Treatment for soft tissue cancer

Tuesday 30 November, 2010

Reviewed: Annie Angle, cancer nurse (Dip. Oncology Nursing, Royal Marsden, London)

On this page: Surgery ι Radiotherapy ι Chemotherapy ι Side effects ι Making decisions ι Questions for your doctor 

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Your doctor will help you decide on the best treatment for your sarcoma depending on:

• the type of sarcoma you have
• where the sarcoma is in your body
• whether or not the cancer has spread (its stage)
• your age, fitness and general health
• what you want.

Treatment may include surgery, chemotherapy and radiotherapy. They can be given alone or in combination.

Surgery

Surgery is the main treatment for most types of soft tissue sarcoma. This usually means removing the cancer as well as some healthy tissue around the sarcoma.

Doctors call this a wide local excision. The healthy tissue is taken away to help decrease the risk of the cancer coming back in that area.

The type of operation you have will depend on where the sarcoma is. Most sarcomas are in the arm or leg, which usually means having limb sparing surgery, or, less commonly, amputation. But sarcoma can develop in other parts of the body, for example the chest or abdomen. Surgery to these areas will depend on the exact position and size of the cancer. Your surgeon will discuss with you the type of
operation you may need.

The most important thing is that you have your surgery done by an experienced surgeon working in a specialist centre for sarcoma.
Plastic surgeons are sometimes asked to work with surgeons to help restore parts of the body affected by surgery. This would be
part of your main operation. The type of surgery you have will depend on the location of the sarcoma and how much tissue needs to be removed.

Before you make any decision about treatment, your surgeon will discuss all your options in detail.

Surgery for sarcoma that has spread to the lungs

Sometimes sarcoma spreads into the lungs. Unlike some other types of cancer, sarcoma lung cancers can sometimes be taken out
using surgery. This depends on the size and number of cancers. You will see a specialist lung surgeon for an opinion. Alternatively, or
as well as surgery, you may have chemotherapy to help stop the cancer coming back.

Limb sparing surgery

This means taking out the cancer as well as a margin of healthy tissue while still keeping your limb. If necessary, bones may be rebuilt using a metal implant (prosthesis) or a bone graft. A graft means taking a piece of healthy bone from somewhere else in your body or from a ‘bone bank'. Any other gaps in the tissue are usually reconstructed using plastic surgery.

After this type of surgery a physiotherapist will work with you to plan an exercise program that will help you gain strength and function back in your limb. There will be some changes in the way the limb looks, feels or functions after limb sparing surgery.

The aim is for your limb to return to as normal a state as possible. This complex surgery needs to be done by a surgeon with a lot of experience in treating sarcoma. This may mean that you have to travel to a treatment centre that has a team of experts. Surgery done well may decrease the risk of the cancer cells spreading to nearby areas or other parts of the body.

Amputation

Sometimes it's not possible to remove all of the cancer without badly affecting the arm or leg. The doctor may advise that the only effective treatment will be to remove the limb (amputation).

Amputation can be very distressing emotionally and physically. Most people will need a lot of support at this time. It could have a huge affect on you and the people who share your life.

After surgery you'll have a carefully planned rehabilitation program. This will include seeing a specialist who makes false (prosthetic) limbs. A physiotherapist will work with you to help you become as independent and mobile as possible.

Other types of support are also useful. You may find it helps to speak with a social worker or counsellor or even someone else who has had the same operation. They may be able to offer advice on ways to cope and what to expect.

Radiotherapy

Radiotherapy uses high-energy rays to destroy the cancer cells. Sarcoma is known to be very sensitive to radiotherapy. It may be used for several reasons, including:

• if the cancer is too big to remove with surgery
• if the cancer has spread to other parts of the body
• after surgery, to destroy any remaining cancer cells and stop the cancer coming back
• if the cancer is in a place in the body that is too difficult to get to using surgery
• before surgery, to destroy the cancer cells and create a ‘rind' around the cancer, which helps the surgeon to perform good surgery.

Radiotherapy can shrink the cancer down to a smaller size. This may help to make surgery easier and safer. Sometimes chemotherapy is given as well as radiotherapy to help make the treatment more effective. This depends on the type of sarcoma.

Radiotherapy is usually given in small doses over a period of time to minimise side effects. For example, you may have a single dose 5 days a week for 5 or 6 weeks. Each dose only takes a couple of minutes, but some preparation time is needed as you have to be treated in the same position each time. Treatment given after surgery will usually begin within 6 weeks after your surgery.

A course of radiotherapy needs to be carefully planned. During your first visit you will need to lie under a large machine called a simulator. Your specialist will use this machine to calculate the correct dose and exact angles on your body for the radiation to target. This process ensures that the cancer receives the highest doses of radiation and the healthy tissue around it gets as little as possible.

Radiotherapy doesn't hurt, but you need to lie very still during the treatment. You can have radiotherapy as an outpatient. Some people are able to continue working throughout their treatment while others become tired. Some people may have a skin reaction. Your treating team will discuss possible side effects with you before you start your treatment.

See our radiotherapy section for more details.

Chemotherapy

Chemotherapy drugs are given to destroy cancer cells. Chemotherapy is most commonly given to treat Ewing sarcoma and sarcoma in
children.

Sometimes it's given to help control symptoms or slow down the growth of sarcoma that has spread. This is known as palliative chemotherapy. It may also be given to help stop a sarcoma coming back after surgery. Your doctor will discuss your options with you. You may also be asked whether you would like to join a clinical trial.

Your treatment will depend on your situation and the type of chemotherapy you have. Your doctor will discuss these with you
before you begin treatment.

Chemotherapy is given as a course of several treatment cycles. You may have one or a combination of drugs. For example, one cycle commonly lasts three weeks. Depending on the drugs you're having, you'll have them over a few hours or days. You'll then have a rest for three weeks before starting another cycle. You may have between three and five cycles before surgery and then more after your
surgery.

The doctor may recommend a ‘central line' (portacath, Hickman line) in your chest or ‘PICC line' in your arm. These are put in under local or general anaesthetic and stay in throughout your treatment. Their main advantage is that the chemotherapy can be given safely through the line: you don't have to have lots of needles. You can also have your blood taken from this line without having a needle.

If you have a central line, you will need to take good care of it. It needs flushing and cleaning regularly to prevent any infection or blockage. A nurse will teach you before you go home or you may have a district nurse to help you take care of it. The line is taken out when treatment is finished.

See our chemotherapy section for more details.

Side effects of treatment

All treatments can have side effects. Many are short term and will disappear once the treatment's over. For example, chemotherapy can cause a drop in your blood cell counts, putting you more at risk of infection, anaemia and bleeding problems. These usually return to normal once your treatment is over.

Some side effects are long term. This may mean a change in the way a part of your body looks, feels or functions. The type of side effects that you may have will depend on the type of treatment and where in your body the cancer is. Some people have very few side effects and
others have more. Your medical team will discuss all possible side effects (long and short term) before your treatment begins.

Making decisions about treatment

It can be difficult to know which treatment's best for you. It's very important that you speak with a sarcoma specialist team before making your decision. Ask them to give you a clear plan of your treatment options including information about long and short-term side effects.

Some people prefer to seek several opinions before feeling confident to go ahead with the treatment.

You may have to attend many appointments. It often helps to take someone with you. They will be able to listen, ask questions and remember what the doctor says. You can discuss your treatment options later. It may also help to take a list of questions.

It's common for people with cancer to seek out complementary and alternative treatments. Many people feel that it gives
them a greater sense of control over their illness, that it's ‘natural' and low-risk, or that they just want to try everything that seems
promising. See our complementary and alternative therapies section for more.

Questions for your doctor

If you have a soft tissue sarcoma there are many questions that you'll need to ask your specialist. Getting the answers will help you make the best decision about which treatment to choose. Here are a few suggestions.

• How will I know if I have a soft tissue sarcoma?
• What has caused my soft tissue sarcoma?
• Is my family more at risk of soft tissue sarcoma?
• If I need to have a biopsy, will I have it at a specialist centre?
• If I need to have treatment, where is the best centre for this type of cancer?
• Is it possible to have surgery to try to cure my soft tissue sarcoma?
• If I can have surgery, which type will I need and why?
• What are the risks and long-term side effects of each type of surgery?
• What type of rehabilitation will I need after my surgery?
• How long will recovery take?
• Will I need to have any other type of treatment, such as radiotherapy or chemotherapy?
• How effective is radiotherapy and chemotherapy for my type of sarcoma?
• If my cancer has spread outside the area it began, what treatment options are there for me?

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