Musculoskeletal Oncology
A sarcoma is a type of cancer that starts in tissues like bone, fat or muscles. Bone sarcomas arise from bones in our body while soft tissue sarcomas develop in soft tissues like fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. They can be found in any part of the body. About half of the sarcomas start in the arm or leg. Some sarcomas may grow from the flanks and retroperitoneum.
In rare cases, sarcomas may start in the chest or in the head and neck region. There are many types of soft tissue tumors, but all of them are not cancerous. Benign tumors may be found in soft tissues or bones at all ages, but these tumors do not spread to other parts of the body.
Sarcomas are not very common tumors. The most common clinical presentation is with new lump or a lump that’s growing in size anywhere in the body, sometimes associated with pain. Retroperitoneal sarcomas have vague symptoms such as abdominal pain or swelling and sometimes pressure effects on adjacent nerves, vessels, and other organs.
Signs and Symptoms
Sarcomas that most often start in bones include osteosarcomas in adolescents, Ewing’s sarcomas in young children and chondrosarcomas in adults. The most common site of origin are bones of the lower limb around the knee joint and upper arm. The diagnosis of bone sarcoma is confirmed with a bone biopsy and MRI to assess the local extent of the tumor. Most patients need a multimodality approach with the correct sequence of surgery, chemotherapy, and radiotherapy.
Currently, most bone sarcomas can undergo surgical resection with limb salvage surgery i.e. no need for amputation of the limb. This procedure involves resection of the part of the bone with a tumor with a replacement of the resected bone with a modular prosthesis. Replacement with prosthesis allows preservation of the limb with normal mobility at the affected joint. Chondrosarcomas are the most common bone tumors in adults. These tumors do not respond to chemotherapy and radiotherapy and need radical surgical resection as the main treatment.
Treatment
Surgery remains the main treatment for soft tissue sarcomas, i.e. wide excision of the tumor with a surrounding cuff of normal tissues, followed by chemotherapy and radiotherapy in selected cases depending on a tumor, size, grade, and biology. Radiation therapy may be delivered by IMRT /IGRT or by interstitial brachytherapy.
Interstitial Brachytherapy, high dose radiotherapy is delivered at the tumor bed locally during the immediate postoperative period. The main advantage is minimal side effects and shorter treatment time.
Dr Ashish Goel -Musculoskeletal Oncologist & Bone Tumor Specialist in Noida Delhi NCR
Dr. Ashish Goel is one of the best musculoskeletal surgeons in Noida, Delhi – India. His expertise includes surgery for bone cancer, soft tissue cancer, skin cancer and Limb Salvage Surgery.