A team of specialist doctors and other professionals discuss the best treatment and care for you. They are called a sarcoma multidisciplinary team (MDT).
The treatment you have depends on:
- the type of sarcoma
- where your sarcoma is
- how far it has grown or spread (the stage)
- how abnormal the cells look under a microscope (the grade)
- your general health and level of fitness
You should be treated at a specialist sarcoma centre. Your sarcoma specialist (consultant) will talk to you about your treatment, its benefits and the possible side effects.
Surgery is the main treatment for soft tissue sarcoma. Surgeons aim to remove as much of the cancer as possible.
Stage 1, 2 or 3 sarcoma might be completely removed with surgery. In some situations, surgery may also be used to remove sarcoma that has spread to other parts of the body (stage 4).
Limb sparing surgery
Removing the cancer but not the affected limb is called limb sparing surgery. It is also called limb salvage surgery.
Surgery to remove a limb (amputation)
Very rarely, your surgeon might need to remove all or part of your limb.
Radiotherapy uses high energy rays to kill cancer cells. It is often used with other treatments for soft tissue sarcoma.
Before surgery (neoadjuvant radiotherapy)
The aim of radiotherapy is to shrink the cancer making it easier to remove with surgery. It might mean you have just the cancer and an area of healthy tissue around it (margin) removed. This is called limb sparing surgery.
After surgery (adjuvant radiotherapy)
Radiotherapy after surgery aims to kill any cancer cells left behind after surgery. It also helps stop the cancer coming back.
You usually begin your treatment some weeks after surgery allowing time for the area to heal before radiotherapy.
On it's own
Sometimes radiotherapy is used on it's own when the position of the cancer makes surgery to remove it too difficult. In this situation, radiotherapy aims to control the sarcoma, and slow it's growth.
Doctors also use radiotherapy to:
- control a sarcoma that has already spread or come back after other treatments
- relieve symptoms
Chemotherapy means using anti cancer drugs to destroy cancer cells.
It is not yet clear how helpful chemotherapy is for some types of soft tissue sarcoma. So you may be asked to join a clinical trial if you are offered chemotherapy.
Chemotherapy is not a standard treatment after surgery. This is because some research shows that it does not help reduce the risk of most types of sarcoma coming back (recurring).
Your specialist will discuss this with you. They are most likely to suggest chemotherapy for people with large, high grade sarcomas who are at most risk of cancer coming back.
Some people might have chemotherapy before surgery (neoadjuvant chemotherapy) to try to shrink the cancer. This aims to make it easier to remove with surgery, but this is not standard treatment.
A specialist technique called isolated limp perfusion means giving chemotherapy into the affected arm or leg. It is a very complicated technique and is only available at a few specialist hospitals.
For some types of sarcoma chemotherapy can be used to treat symptoms. Or it is used to control sarcoma that has spread or come back after other treatments.
Targeted cancer drugs work by ‘targeting’ those differences that help a cancer cell to survive and grow.
People with gastrointestinal stromal tumours (GISTs) that have spread might have a drug called imatinib (Glivec). Imatinib can work very well at controlling the growth of GISTs for several years or more.
Treatment by stage
Small localised sarcoma
Surgery is the main treatment and it might cure you. Your surgeon aims to remove the cancer and a border of healthy tissue around it. Having a border of healthy tissue (with no cancer cells) lowers the risk of sarcoma coming back (recurring).
You might have radiotherapy after surgery. The aim of this is to kill any cancer cells left behind if the surgeon is unable to remove enough healthy tissue around the cancer. Radiotherapy can also help to stop the cancer coming back.
Large sarcoma 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
Specialist surgery might be possible for sarcoma that has spread to the lungs or liver, but not to other parts of the body. This is not suitable for everyone. Your specialist will discuss it with you if it is an option in your situation.
Radiotherapy or chemotherapy (or a combination of both) aims to help keep the cancer under control for longer and to relieve symptoms.
People with a type of sarcoma called gastro intestinal stromal tumour (GIST) may have the targeted drug imatinib (Glivec). If that stops working, your doctor may recommend another targeted drug called sunitinib (Sutent).
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.