Medical Minute – Sarcoma

By: Dr. James Lee

July is Sarcoma awareness month. Sarcomas are uncommon group of cancers that originate from bone or connective tissue, such as nerves, muscles, tendon, cartilage, fat, cartilage, and blood vessels. They comprise less than 1% of all adult cancers, but 15-20% of pediatric cancers. Soft tissue sarcomas are more common than bone cancers; being diagnosed in 12,000 people and 3,000 people yearly in the U.S., respectively. About 5,120 people are expected to die of soft tissue sarcoma in 2020.

Celebrities who have died of sarcomas include Actors Robert Urich and Michelle Thomas, NASCAR driver Casey Elliott, Physicist Richard Feynman, YouTuber and internet personality Technoblade, Professional wrestlers Jake “The Snake” Roberts and Zack Ryder, Top Chef Fatima Ali, and Entrepreneur Leila Janah.

There are more than 50 types of soft tissue sarcomas and over 150 subtypes. Sarcomas arise on the legs, arms, chest, abdomen, and head or neck. Certain types of sarcoma have a propensity to arise in specific body areas. The most common types of sarcomas in adults are Undifferentiated pleomorphic sarcoma and liposarcoma, which are most common in legs; and leiomyosarcoma which are more common in the abdomen.

Risk factors for sarcoma include radiation exposure, exposure to certain chemicals like chlorophenols in wood preservatives, phenoxy herbacides, and vinyl choride used in manufacture of plastics, like PVC. There are also several familial syndromes that are associated with soft tissue sarcomas.

Signs and symptoms of soft tissue sarcomas are primarily a lump that grows over time, half the time in the arm or leg, but can be in the torso, head, or neck. They are usually painless but may cause pain depending on the origin of the tissue involved and its location. Sarcomas that grow in the back of the abdomen, retroperitoneum, which compromises 40% of sarcomas, cause other symptoms, including abdominal pain, rectal bleeding, vomiting blood, or constipation.

Diagnosis of sarcoma is usually done initially by imaging with CT or MRI. MRI can often better differentiate between benign and malignant soft tissue tumors. Ultimately, tissue is needed to make the diagnosis of sarcoma type. This is often done by image guided needle biopsy. Needle biopsy allows for tissue diagnosis without disrupting the tumor. The treatment can then be individualized based on sarcoma type, aggressiveness (grade), and location.

Surgery is the mainstay of treatment for sarcoma. For early, stage I, sarcomas, surgery alone is adequate if the tumor is removed with negative margins. Stage II and III sarcomas are best treated with multiple modalities, including surgery, radiation, and chemotherapy. Sometimes large tumors, or tumors in a place that makes surgery difficult, are treated with chemotherapy and radiation therapy before surgery. This is called neoadjuvant therapy. In rare cases, amputation may be necessary to remove the tumor. Stage IV sarcoma is a sarcoma that has spread to distant parts of the body and is generally considered incurable. Some patients may be cured if the main tumor and the areas that it spread to can all be removed by surgery. The best results are in those patients who have metastasis to the lungs. New targeted drug therapy is also available for some sarcomas. This therapy uses drugs that specifically and precisely attack cancer cells. This can be used alone or in combination with other modalities like surgery, radiation, and traditional chemotherapy.

If you have noticed a lump in your body, it is best to get this checked out by your physician, as early detected sarcomas have the best overall survivability.

Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.

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