Newest Techniques to Treat Sarcoma Can Help Save Your Limbs

Grafts and custom implants fill in after cancer removal
Newest Techniques to Treat Sarcoma Can Help Save Your Limbs

Sarcoma is a rare form of cancer that occurs in the soft tissues and bones. Unlike more common cancers such as breast or lung cancer, sarcomas can occur anywhere in your body. But new techniques are allowing doctors to keep more of your body intact as they treat the condition.

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Sarcoma is a slow-growing cancer and often doesn’t produce symptoms. It may appear as a painless lump under the skin. Some sarcomas may form deep in your abdomen and not cause symptoms until it is quite large.

Sarcoma is a rare cancer, and represents less than 1% of all cancers, says oncologist Dale Shepard, MD, PhD.  “There are only about 12,000 soft tissue sarcoma cases a year and they can occur in people of any age,” he says.

As a result, there often are major delays in diagnosing and treating sarcoma, Dr. Shepard says.

“They can grow really slowly, so patients report no symptoms until the sarcoma starts to press on the organs, nerves or muscles,” Dr. Shepard says. At that point, symptoms may include pain and problems with breathing.

If your doctor says you have a sarcoma, it’s a good idea to get evaluated at a hospital with the medical expertise and experience to treat this kind of rare cancer, Dr. Shepard says.

“If you have lung cancer, which is far more common, most oncologists are comfortable treating it,” he says. “However, not many hospitals or physicians are familiar with treating a sarcoma, so it’s best to seek evaluation at a medical center that specializes in sarcoma.”

Treatment options for sarcoma

At a larger medical center that specializes in sarcoma, you can expect to be treated by a multidisciplinary team of surgeons, radiologists, medical oncologists, radiation oncologists, pathologists, pediatric specialists (if treating a child), psychologists and social workers,  says orthopedic surgeon Nathan W. Mesko, MD, Co-Director of Cleveland Clinic’s Sarcoma Center.

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How the team treats you — with surgery, radiationchemotherapy or targeted therapy — depends on the type of sarcoma, where it is located and how far it has progressed locally and systemically.

In the past, surgeons treated many sarcomas in the arms or legs by amputation. Most treatment today avoids amputation. A surgical team typically can remove the tumor and then follow up with radiation therapy.

Dr. Mesko says that newer limb-saving options include:

  • Implanting bones from cadavers.
  • Creating a graft by borrowing muscles or bones from elsewhere in the body.
  • Using metal implants or custom implants.

How does treatment work?

The sarcoma team may try to shrink the tumor first with radiation therapy or chemotherapy.

Then a surgeon will remove the tumor by a wide local excision. This means he or she removes the diseased tissue with a margin of healthy tissue at the edges to ensure all the cancer is out.

If necessary, a graft or prosthesis can replace the tissue or bone that has been removed. This may use tissue and bone taken from another part of your body, or the surgeon may use a bone or metal implant.

“Metal implants, in particular, can help provide you with that structural support again so that you remain functional over the years,” Dr. Mesko says. “One of the things we’re always thinking about is long-term — how durable the reconstruction is and how well it is going to withstand the test of time.

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“The technology, at least from the surgical world, is moving forward trying to find longer-term solutions to providing durability, and is minimizing re-operations and complications.”

Creative solutions with custom implants

Custom implants to rebuild some parts of the anatomy — the pelvis or shoulder girdle, for instance — are still a developing technology.

“A custom implant, while becoming popular, is still not commonly used,” Dr. Mesko says.

“Sometimes, the tumor forces us to remove a significant part of someone’s structurally supportive anatomy,” he says. “To rebuild that part, we may need a custom solution where we can match the part that has been removed.”

The Food and Drug Administration (FDA) approval process for custom implants and engineering is often lengthy — up to 10 weeks — which limits their use for now, Dr. Mesko says.

“In some scenarios, when the patient needs surgery now, we can’t afford a delay,” he says. “And obviously this is a barrier that prevents us from doing some kind of more creative solution.”

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