Sarcomas are rare tumours that arise in bone, cartilage or other soft tissues (eg fat, muscle, nerves, blood vessels). They comprise only one percent of all cancers diagnosed.
Sarcomas most commonly develop in the arms or legs but can also grow in the pelvis, abdomen, chest, head and neck region or within internal organs.
There are many different types of sarcomas and, given their rarity, management is generally supervised by a specialised sarcoma unit.
What are the Causes of Sarcomas?
The causes of the vast majority of sarcomas are unknown. There are several known risk factors but these apply to a very small number of cases of sarcoma. Some rare, inherited genetic conditions can put people at more risk of sarcoma, for example, neurofibromatosis, Li-Fraumeni syndrome, Gardner syndrome, retinoblastoma. There can also be a very small risk for people who’ve had previous radiation therapy. The risk is higher for people who had high doses of radiation therapy at a very young age.
Most people who’ve had radiation therapy in the past won’t develop a sarcoma. Exposure to certain chemicals at high doses (e.g. phenoxyacetic acid) may be a risk factor but this is not known for certain.
A previous injury is not a risk factor for developing a sarcoma.
What are the Symptoms of Sarcomas?
Sarcoma typically presents as a painless lump. Other symptoms will depend on where in the body the sarcoma is.
What are the Treatments for Sarcomas?
The main types of treatment for sarcomas are surgery, radiation therapy and drug therapy (e.g. chemotherapy or “targeted” therapies). There are many different types of sarcomas and each will have its own treatment pathway depending on the person’s age, the sarcoma subtype, its location and whether or not it has spread. Due to their rarity, sarcomas are generally managed within (or in close consultation with) specialised sarcoma units. Most people who have localised sarcoma (i.e. it has not spread from where it started) will have their tumour removed surgically.
Radiation therapy can be used in addition to surgery in certain circumstances to reduce the risk of the cancer coming back or to help preserve the function of the area being treated (e.g. to avoid the need to amputate a limb). It can be given after surgery, to eliminate any remaining cancer cells and to reduce the risk of the cancer coming back. More commonly, it is given before surgery (neoadjuvant) to ‘shrink’ the tumour and make it easier for the surgeon to remove it successfully, or to avoid having to amputate the limb. Palliative radiation therapy can also be given to relieve the symptoms and control a sarcoma that has come back after treatment or spread to another part of the body.
Chemotherapy is commonly used for childhood sarcomas and bone sarcomas but is only selectively used in the initial curative treatment of adult soft tissue sarcomas. Chemotherapy and radiation therapy are commonly used to palliate sarcomas that have metastasised (spread to other parts of the body).
What are the Side Effects of Radiation Therapy?
The side effects of radiation therapy for sarcoma will depend on what part of the body is receiving radiation therapy and what dose is required to treat that particular tumour.
Side effects during/soon after treatment (Early or ‘acute’ side effects)
General side effects during treatment can include fatigue and irritation of the site being treated (e.g. skin reddening, dryness, discomfort, and hair loss). The acute reactions such as skin reaction, typically recovers about 4 weeks after you finish treatment. The tiredness is a common side effect, and may continue for months even after completing treatment.
Where radiation is used before surgery (neoadjuvant) to improve control and long term function, there can be a slight increased risk of post-operative wound complications in the short term.
Late or long-term side effects (Side effects well after treatment)
Whilst radiation therapy is used to help preserve function, long term side effects can include some stiffening (fibrosis) of the treated area. After radiation therapy, lymphoedema, or swelling can develop. This is permanent, but often manageable. Radiation therapy to a limb can cause increased risk of fracture in the bone of the treatment area. This is rare, and most patients who have radiation therapy will not have any bone problems.
Radiation therapy can cause a secondary malignancy, but this is a very uncommon long term-risk. The chance of developing a second cancer is so small that the benefit of radiation therapy will outweigh the risk.
The best person to discuss radiation therapy with is a Radiation Oncologist. You can ask your general practitioner (GP) for a referral to a Radiation Oncologist for a discussion about how radiation therapy might fit into your treatment program.
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Page last updated: 30/11/2020