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Types of sarcoma surgery

Men and woman discussing soft tissue sarcomas

This page is about different types of surgery for soft tissue sarcoma. There is information below about

 

A quick guide to what's on this page

Types of sarcoma surgery

Surgery for sarcomas is very specialised treatment. You should be treated by surgeons trained and experienced in this type of surgery. The aim of most surgery is to completely remove the tumour. The most common operation is called a wide local excision. This means removing the cancer with a border of healthy tissue around it.

The type of operation you have will depend on where in your body the sarcoma is. Many sarcomas are in the arm or leg. But they can start anywhere in the body.

Limb sparing surgery

If your tumour is in an arm or leg, your surgeon will want to do limb sparing surgery if at all possible. This means removing the cancer, but not the arm or leg.

Amputation

Sometimes the only possible treatment is to remove the limb or part of the limb in which the sarcoma is growing. You should have access to a specialist team of doctors, nurses, physiotherapists and a prosthetist. They will help you before your operation and with your recovery and rehabilitation afterwards.

Plastic surgery

Sometimes the surgeon has to remove quite a lot of tissue. So you may need some plastic surgery to repair the area. You have this at the same time as your sarcoma operation. The exact operation you have will be unique to you. The aim will be to give you as natural looking a result as possible, and to keep the part of the body working as well as possible.

Surgery for sarcoma that has spread

The most common place for sarcoma to spread is to the lungs. It may also sometimes spread to the liver. It is sometimes possible to operate to remove areas of sarcoma in the lung or liver. Or sometimes you may have specialised surgery techniques that heat or freeze the sarcoma cells. Sometimes for liver tumours a high dose of chemotherapy can be given into the liver along with an oily substance that keeps the chemotherapy in the liver for a while (chemoembolisation).

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating soft tissue sarcoma section.

 

 

Types of operation for sarcoma

Surgery is the main treatment for most primary soft tissue sarcomas. It is very specialised treatment. You should be treated at a major hospital that has surgeons who are trained and very experienced in this type of surgery.

The aim of most sarcoma surgery is to completely remove the tumour. The most common operation is called a wide local excision. This means removing the cancer with a border of healthy tissue around it. Having a border of healthy tissue with no cancer cells helps the surgeons to be sure they have removed all the cancer. This lowers the risk of the sarcoma coming back.

It is difficult to give general information about sarcoma surgery. The type of operation you have will depend on where in your body the sarcoma is. Many sarcomas are in the arm or leg. But they can start anywhere in the body. For example, leiomyosarcoma can grow in the womb (uterus). 

We have general information about surgery in our surgery section and you can find information there that may help you. For specific information about the type of operation you will need you can ask your doctor or specialist nurse. They will be happy to talk things through with you.

 

Limb sparing surgery

If your sarcoma is in an arm or leg, your surgeon may be able to remove just the cancer and a surrounding area of healthy tissue. They call this limb sparing surgery. You will be in hospital for about 7 to 10 days after this type of surgery. Unless you have a low grade sarcoma, it is likely that you will have radiotherapy after your wound has healed (about 6 weeks later). The radiotherapy lowers the chance of the cancer coming back in that area.

While your wound is healing, you may want a waterproof cover for your arm or leg, so that you can have a bath, shower or even go swimming without getting it wet.

If the sarcoma does come back, you will have another operation to remove more tissue, and may need to have your arm or leg removed (amputated) in the future.

 

Amputation

Sometimes the only way to completely get rid of a sarcoma is to remove the whole limb or a part of the limb where the sarcoma is growing. Sometimes amputation is needed because a sarcoma has come back in the same limb after previous limb sparing surgery.

If you have to have an amputation, you will have access to a specialist team of doctors, nurses, physiotherapists and prosthetists called a multidisciplinary team. The team will help you before your operation and with your recovery and rehabilitation afterwards. 

Psychological support is very important. If you need to have a limb removed you are likely to have many strong feelings. It affects your body image (the way you see yourself). You can ask your doctors and nurses about the support services available to you. There are also support groups and organisations who may be able to help you before and after surgery.

 

Plastic surgery

During some operations for soft tissue sarcoma the surgeon needs to take away quite a lot of tissue. So you may need some plastic surgery to repair the area. This happens at the same time as your sarcoma operation. The exact operation you have will be unique to you. It will depend on where in the body you have the sarcoma and how much tissue the surgeon has to remove. So it isn't possible to give very many details here.

Whichever type of plastic surgery operation you have, the surgeon's main aim will be to give you a result that is as natural looking as possible and that works as normally as possible.

With smaller sarcoma operations, the surgeon may just be able to pull the underlying tissues together and stitch them together. But sometimes, there isn't enough healthy skin to use, so the surgeon needs a skin graft to repair the surface. A skin graft uses a strip of skin taken from another part of your body. The area where the skin is removed is called a donor site. The donor site heals itself in the few weeks after your operation. The repair site, where the donor skin goes, will also heal but will be more delicate and it may take longer.

To repair a larger area, your plastic surgeon may need to use a specialist technique called a tissue flap. There are several types of flap repair. The area of the sarcoma and the size of the wound will affect which type your surgeon needs to use. A local flap means that the surgeon uses tissue next to the wound to repair it. A pedicle flap is a flap taken from a little further away but close enough to leave the flap's original blood supply connected.

A free flap is a transplant of tissue from one part of your body to another. The tissues under the skin are taken from the donor site, as well as the skin. The flap of tissue and skin is removed with its own blood vessels. The surgeon connects the blood vessels up in the new site, so that the flap has a good blood supply. This is vital for it to heal properly.

 

Surgery for sarcoma that has spread

When sarcoma spreads to a different part of the body, it is called secondary cancer. The most common place for sarcoma to spread is to the lungs. It may also sometimes spread to the liver. It is sometimes possible to operate to remove areas of sarcoma in the lung or liver. But this is only possible for a small number of people who have a limited number of secondary tumours. This is major surgery and your doctor can explain it to you. You can find information about lung surgery in our section about lung cancer surgery. You can find information about liver surgery in the section about surgery for liver cancer.

If your sarcoma has spread anywhere else in your body, your doctor is unlikely to offer you surgery. They will probably suggest chemotherapy instead because that circulates throughout the body and so treats all areas of cancer spread.

If you only have cancer cells in the liver or lung and not in other parts of your body, your doctor may recommend one of the following types of specialised surgery. All of these procedures aim to kill off the cancer cells without causing too much bleeding or other side effects. Your doctor will take several factors into account before deciding whether any of these types of surgery are possible for you. They will talk to you about the possible benefits and risks of these treatments in your situation. There is information below about

Hepatic artery chemoembolisation

This treatment is for liver secondaries. The doctor puts an oily liquid into the main artery taking blood to the liver. The liquid blocks the blood vessels taking blood away from the liver. The liquid also contains chemotherapy.

First, you may have a medicine to make you feel drowsy. The surgeon then injects a local anaesthetic into the skin over a blood vessel at the top of your leg. While using X-ray pictures the surgeon slides a thin plastic tube into the blood vessel. They push the tube gently upwards until the tip is in the artery that takes blood to the liver. When the tube is in position the surgeon injects a chemotherapy drug mixed with the oily liquid. The surgeon then removes the tube.

High levels of chemotherapy stay in the tumour for a few hours. This kills some of the cancer cells and shrinks the tumour. The treatment takes from 30 minutes to a couple of hours. Afterwards, you may have some pain, feel or be sick, and have a high temperature.

Radiofrequency ablation (RFA)

Radiofrequency ablation uses radio waves to destroy cancer cells in the liver or lung by heating them to high temperatures. You usually have a sedative to make you drowsy but some people have a general anaesthetic. If you have the sedative, your doctor injects a local anaesthetic into the skin of your tummy (abdomen) or chest to numb it. They then push a thin needle through the skin and into the centre of each tumour. They use a CT or ultrasound scan to make sure the needles are in the right place. Then they pass radio waves through the needle to heat the tumours and destroy them.

Doctors use RFA to treat tumours up to 5cm (2 inches) in size. It takes about 10 to 15 minutes. Usually, you can go home a few hours afterwards. You may need to have the treatment repeated. The main side effects are pain and a high temperature for a few days.

Radiofrequency assisted surgery

Radiofrequency assisted surgery uses high frequency radio waves to destroy the cancer, as in radiofrequency ablation. The surgeon uses an ultrasound scan to see where the radiofrequency probe is. When the probe is in the right place, the surgeon uses it to destroy the cancer and the liver tissue around it. Then they surgically remove the dead tissue along with the cancer.

The idea behind this treatment is that heating the tissues seals blood vessels. So there isn't as much bleeding as there would be with a standard operation to remove cancer from the liver. The National Institute for Health and Care Excellence (NICE) has issued guidance saying that this procedure appears to be safe and works well enough to be used on cancer in the liver. But there is a higher risk of getting an infection afterwards. NICE says there isn't enough evidence yet to show that it is any better than other ways of removing cancer in the liver. We don't yet know much about how well this treatment may work for lung tumours.

Cryotherapy

Cryotherapy is also called cryosurgery. It means removing cancer by freezing it. NICE has approved cryotherapy as a treatment for small liver secondaries (usually up to 4 cm in diameter). Using it for lung tumours is still very experimental. The procedure takes about 30 to 60 minutes. You may have it as part of open surgery under general anaesthetic or using keyhole techniques under local or general anaesthetic. 

The surgeon puts one or more cryotherapy probes (called cryoprobes) through a small cut in the skin and into the cancer. They use a CT or ultrasound scan to make sure each probe is in the right place. The tip of the cryoprobe is then cooled to below freezing. The probe creates an ice ball within the surrounding tissue that aims to destroy the cancer cells. Sometimes the area is thawed for 10 to 15 minutes and then frozen again. You will have some pain afterwards and possibly a high temperature, but you will have painkillers to help. You usually have a short stay in an intensive care unit followed by around 2 days on a specialist ward.

Microwave ablation

Microwave ablation uses microwave energy to produce heat and kill cancer cells. You can have this treatment for more than one secondary liver or lung tumour. You may have a local or general anaesthetic. The doctor puts a thin needle into each tumour. They use a CT or ultrasound scan to make sure the needles are in the right place. Then they connect the needles to a microwave generator. The microwaves are released through the needles to destroy the cancer cells.

NICE has approved microwave ablation as a treatment for cancer that has spread to the liver. NICE said that it is safe but we don't yet have much evidence about how well it works and need more research. Your doctor may suggest microwave ablation as part of a trial. Before you have this treatment, your doctor must make sure they explain all the risks involved and tell you about other available treatments. We don't yet know much about how well this treatment works for lung tumours.

Laser therapy

Laser therapy is also called laser ablation. The surgeon uses a very high powered beam of light to destroy cancer cells in the liver or lung, by heating them to high temperatures. You usually have a sedative to make you drowsy but you may have a general anaesthetic. If you have the sedative, your doctor will inject a local anaesthetic into the skin of your tummy (abdomen) or chest to numb it. They then push a flexible tube that carries the laser light through the skin and into the centre of each tumour. The doctor uses a CT or ultrasound scan to make sure the tip of the tube is in the right place. Then the laser heats the tumours and destroys them.

Doctors use laser therapy to treat tumours up to 5cm (2 inches) in size.  It takes about 10 to 15 minutes. Usually, you can go home a few hours afterwards. You may need to have the treatment repeated. The main side effects are pain and a high temperature for a few days afterwards.

Alcohol treatment

This treatment is for liver tumours. It uses sterile alcohol to destroy cancer cells. It is only suitable for liver tumours smaller than 4 to 5cm (1½ to 2 inches). You may have medicine to make you drowsy. The surgeon then injects local anaesthetic into the skin over the liver. They push a thin needle through the skin and into the tumours using a CT or ultrasound scan to make sure the needle is in the right place. Then they inject the alcohol directly into the tumour. 

You can have this treatment for more than one tumour in the liver. It can be painful, so you take painkillers for a while afterwards. Some people feel drunk for about 10 to 15 minutes after the injection. You usually stay in hospital for a few hours after your treatment, in case you have any bleeding or pain. You can have the treatment again some time later if the tumours grow back.

Electrical impulse treatment

This treatment is for lung secondaries, although it is not used very often for people with sarcoma. It is called irreversible electroporation. You have a general anaesthetic and a drug to prevent muscle spasms. The surgeon pushes special needles through the skin of the chest and next to the tumour, using ultrasound or X-ray guidance. A series of short electrical impulses then pass between the needles over several minutes to destroy the tumour cells. The needles may then be moved to repeat the process until the whole tumour has been treated along with a small area of surrounding tissue.

NICE has said that currently there is not enough evidence to be sure about how well the procedure works or how safe it is. So it should only be carried out as part of research studies. It may also cause temporary changes in the heartbeat for some people.

 

More information about soft tissue sarcoma surgery

If you have questions about soft tissue sarcoma surgery, you are welcome to contact the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. You can also contact one of the soft tissue sarcoma organisations or look at our soft tissue sarcoma reading list.

You can find some helpful questions about surgery for soft tissue sarcoma on the questions to ask your doctor page.

If you want to find people to share experiences with online, you could use CancerChat, our online forum. 

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Updated: 11 February 2015