Soft-tissue sarcoma

Soft-tissue sarcomas arise in tissues such as fat, muscles, nerves, tendons, and blood and lymph    vessels – the soft tissues that connect, support, and surround other parts of the body.

Sarcomas are rare tumours which can occur anywhere in the body.

There are more than 50 different types of soft-tissue sarcomas, each with a different behaviour, management and outcome. Patients are best treated in a specialist hospital by a team of experts with a dedicated interest and experience in the management of all types of soft-tissue sarcomas.

Groote Schuur Hospital offers a full range of soft-tissue sarcoma diagnosis, treatment and care services for patients: 

Cancer genetics  

Surgery  

Chemotherapy  

Radiotherapy  

Critical care  

Rehabilitation  

Palliative and supportive care

 

Diagnosis and assessment

 

Most lumps and bumps will not be cancer. A lump is more likely to be a sarcoma if it is increasing in size or if it is big – more than 5 cm across. Lumps that are deep in the body tissues are also more likely to be sarcoma. Pain is uncommon in sarcoma unless it is advanced or in a site close to a nerve or bone.

We are happy for patients to be referred to Groote Schuur on the suspicion that a lump may be a sarcoma. We will arrange appropriate scans and perform tissue biopsy when ever possible at your first appointment.

A diagnosis is established through a combination of clinical assessment, needle biopsy and specialised radiological scans.

Biopsy 

The most important part of the diagnosis is a biopsy of the tumour. This is mainly performed under local anaesthetic in the clinic, and every biopsy and histological diagnosis is examined and reviewed by a specialist sarcoma pathologist. Histopathologists with a sarcoma interest working at Groote Schuur will fast track your histology results.

Scans 

Radiological investigations of the tumour and systemic staging are performed and reported by specialist soft-tissue sarcoma radiologists. These state-of-the-art scans may include ultrasound, CT scans, MRI scans, bone scans and PET scans.

 

Treatment 

Surgery 

Surgery often plays an important part of treatment of soft-tissue sarcomas. The main goal of surgery is to remove the whole tumour with a margin of healthy tissue while preserving good function in the part of the body where the tumour developed.

Surgery is performed at Groote Schuur, where surgeons, anaesthetists, nursing staff and postoperative care are dedicated to the management of soft-tissue sarcoma patients. In sarcoma surgery, the first operation is often the best opportunity to achieve cure.

Limb soft tissue sarcomas 

Sarcomas are unusual in that they can occur in any site of the human body, although about 50 percent occur in the limbs. Surgery remains the primary treatment for most soft tissue sarcomas. It is very specialised treatment taking into account factors such as an accurate diagnosis and staging, tumour subtype and grade, treatment side-effects, complete tumour resection and limb-function preservation.

The majority of limb sarcomas when greater than five centimetres in size or high grade are managed by a combination of surgery and radiation therapy. Radiation therapy may be used before or after surgery.

Retroperitoneal sarcomas 

Retroperitoneal sarcomas occur in the retroperitoneum. This is an area behind the peritoneum, the lining of the abdominal space that covers the abdominal organs. The retroperitoneum is deep in the abdomen and pelvis, behind the abdominal lining, where organs such as the major blood vessels, kidneys, pancreas and bladder are located.

 

Radiotherapy 

The decision whether to use radiotherapy is made on a patient-by-patient basis. There are more than 50 different types of soft tissue sarcomas which respond to radiotherapy in different ways so each patient requires an individualised treatment plan.

Radiotherapy may not be suitable for all types of soft tissue sarcomas. The doctor responsible for a patient’s radiotherapy treatment is called a radiation oncologist. The treatment is planned by a team of planning radiographers and physicists.

Radiotherapy is usually given during outpatient visits. Before starting radiotherapy you will usually need to attend the hospital for treatment planning.

Radiotherapy is delivered by a machine that directs the high-energy radiation, usually X-rays, at the cancer site whilst keeping the volume of surrounding normal tissue irradiated to a minimum. Treatment takes several minutes and is painless and delivered daily for up to six and a half weeks.

 

Rehabilitation and follow-up care 

Physiotherapy and rehabilitation, when needed, are provided by dedicated personnel.

Once the surgical treatment has finished, patients are seen and followed up in a joint surgical and oncology sarcoma clinic. Consultation regarding the need for additional treatment in the form of radiotherapy or chemotherapy is made at the first postoperative visit.

Once treatment has finished, continued follow-up care is provided at Groote Schuur for up to ten years after diagnosis. These will include clinical examinations and scans to monitor for a recurrence or spread of the cancer.