Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
The treatment you have depends on:
- where your cancer is
- how far it has grown or spread (the stage)
- the type of cancer
- how abnormal the cells look under a microscope (the grade)
- your general health and level of fitness
Your doctor will discuss your treatment, its benefits and the possible side effects with you.
The main treatments for soft tissue sarcoma include:
An operation to remove the tumour is the main treatment for most soft tissue sarcomas. The aim of the surgery is to remove as much of the cancer as possible.
Surgery is used to remove stage 1, 2 and 3 sarcomas. In some situations, surgery may also be used to remove sarcoma that has spread to other parts of the body (stage 4).
In the past, surgery for sarcomas in the arm or leg often meant removing the affected limb completely (amputation). But there have been big improvements in surgical techniques which means that amputation can now be avoided in most people and you may have limb sparing surgery instead. Fewer than 1 in 20 people diagnosed with sarcoma need amputation these days.
Many people have radiotherapy after surgery to try to kill off any remaining sarcoma cells and reduce the risk of the sarcoma coming back. Whether you need radiotherapy or not depends to some extent on the grade, size and site of your sarcoma.
Radiotherapy uses high energy rays to kill cancer cells. You may have radiotherapy before or after surgery for sarcoma, or on its own as your main treatment.
The aim of radiotherapy before surgery is to shrink the tumour so that it is easier to remove. You may be able to have a smaller operation than you otherwise would have.
Doctors use radiotherapy for sarcoma after surgery, to kill off any cancer cells that may have been left behind. If you do have radiotherapy after surgery, you usually begin your treatment between 6 and 12 weeks after your operation. This gives the area time to heal before the radiotherapy starts. Radiotherapy treatment may last for up to 7 weeks.
Sometimes, radiotherapy may be the main treatment for sarcoma – for example with Ewings tumours, you have radiotherapy to try to cure the sarcoma. But otherwise radiotherapy is usually used when the position of the cancer makes surgery to remove it too difficult. In this situation, radiotherapy is used to try to control the sarcoma and slow its growth.
Doctors also use radiotherapy to treat symptoms or try to control a sarcoma that has already spread or has come back since it was first treated.
Chemotherapy means having anti cancer drugs. For sarcoma, chemotherapy is mostly used to treat:
- Ewing's sarcomas
- embryonal or alveolar rhabdomyosarcoma
- children or young adults with sarcoma
- sarcomas that have spread
It is not yet clear how helpful chemotherapy is in other situations. So you may be asked to join a clinical trial if you are offered chemotherapy.
Chemotherapy is not a standard treatment after surgery as some studies have shown that it does not help to reduce the chance of most types of sarcoma coming back after surgery. Your specialist will discuss this with you individually. They are most likely to suggest chemotherapy for people with large, high grade sarcomas, who are most at risk of the cancer coming back.
Chemotherapy for soft tissue sarcoma can sometimes be given before surgery to try to shrink the cancer. This may make it easier to remove but is not standard treatment. Occasionally people have chemotherapy to shrink their sarcoma before surgery using a technique called isolated limb perfusion. This is a way of giving chemotherapy into just one arm or leg. It is complicated to do and is only available as a treatment for sarcoma at a few hospitals in the UK at the moment.
Chemotherapy can be used to treat symptoms or try to slow down a cancer that has already spread or has come back since it was first treated.
Biological therapy drugs work by stopping a series of chemical reactions that make the cancer cells grow and divide.
People with gastrointestinal stromal tumours (GISTs) that have spread may have a biological therapy drug called imatinib (Glivec). Imatinib can work very well at controlling the growth of GISTs for several years or more.
The main treatments
Small, localised sarcomas
Surgery is the main treatment and may cure you. You are likely to have radiotherapy afterwards if your surgeon could not completely remove the sarcoma with a wide border of healthy tissue containing no cancer cells. The radiotherapy helps to stop the cancer coming back.
Large tumour that has not spread
You may have radiotherapy or chemotherapy before surgery. This is only done with particular types of sarcoma such as rhabdomyosarcoma and Ewings sarcoma. Some types of sarcoma do not respond so well and are less likely to shrink. You may also have radiotherapy after surgery, to kill off any cancer cells that may have been left behind.
Sarcoma that has spread
If your sarcoma has spread, for example to the lungs or liver, you may have surgery to remove the areas of spread. This can help to relieve symptoms and keep the cancer under control for longer. You may also have chemotherapy, radiotherapy or any combination of these 3 types of treatment.
People with a type of sarcoma called gastro intestinal stromal tumour (GIST) may have the biological therapy drug imatinib (Glivec). If that stops working your doctor may recommend another biological therapy drug called sunitinib (Sutent).
Clinical trials to improve treatment
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to improve treatment by:
- making existing treatments better
- developing new treatments