Treatment for soft tissue sarcoma

Because soft tissue sarcomas are a rare group of cancers, it’s important to be referred to a specialist sarcoma unit or treated by a specialist sarcoma multidisciplinary team (MDT). The MDT usually includes a:

• surgeon
• radiologist (who interprets scans)
• radiation oncologist (for radiation therapy)
• medical oncologist (for drug therapies, such as chemotherapy)
• pathologist or histopathologist (examines tissue under a microscope to make a diagnosis)
• genetic specialist (checks for inherited risk factors), and
• cancer nurse.

Other health professionals may be a part of the MDT. You may also receive care from a dietitian, social worker, psychologist or counsellor, physiotherapist and occupational therapist. The treatment recommended for you will depend on:

• your test results
• the type of sarcoma
• where the cancer is
• whether it has spread, and
• your age and general health.

The main treatments for sarcoma include surgery, radiation therapy and chemotherapy. Targeted therapy and immunotherapy are sometimes used to treat sarcoma. You may have one treatment or a combination of treatments.

Surgery

Surgery is the main treatment for most soft tissue sarcomas. The operation you have will depend on:

• the sarcoma type
• where it is in the body
• the size, and
• whether it has spread.

Many sarcomas are in the arm or leg. Limb-sparing surgery is used to remove the tumour in one piece, along with some surrounding healthy tissue. Having part or all of an arm or leg removed (called an amputation) is only done if there are no other options.

For large sarcomas, a skin graft or skin flap will be used to cover the area where the tumour was removed. If the sarcoma is in the chest or abdomen, you may have open surgery (uses a larger cut) or keyhole surgery (which uses several smaller cuts).

Your surgeon will explain the type of surgery needed and any risks. Check that your operation will be done by an experienced surgeon at a specialist sarcoma unit.

How long it takes to recover depends on the type of surgery and your general health, but most people stay in hospital for a few days. You’ll be given medicine to control any pain.

Radiation therapy

This treatment uses a controlled dose of radiation to kill or damage cancer cells. The radiation is usually in the form of x-ray beams.

Radiation therapy can be given before or after surgery to treat the sarcoma and surrounding area and reduce the risk of the cancer coming back. Radiation therapy may also be used:

• if surgery isn’t possible because the sarcoma is in a hard-to-reach area
• on its own or at the same time as chemotherapy (called chemoradiation) 
• in rare cases, internally (called brachytherapy) by placing the radioactive material near the tumour
• to kill any remaining cancer cells after treatment.

Radiation therapy needs to be carefully planned during your first appointment with a radiation oncologist. You’ll have a CT scan to map the area and help work out the radiation treatment plan. A radiation therapist will then deliver the radiation therapy.

The number of treatments and how long you have radiation varies from person to person. The treatment is done at a hospital or treatment centre on weekdays. Radiation therapy doesn’t hurt and you can go home afterwards.

Radiation therapy often causes general side effects (e.g. fatigue, nausea), as well as side effects specific to the area being treated (e.g. sore skin on the arm). These side effects may not always happen straightaway.

Many people feel very tired after radiation therapy, while others are able to continue working or doing their usual activities.

Chemotherapy

Chemotherapy (also called “chemo”) uses drugs to kill or slow the growth of cancer cells.

It may be used before surgery to help shrink the sarcoma and make it easier to remove. It’s also commonly used after surgery or other treatments to reduce the risk of sarcoma spreading or coming back.

The chemotherapy drugs used will depend on your general health and the type of sarcoma you have. You may have one drug or a combination of drugs.

Chemotherapy is usually given through a drip into a vein (intravenously). This may take a few hours during a day visit to the hospital or treatment centre.

Occasionally you may need to stay in hospital for a few days while having chemotherapy. It may sometimes be given as tablets you take at home. Treatment is given in cycles. For example, you may have one dose of chemotherapy every three weeks, over six months.

How often, and for how long you have treatment will depend on the type of chemotherapy drugs used and your health.

Targeted therapy

Targeted therapy is a drug treatment that targets specific features of cancer cells to stop the cancer growing and spreading. Drugs are given as tablets or intravenously. They travel through the body like chemotherapy, but they work in a more focused way.

Targeted therapy may help slow the growth of some sarcomas. It’s mostly used for rare types of sarcoma, or when sarcoma is advanced, has spread or has come back.

Your doctor may suggest you have genomic tests to look for specific changes in the cancer cells. This helps to show whether targeted therapy is likely to work for you.

Immunotherapy

Immunotherapy is a treatment that uses your body’s own immune system to fight cancer. It’s only used for some types of sarcoma and usually as part of a clinical trial. Your doctor will tell you if immunotherapy is suitable or available for you.

There are different types of immunotherapy. Checkpoint inhibitors help the immune system to recognise and attack cancer cells. Other types of immunotherapy stimulate the immune system to help it work better against cancer.

Your doctor will explain whether immunotherapy is recommended for you.

Side effects of treatment

The side effects you have will depend on the type of treatment, the medicines used, the dose and how long your treatment lasts.

For example, different chemotherapy drugs may cause different side effects and people can react to the same treatment in different ways. Some people have very few side effects, while others have more.

Most side effects are temporary, but some can be permanent. Some don’t start until months or years after treatment ends. These are called late effects. Before you start treatment, ask your treatment team about what side effects to expect.

There are common side effects and others that are less common. Some cancer treatments may affect your ability to have children (fertility). Ask your doctor if your cancer treatments could affect your fertility now or in the future.

Follow-up appointments

You’ll have regular appointments for at least five years to check that the sarcoma hasn’t come back. These appointments may include scans (such as MRI, CT and/or PET) and physical examinations. At first, it’s common to have scans of the affected area regularly.

You may also have a chest CT or x-ray, as the lungs are the most common place for sarcoma to spread to. Tell your doctor if you notice a lump, swelling or any health problems between appointments.

Some cancer centres give you a survivorship care plan. This outlines:

• times for appointments and follow-up tests
• symptoms and long-term side effects to look out for
• support for medical or emotional problems, and
• tips for staying healthy.

If you don’t have a survivorship care plan, ask your specialist for a written summary of your cancer treatment, and give a copy to your GP and other doctors. Learn more about living well after cancer.

If the cancer comes back

Questions to ask your doctor