Sarcomas are a diverse group of cancers that can be found in the bones as well as soft tissue. Our clinic sees primarily soft tissue sarcomas, which can be found in various soft tissues in the body including fat, muscle, blood vessels, and lymphatics. While soft tissue sarcomas can develop anywhere in the body, more than half develop as a painless mass in the limbs or trunk. In 2016, just over 1000 Canadians were diagnosed with soft tissue sarcoma.
Diagnosis of a soft tissue sarcoma can sometimes be difficult as these are very rare tumors. Generally, MRIs are used in the workup of a soft tissue mass on the extremity, and CTs are used in the workup of a soft tissue mass in the trunk. From there, biopsy is required for definitive diagnosis, the preferred method being a core needle biopsy.
Due to the various tissues that can be affected by sarcomas and the wide distribution of tumor locations in the body, treatment must often be individualized. Regardless, surgical resection is often essential in sarcoma management, with the aim of total en bloc excision of the tumor with a wide enough margin. If the tumor is small, low-grade, and localized, primary surgical resection alone can be considered. However, high-grade soft tissue sarcomas that are larger than 2 inches are often treated with a combination of surgery and radiotherapy.
There are various surgical options for soft tissue sarcomas. Wide local excision consists of surgical removal of the tumor with a large enough margin of healthy tissue around the tumor to make sure that all of the cancer cells are resected. Limb-sparing surgeries remove the tumor from an arm or leg without removing the entire limb and preserving nearby vessels and nerves. Reconstructive surgeries consist of tumor removal requiring tissue from another part of the body to be used as muscle flaps and skin grafts to “reconstruct” normal anatomy. Amputation removes the entire limb, including nearby vessels, muscles, and nerves.
Like many other cancers, sarcomas usually require multimodal therapy, not only surgery. Evaluation and management of soft tissue sarcomas should ideally be carried out in a specialized center with expertise in sarcomas. BC Cancer is one such centre, and our surgical oncologists have extensive training in the management of sarcomas and work closely with other cancer specialists for an multimodal approach to sarcoma treatment.