Sarcomas (Soft Tissue)

 

OVERVIEW

Soft tissue sarcomas are cancerous tumors that develop from fat, muscle, nerves, and fibrous connective tissues that surround joints, blood vessels, or deep skin tissues. Types of sarcomas include dermatofibrosarcoma, protuberans, and angiosarcoma (a blood vessel cancer). About 55 to 60 percent of soft tissue sarcomas occur in the legs or arms, 15 percent in the trunk, 15 percent in the retroperitoneum (back of the abdominal cavity), 8 to 10 percent in the internal organs, and a small percentage in the head and neck. These tumors tend to spread very quickly.

In 2007, the American Cancer Society estimates that 9,000 men and women in the United States will develop sarcomas.

At The Cancer Center, the orthopedic oncology team of the Division of Sarcoma and Skin Cancer is pioneering innovative techniques in sophisticated limb-sparing surgery and the use of heat energy in radiofrequency ablation and extreme cold in cryosurgery to provide patients with the most advanced orthopedic cancer care in North Jersey. Advancements in surgical techniques, new modalities, technology, orthopedic materials, chemotherapy, radiation, and imaging studies at The Cancer Center mean that 95 percent of patients with an orthopedic malignancy such as a soft tissue sarcoma do not need to lose a leg or arm to cancer.

Our chief of the Division of Sarcoma and Skin Cancer, James C. Wittig, M.D., is one of only a handful of orthopedic oncologists in the metropolitan New York-New Jersey area who is experienced in performing complicated limb-sparing surgeries and other orthopedic cancer techniques. During a two-year fellowship in orthopedic oncology at the Washington Cancer Institute in Washington, D.C., he trained in vascular surgery and plastic surgery as well as his specialty. He offers patients these additional skills and can perform an entire limb-sparing surgery himself.

If you are diagnosed with a soft tissue sarcoma, it is important to be treated in a major academic and research center such as Hackensack University Medical Center because there are specialists here that you will not find in community hospitals. These include not only Dr. Wittig, but also musculoskeletal radiologists, who make diagnoses and monitor treatment, and interventional radiologists, who perform minimally invasive percutaneous biopsies, which can be complex with soft tissue sarcomas.

Dr. Wittig and the orthopedic oncology team at The Cancer Center offer their patients the following advanced diagnostic and treatment methods:

  • limb-sparing surgery, during which Dr. Wittig removes the bone or portion of the bone containing the tumor and replaces it with a metal prosthesis;
  • radiofrequency ablation, during which Dr. Wittig places a probe into the tumor and destroys it with heat energy;
  • cryosurgery, during which Dr. Wittig pours liquid nitrogen into the surgical site to kill any remaining tumor cells;
  • pre-operative chemotherapy to kill soft tissue sarcomas prior to surgical removal, making the surgery less extensive and reducing the chance of recurrence;
  • external beam radiation therapy following surgery in some cases;
  • minimally invasive percutaneous biopsies performed by interventional radiologists, who extract the tissue needed for a diagnosis without cutting; and
  • epineural analgesia to provide post-operative pain relief directly to the surgical site.

 

DIAGNOSTIC SERVICES

To diagnose soft tissue sarcoma, your physician may use one or more approaches:

  • fine needle aspiration biopsy
  • core needle biopsy
  • excisional biopsy (removing the entire mass)
  • incisional biopsy (removing a small part of the tumor)
  • laboratory tests
  • ultrasound
  • CT scan
  • MRI
  • chest X-ray
  • PET scan

 

RISK FACTORS

Risk factors for soft tissue sarcomas include:

  • past exposure to ionizing radiation for the treatment of other tumors
  • a family history of certain inherited conditions, such as neurofibromatosis, Gardner syndrome, Li-Fraumeni syndrome, and retinoblastoma
  • a damaged lymph system because of disease or damage from radiation therapy

 

SYMPTOMS

Symptoms of soft tissue sarcomas include a new lump or a lump that is growing anywhere on the body, abdominal pain that is getting worse, or blood in the stool or vomit.

 

TREATMENT SERVICES

Surgery is the most common treatment for soft tissues sarcomas. Surgery may also be combined with chemotherapy, external beam radiation therapy, brachytherapy, cryosurgery, or radiofrequency ablation for optimal treatment.

Surgery

In the past, amputation of an arm or leg because of a soft tissue sarcoma was common. Today, at The Cancer Center, 95 percent of our patients with an orthopedic malignancy can be treated successfully and do not need to lose the limb. However, in about 5 percent of cases, amputation of the limb is necessary.

Our chief of the Division of Sarcoma and Skin Cancer, James C. Wittig, M.D., is one of only a handful of orthopedic oncologists in the metropolitan New York-New Jersey area who is experienced in performing complicated limb-sparing surgeries. During a two-year fellowship in orthopedic oncology at the Washington Cancer Institute in Washington, D.C., he trained in vascular surgery and plastic surgery as well as his specialty. He offers patients these additional skills and can perform an entire limb-sparing surgery himself. Dr. Wittig is also skilled in delivering epineural analgesia directly to the surgical site to provide post-operative pain relief.

Radiofrequency Ablation

Radiofrequency ablation is a minimally invasive procedure that involves placing a probe into a tumor and destroying it with heat energy.

Cryosurgery

Cryosurgery may be used in combination with surgery to kill any remaining tumor cells with extremely cold temperatures. Cryosurgery involves pouring liquid nitrogen into the surgical site.

Chemotherapy

Our chief of the Division of Sarcoma and Skin Cancer, James C. Wittig, M.D., is investigating the use of pre-operative chemotherapy to kill soft tissue sarcomas prior to surgical removal. This makes the surgery less extensive and reduces the chance of recurrence of the cancer. Chemotherapy may also be given as a primary treatment if the cancer has metastasized and cannot be cured. Chemotherapy for soft tissue sarcomas usually involves a combination of drugs.

Radiation Therapy

External beam radiation therapy may be used before surgery to shrink the tumor or after surgery alone or combined with brachytherapy (using rice-like "seeds" of radiation) to kill any remaining cancerous cells. Radiation therapy is also useful to palliate symptoms if the cancer has metastasized and cannot be cured.