoma, each with its own particular features. This disease is very rare, which is why it’s so important to see a sarcoma specialist if you do get a diagnosis.
Resource: You say sarcomas are very rare – how many people get this type of cancer?
Dr. Belzarena: More than 13,000 people in the U.S. are expected to be diagnosed with a soft tissue sarcoma this year – that number includes adults and children. The most common subtypes of soft tissue sarcoma are undifferentiated pleomorphic sarcoma, liposarcoma and leiomyosarcoma. Additionally, more than 3,500 children and adults will be diagnosed with a bone sarcoma this year. The most common subtypes of bone sarcoma are osteosarcoma, Ewing’s sarcoma and chondrosarcoma.
Resource: Who is at risk for developing sarcoma?
Dr. Belzarena: Anyone can be diagnosed with a sarcoma – the disease affects both children and adults. Certain syndromes or genetic mutations can predispose some individuals more than others, but the vast majority of our patients do not have any of those conditions. This is why it’s so important to have any new mass you notice checked by a doctor.
Resource: How is sarcoma recognized and diagnosed?
Dr. Belzarena: With soft tissue sarcoma, the patient may notice a lump that can be felt through the skin and which may or may not be painful. They may have abdominal pain or unexplained weight loss. Or, in the case of bone sarcoma, they may have persistent bone pain or a broken bone that happens without warning or any precipitating injury.
We start by obtaining a thorough history of the patient and conducting a detailed examination. Following that, we obtain imaging studies; for most patients, this would be a contrasted MRI but there might be exceptions. We then review the images and assess the mass, noting its features, its anatomical location and its relationship to other structures such as vessels and nerves. The next step is a biopsy, which can be done with a needle or through a small surgical procedure. The sample then goes to the pathology department for analysis – usually under a microscope but in some cases it may involve genetic testing of the sample.
Resource: How is sarcoma typically treated?
Dr. Belzarena: At Miami Cancer Institute, patients can find all the specialists and treatment modalities they need under one roof. Sarcoma patients are treated by a multidisciplinary team that typically includes an oncology orthopedist, a radiation oncologist, a medical oncologist, a plastic surgeon and a rehabilitation expert. All are key players in the patient’s care. Once we have a diagnosis of sarcoma, the case is discussed among all specialists at our tumor board, a meeting where all sarcoma doctors get together to discuss the treatment plan of our patients.
The main treatment strategy for sarcomas is to remove them via surgical resection. Depending on the tumor’s features and the stage of the disease, adjuvant therapies will be added, such as radiation therapy or systemic treatment. We have an amazing team of radiation oncology experts here, and every type of radiation therapy is available under one roof for our patients.
Also, the modern surgical procedures and cutting-edge reconstruction techniques we employ here allow us to perform complex limb salvage procedures – removing the tumor while preserving the functional limb – so that the patient can continue to maintain a good quality of life doing the things that they enjoy.
Resource: Are there any promising new sarcoma therapies on the horizon?
Dr. Belzarena: Aside from surgery, new treatment alternatives now being studied include cryoablation and hyperthermia treatments. Also, radiotherapy is now being enhanced with the use of nanoparticles. Current research is centered on genetic targetable mutations as an alternative for new systemic treatments. All of these developments should provide great hope for anyone diagnosed with sarcoma.
Resource: Is there anything else people should know about sarcoma?
Dr. Belzarena: Like other cancers, the sooner you diagnose sarcoma, the better your chances are of surviving this disease. Left untreated, a sarcoma will continue to grow and spread from its original location to other organs and body sites. Once it starts to metastasize, the disease can no longer be cured but it can be treated and controlled.
If you notice a mass that isn’t going away or is growing, get it checked as soon as possible. And remember, not all sarcomas can be palpated, especially if they are deeply located, in which case you may not feel a mass but you may feel pain. If you have unexplained pain that persists for more than six to eight weeks, you should definitely see a doctor.