There are a few different major categories of treatment options for sarcoma. The best course of action is chosen on a patient by patient basis, after considering the type, stage, and location of the tumor.
Surgery:
The aim of surgery is to completely remove or excise the tumor. At times, more than one surgery may be necessary to achieve “clean margins,” meaning all evidence of tumor cells have been removed from the surgical site. The evaluation of the margins is done in the laboratory by a pathologist, who examines the tumor sample carefully under the microscope. One area the pathologist will focus on is how close tumor cells are found in relation to where the surgeon removed the tumor. Ideally, a margin of normal tissue around the tumor is desirable to minimize the chance that tumor cells have been left behind. Surgical efforts also generally attempt to preserve the best possible function of the affected body part with minimal long-term problems. For example, a surgeon may be able to achieve clean margins in removing a sarcoma on an arm or a leg while leaving a fully or partially functioning extremity, as opposed to amputation of an entire limb.
However, amputation may still be considered if the tumor extensively involves major arteries, nerves, bone, surrounding soft tissue or a great deal of skin. It may also be considered if there is recurrence after surgery and postoperative radiation or if you were resistant to preoperative radiation and chemotherapy.
Generally, small tumors can be treated with surgery alone. However, for larger tumors surgery may not be the only treatment recommendation made. Before undergoing surgery, your physicians may recommend administration of chemotherapy or radiation therapy alone, or in combination with one another (this type of treatment is said to be given neoadjuvantly) to reduce the size of the tumor. This will ideally reduce the extent of surgery and improve the chance of saving a limb. If necessary, therapy can also be given after surgery to control microscopic residual disease and reduce the risk of recurrence. If appropriate, fertility issues should be discussed prior to beginning chemotherapy.
Radiation Therapy:
Radiation therapy is the use of ionizing radiation to kill cancer cells and shrink tumors. Radiation therapy injures or destroys cells in the area being treated by damaging their genetic material, making it impossible for these cells to continue to grow and divide. Although radiation damages both cancer cells and normal cells, most normal cells can recover from the effects of radiation and function properly. Radiation focused on a cancer from a source outside the body is called external beam radiation. This it the type of radiation therapy most often used to treat bone sarcomas. Types include brachytherapy, external beam radiation, intraoperative radiation, proton beam radiation, and intensity modulated radiation therapy.
Chemotherapy:
Chemotherapy may be recommended before surgery (perhaps in combination with radiation therapy) when dealing with high grade sarcomas. Chemotherapy is the use of medicines known to kill cancer cells by disrupting their growth (referred to as a cytotoxic agent) and is frequently given intravenously (through the bloodstream by a catheter in your arm or by a device called a port) but can also be taken by mouth. These drugs enter the bloodstream and reach all areas of the body.
Different chemotherapy drugs may be given in different combinations and doses depending on your doctor’s clinical judgment based on age, other health problems, and other considerations. Chemotherapy is usually given in cycles, consisting of a few days of chemotherapy infusion, followed by a break. Your medical oncologist (chemotherapy doctor) will decide with you how many cycles are appropriate.
Targeted drugs:
This is currently a major area of research.
This classification of drugs has been discovered to selectively kill cancer cells by inhibiting specific signals in a cell’s function. These oral targeted chemotherapies are given by mouth and are absorbed through the intestines into the bloodstream, which then carries the medication to where the cancer cells are located. This class of therapy includes Imatinib mesylate (Gleevec) and sunitinib malate (Sutent), both effective in the treatment of GIST.
Oral targeted chemotherapies kill cancer cells but also kill some normal cells, such as the blood-producing cells of the bone marrow, the cells lining the gastrointestinal tract, and cells of the skin. Temporary side effects of oral targeted therapy might include nausea, diarrhea, abdominal pain, mouth sores, and rash. Some other side effects may include fluid retention, painful calluses on hands and feet, and high blood pressure.
Because oral targeted chemotherapies can kill normal blood cells, patients may have low blood cell counts, which can result in:
· Fatigue (often due to low red blood cell counts)
· Increased chance of infection (due to a shortage of white blood cells)
There are treatments for many of the temporary side effects of oral targeted therapies, so be sure to discuss the side effects with your cancer care team. For example, anti-nausea drugs can be given to prevent or reduce nausea.
Many medications, vitamins, and herbs you may be taking could potentially interact with the oral targeted chemotherapies. Be sure to notify your cancer care team of all medications and supplements you are currently taking.
Immunotherapy: This area of drug therapy is also a being actively tested and researched. These types of medications will stimulate the immune system to recognize and destroy cancer cells.
Complementary methods: This category encompasses a diverse group of health care practices, systems and products such as vitamins, herbs, dietary supplements, acupuncture, massage, etc. used in conjunction with the medical care listed above. If you are considering any alternative or complementary treatments, it is best to discuss them openly with your cancer care team. Some therapies may be helpful but many can interfere with the effectiveness of your treatment program or cause serious side effects.