Sarcoma

Overview

I have built relationships with patients, nurses, doctors and supportive care team members. Those relationships are what carried me through treatment and gave me the strength to continue to fight." Hannah Komai, bone cancer survivor

If you’ve been diagnosed with a sarcoma or musculoskeletal cancer, talk to us about treatment options. This group of cancers is quite rare and each one is unique, requiring expert detection, treatment and rehabilitation for successful treatment

At City of Hope, our dedicated team of health professionals take a patient-centered approach to diagnosing and treating sarcomas, which include tumors and cancers of the bone, cartilage, muscle, fat, nerves, blood and lymph vessels, deep skin tissue, joint tissue.

Request a consultation

If you have been diagnosed with a sarcoma, are at a high risk for developing this disease or are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673 (HOPE). Please visit Making Your First Appointment for more information. 

City of Hope is a nationally recognized leader in the research and treatment of sarcomas. We are one of the few facilities designated a comprehensive cancer center by the National Cancer Institute, and for over a decade, U.S. News & World Report has named City of Hope one of the top cancer hospitals in America.

Our physicians have been consistently named "America's Top Doctors" by Castle Connolly and are active participants in the National Comprehensive Cancer Network, which sets evidence-based best practices for detecting, evaluating and treating sarcomas nationwide.

Our multidisciplinary staff pursues an integrated approach to treating sarcomas by combining the latest research findings with outstanding patient care. This includes using advanced technologies and specialized techniques such as:

  • Minimally invasive surgical approaches that reduce discomfort, blood loss and recovery time
  • Innovative limb-sparing surgeries that can preserve patients’ range of motion and quality of life
  • Expandable limb implants that can “grow” with the patient, eliminating the need for additional surgeries
  • Highly precise radiation delivery that uses advanced imaging technology to guide radiation dose and focus, increasing its cancer-fighting effectiveness while minimizing exposure in normal tissues
  • Individually customized chemotherapy and targeted therapy regimens, including isolated-limb delivery that may be more effective against the cancer and less toxic to the patient
  • Comprehensive rehabilitation program to help restore motion and function after treatment
  • An adolescent and young adults program to address the concerns of sarcoma patients, who are typically diagnosed at a younger age

Additionally, City of Hope patients have access to our extensive team of supportive care experts, who will help you and your caregivers achieve and maintain a better quality of life during and after your cancer treatment.

NEWS & BREAKTHROUGHS

What are sarcomas?

Sarcomas are uncommon cancers that develop in your body’s connective tissues, including bone, cartilage, fat, muscle, nerves, blood vessels and lymph vessels.

Sarcomas are typically divided into two main types, bone cancer (osteosarcoma) and soft tissue sarcoma, the latter of which has over 50 classifications, depending on tissue type affected, such as:

  • Chondrosarcoma (cartilage)
  • Liposarcoma (fat)
  • Angiosarcoma (blood vessels)
  • Rhabdomyosarcoma (skeletal muscles)
  • Leiomyosarcoma (smooth muscles)
  • Synovial sarcoma (tissue surrounding joints)
  • Fibrosarcomas (fibrous connective tissue)
  • Schwannoma and neurosarcoma (peripheral nerve cells)
  • Kaposi’s sarcoma (under skin or mucus tissue in nose, mouth or anus)

What risk factors are linked to sarcomas?

Factors that can elevate sarcoma risk include:

  • Family history
  • Previous cancer radiation or chemotherapy
  • Exposure to radiation
  • Rare genetic disorders such as Li-Fraumeni syndrome, Rothmund-Thomsund syndrome and retinoblastoma
  • Paget disease: a precancerous condition involving abnormal bone formation, typically found in people over the age of 50
  • Prolonged arm or leg swelling (lymphedema)

What are the symptoms of sarcomas?

Sarcoma symptoms vary depending on the area and tissue type affected, and may include:

  • Swelling or a lump, particularly one that grows over a short period of time (a few weeks or months)
  • Pain, especially with movement
  • Bone fractures
  • Numbness or weakness in a limb
  • Abdominal discomfort
  • Bloody or black stools

Although these symptoms can be caused by other conditions, you should check with your doctor to get a definitive diagnosis.

Sources: National Cancer Institute and American Cancer Society

Diagnosing sarcomas

Precise sarcoma tests are crucial for treatment planning, and City of Hope is equipped with state-of-the-art technologies and specialized staff to ensure an accurate, comprehensive diagnosis of these cancers.

Highlights of our screening and diagnosis services include:

  • Advanced imaging technology to better locate tumors and determine treatment response
  • Genomic and molecular profiling of the cancer, which can lead to more effective, less toxic treatments

How are sarcomas detected?

Your doctor may use the following tests to look for sarcomas:

  • Physical exam
  • Blood test
  • Bone scan X-ray
  • Biopsy: Examination of suspicious tissue — depending on its location, this may using a fine needle to extract a sample or surgically removing a small piece of the tissue.
  • CT or CAT (computed tomography) scan: This test involves taking a series of X-ray images to form a computer-generated image, which determines tumor size, location and spread. Special dyes may be used to enhance this scan.
  • MRI (magnetic resonance imaging) scan: This procedure uses radio waves and strong magnets to produce detailed images of the body’s tissues, including tumor size and location.
  • PET (positron emission tomography) scan: For this test, a small amount of radioactive sugar is injected into the bloodstream, followed by a radioactivity scan to detect cancer cells (which takes up sugar at a faster rate than normal cells.)
  • FISH (fluorescence in situ hybridization): A laboratory test that looks for genetic or chromosomal changes in the biopsied cells, which can be used to guide treatment.
  • Immunohistochemistry: A test that looks for antigens in biopsied tissue sample to help determine cancer type.

Based on the results of these tests, the cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs. Generally, cancer caught in earlier stages will have better outcomes than those caught in advanced or metastasized stages.

What are the current screening guidelines for sarcomas?

There are currently no screening guidelines for sarcomas, since no screenings have been shown to lower risk of dying for people of average risk. However, your physician may recommend more vigorous monitoring if you are at a high risk of developing this disease, which includes:

  • Previous cancer therapy
  • Genetic conditions that elevate sarcoma risk
  • Family history of sarcoma

Sarcoma treatment options

It's not just the patient. They've got siblings. They've got parents, aunts, uncles, all there to make sure the child gets the best care. It's one of our greatest challenges and the greatest reward." Judith K. Sato, M.D., director, Musculoskeletal Tumor Program

Sarcomas, due to their unique nature in types and locations affected, require a personalized treatment plan for the best clinical and quality-of-life outcomes. At City of Hope, our multidisciplinary team of medical experts across different fields — including surgery, radiation oncology, medical oncology, pathology, rehabilitation and supportive care medicine — will review your individual case together to determine the best course of therapy.

Our physicians are active members in many collaborations and cooperative groups, such as WEST (Western Sarcoma Team) and Children’s Oncology Group. Our team also participate in numerous clinical trials for detecting, treating and preventing sarcomas. This dedication to research means our patients have access to the most promising and leading-edge cancer therapies available.

Learn more about our sarcoma treatment options below:

Surgery

Many of my patients are teenagers ... and it's very satisfying to see them grow, graduate high school, go off to college and have families of their own." Dominic Femino, M.D., chief, Division of Orthopaedic Surgery

For early stage or locally advanced sarcomas, surgical removal of cancerous tissue is the primary treatment. The type of surgery varies depending on the type, size and location of the cancer.

City of Hope offers the latest advances in sarcoma surgery, meaning you can achieve outcomes not possible elsewhere. This includes our surgeons’ innovative approaches to cancer removal, devotion to preserve normal tissues and specialized prosthetic options to maintain or restore your quality of life.

When possible, minimally invasive surgeries — which uses smaller incisions compared to a traditional open procedure — will be performed. This can significantly reduce discomfort, blood loss, hospital stay and recovery time while maintaining optimal outcomes.

Highlights of our sarcoma surgery program include:

  • Limb-sparing surgery: When possible, our surgeons will aim to remove cancer without amputation to preserve mobility and quality of life. This includes:
    • Minimal removal of normal tissue
    • Replacing the excised area with grafts or fillers, such as bone cement
    • Bone and joint reconstruction with natural or synthetic materials
  • Rotationplasty: For patients with sarcomas at or near the knee, rotationplasty is a modified amputation that replaces the knee joint with the ankle and foot (see right), which is then fitted with a lower leg prosthetic. This allows for a significantly enhanced balance, coordination and range of motion following sarcoma surgery.
  • Expandable bone protheses that uses specialized magnets to help lengthen prostheses to keep up with the patients’ growth, without requiring additional extra surgeries to manually expand (or replace) traditional bone prostheses.
  • Experience in surgically addressing complex cases of sarcomas, including:
    • Locally advanced cancers
    • Large or disfiguring tumors
    • Tumors at or near vital organs or structures
    • Surgery in pediatric and young adult patients, when bone and connective tissues are still growing
    • Other health conditions that can complicate surgery

Following cancer surgery, we also provide a broad range of rehabilitation services to help restore mobility and activity using a combination of physical, occupational and recreational therapy.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It is may be delivered externally using beams of energy focused on the tumor site, or internally by placing radioactive substances in or near the tumor site.

Radiation can treat tumors that cannot be removed by surgery (sometimes shrinking them enough to be operable) and can be used to relieve pain and other cancer symptoms. It may also be used after surgery to kill any remaining cancer cells at the tumor site to reduce likelihood of recurrence.

City of Hope is a leader in image-driven radiation planning, using advanced imaging technologies — such as computed tomography, magnetic resonance imaging and positron emission tomography scans — to determine tumor size and location, and “sculpt” radiation delivery to the cancerous areas. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.

Drug Therapy

Drug therapy may be given to patients to fight sarcoma cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:

  • Chemotherapy, which targets rapidly dividing cells, including cancer cells
  • Targeted therapy, which selectively attacks cancer cells based on specific characteristics
  • Immunotherapy, which stimulates the patient’s own immune system to recognize and attack cancer cells

The drug or drug combination used depends on the type and stage of sarcomas, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and/or less toxic.

In addition to traditional drug regimens, sarcoma patients at City of Hope may be eligible for isolated limb infusion therapy, which delivers cancer-fighting drugs directly to the affected arm or leg. This is done by applying a tourniquet to the affected limb and connecting its primary artery and vein to the drug-delivery mechanism. This allows for higher drug concentrations to be prescribed while reducing the likelihood and severity of systemic side effects, such as nausea and fatigue.

City of Hope patients may also be eligible for new, promising drugs through our clinical trials program.

Care is provided by a multidisciplinary team of surgical oncologists, medical oncologists and radiation oncologists who work together with pathologists, radiologists, rehabilitation experts and others to achieve the best possible outcomes for patients.

Orthopaedic Surgery

Dominic Femino, M.D.

Clinical Specialties

  • Orthopaedic Surgery
  • Orthopaedic Oncology

Pediatric Hematology-Oncology

Judith K. Sato, M.D.

Clinical Specialties

  • Pediatric Hematology-Oncology

Sarcoma research and clinical trials

At City of Hope, sarcoma clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, novel surgical techniques, innovative radiation approaches and new prevention strategies.

These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide. Visit our clinical trials page to learn more about current studies and their eligibility criteria.

Our current sarcoma research projects include:

  • Identifying biomarkers for sarcoma recurrence, which can help predict and detect cancer relapse for earlier, more effective treatment
  • New targeted therapies for advanced or recurrent sarcomas that do not respond to standard treatment
  • Using high-dose chemotherapy with stem cell transplantation to improve outcomes
  • Building a tissue bank of sarcoma cells to better understand its biology, variation and development
  • Ongoing survivorship studies to improve the health and quality of life for sarcoma survivors, who are typically younger than other cancer patients

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Living with sarcoma

It’s definitely going to be a tough road no matter what. But attitude is everything. Try to keep the best focus on the outcome in the end. Keep a positive attitude." Trevor Hoffman, muscle cancer survivor

When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your loved ones take each step during and after your sarcoma treatment.

We can help with all of the following concerns, and more:

Learn more about these resources at our Living with Cancer or Supportive Care Medicine sites.

For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE).

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Hannah Komai Success Story Image
Hannah, bone cancer survivor

Now cancer-free, Hannah draws inspiration from the care she received at City of Hope and is in college pursuing a nursing degree in college.

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