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Get a LEG up on Sarcomas

By Ashlyn Seeley Everett, M.D., radiation oncologist at Alliance Cancer Care

July is Sarcoma Awareness Month. This is a rare tumor that often occurs in the leg. Learn more about this tumor type and its treatment options.

What is sarcoma?

Sarcomas are a rare group of malignant cancers that develop in the soft tissue of muscles, cartilage, fat, blood vessels, or the bone. There are more than 60 subtypes of sarcoma, which vary on a spectrum of non-aggressive to very aggressive. There are only about 13,000 new cases of sarcomas each year in the United States, including pediatric and adult cases.

Sarcomas often arise in the musculature in the extremities or the torso. The most common location for sarcoma is the femur, which is the large bone of the thigh. However, some types of sarcomas (leiomyosarcoma) are more commonly found in the abdomen. The most common types of sarcomas in adults include undifferentiated pleomorphic sarcoma, liposarcoma, and leiomyosarcoma. These names reflect the origin of the tumor as determined by a pathologist.

These types of tumors can be locally destructive, but can also spread commonly to the lungs. They uncommonly involve lymph nodes, as other cancer types often do.

What are the risk factors for sarcoma?

Unlike other common cancers, smoking and lifestyle have not been linked with increased risk of sarcoma. Patients with a history of lymphedema, chemical exposure, and prior radiation therapy (typically more than 10 years prior) are at increased risk of developing sarcomas. There are also some familial cancer syndromes associated with sarcomas:

  • Neurofibromatosis
  • Garner syndrome
  • Li-Fraumeni syndrome
  • Werner syndrome
  • Gorlin syndrome
  • Tuberous sclerosis

What are the symptoms of sarcoma?

Roughly 50% of sarcomas develop in the arms or legs. The majority of patients notice a painless lump or mass in the arm or leg that grows over several weeks to months. In the case of sarcomas that start in the abdomen, there are usually few symptoms until the tumor grows large enough to cause stomach distention, abdominal pain, decreased appetite, bowel habit changes, or blood in the stool.

What testing is done to diagnose sarcomas?

If sarcoma is suspected, your doctor will order testing to help with the diagnosis. Imaging studies including ultrasound, CT scans, or MRI are often performed to define the size of the mass and its characteristics. CT scans of the chest are often performed to ensure that the cancer has not spread to the lungs. An MRI is typically required for sarcoma imaging. This gives fine detail of the soft tissue surrounding the tumor and the tumor itself to help in planning treatment recommendations.

Once imaging is performed, and sarcoma is suspected, your doctor will likely order a biopsy. This is a very important step. Your biopsy should be done by a well-trained surgeon to ensure the highest success with the treatment of the sarcoma. Biopsies that are not done with proper attention to technique can lead to tumor spread and possible problems with treatment later on.

What are treatment options for sarcomas?

Sarcomas are typically treated with surgery, with or without additional radiation treatment. Most forms of sarcoma are not very sensitive to chemotherapy, though chemotherapy may be required in some situations with very large tumors.

You should talk with your doctors about whether you should have surgery or radiation first. For sarcoma in the leg or arm, radiation therapy is often given before surgery to improve treatment success. Radiation given before surgery for tumors in the extremities has a few advantages:

  • Your doctor can see the tumor well and can treat a smaller area.
  • Your doctor may use a lower dose of radiation pre-surgery, leading to fewer long-term complications such as fibrosis (scarring) and lymphedema (swelling).
  • There is less risk of a positive margin (tumor being left behind) with radiation given upfront.

Radiation therapy given before surgery does increase the risk of wound healing after surgery.

Surgery for sarcomas involves a “wide local excision” to remove all the tumors with a rim of normal tissue. This should be performed by an experienced surgeon for the best outcome.

What are the side effects of treatment?

Radiation

Side effects from radiation treatment may occur during treatment or after treatment. Radiation treatment typically causes side effects while on treatment, including fatigue and skin changes like a light sunburn. This can cause itching, tenderness, darkening, or stiffness in the skin. These side effects gradually increase during treatment and improve after radiation ends. However, some of the effects of radiation may linger, including stiffness of the skin or muscle. After radiation treatment, some patients also experience swelling in or below the area treated with radiation. This is called lymphedema, and many patients experience heaviness, tenderness, firmness, or swelling. Lymphedema is often not completely reversible, but it can be improved with physical therapy, massage, and compression garments.

Surgery

Risks of surgery include bleeding, infection, and scarring. In addition, surgery may lead to increased weakness of the area, depending on the amount of muscle and tissue that must be removed during surgery. Physical therapy can help recover from surgery.

What kind of recovery is involved after treatment?

When radiation treatment ends, it typically takes about 4-6 weeks for the skin changes to heal. This is about the timing when patients are seen by their surgeon for consideration of their cancer surgery (if not done before radiation).

After surgery, patients typically have a period of 4-6 weeks needed for healing of the scar before resuming normal activity. Your surgeon will give you specific instructions after surgery for recovery.

Physical therapy can be an important aspect of recovery after either surgery or radiation treatment.

What happens after completing all treatment?

After completing treatment for sarcoma, your doctor will schedule you for regular check-ups. You will typically see your doctor(s) every 3-6 months, possibly with scans done every 6-12 months. Your doctor will monitor both for side effects related to treatment, as well as for any return of cancer.

If you have side effects related to stiffness in the muscle or lymphedema, your doctor can address those at your follow-up visits. Your doctor will likely recommend physical or lymphedema therapy to help with these issues, as needed.

What happens if the tumor returns or spreads?

Most commonly, sarcoma returns at the site where it started. If it spreads, the most likely place it spreads to is the lungs.  In either situation, your doctors will make an individualized treatment plan with you based on your prior treatment, the characteristics of your cancer, and your overall health status.

Where can I find more information?

American Cancer Society

National Cancer Institute

If you were diagnosed with sarcoma and would like to discuss treatment with one of our expert physicians, please contact our office at 256-319-5400 to schedule a consultation.