Increasing Awareness of Sarcoma

Research carried out by Sarcoma UK found three in four people do not know what sarcoma is. That’s exactly why greater awareness is needed, says Rob Pollock, Orthopaedic Surgeon at The Princess Grace Hospital and Clinical Director of the Joint Reconstruction and Sarcoma Units at The Royal National Orthopaedic Hospital.

Sarcoma is a rare cancerous tumour of bone and soft tissues such as muscle, fat, blood vessels, connective tissues and nerves. Sarcomas mainly occur in arms and legs, though you can get sarcomas anywhere on the body. This includes the abdomen, trunk, spine, head and neck.

Sarcomas are extremely rare tumours and account for less than 1% of cancer deaths. Around 500 bone sarcoma and 2,000 soft tissue sarcoma cases diagnosed annually in the UK. Bone sarcoma is normally diagnosed in children and young adults, aged 10 to 30. Occasionally, there are cases of under 10s and over 30s but the vast majority occur in teenagers and young people. In contrast, soft tissue sarcomas can happen at any age.

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What to look out for

Soft tissue sarcomas usually appear as a lump under the skin of your arm or leg. The lump could be painful but that’s not always the case. Lumps are often small to start with but can grow quickly and the rule of thumb is if a lump is bigger than a golf ball, it’s highly suspicious of a sarcoma.
In children and young adults with bone sarcoma, pain in the hip or knee tends to be the most common symptom. The difference between sarcoma pain and other musculoskeletal pain is that sarcoma pain constant and often wakes people at night. If a child has pain in their bones that wakes them up, that is a worry and should be investigated.

Increased awareness of sarcoma is needed in both primary and secondary care, as sarcoma should not be difficult to diagnose. The right test for a suspected soft tissue sarcoma is an ultrasound and for a suspected bone tumour, an X-ray. Sarcoma should be considered when a patient presents with a soft tissue lump or has unexplained bone pain that wakes them at night. While this type of cancer is rare, it is important not to miss a sarcoma.

Early detection is very important before a soft tissue sarcoma begins to spread and involve major blood vessels or other structures. When sarcoma is treated at the earliest stage, the operation to remove the tumour is less complex and when a lump is small, we can sometimes avoid radiotherapy.

For bone sarcoma, early diagnosis helps us to identify small bone tumours and these are much easier to treat. We want to avoid the bones inside the tumour becoming weak as this can increase the risk of an arm or leg break, making surgery more difficult.

Genomics is helping to change the way we think about and treat sarcoma. By unravelling the DNA makeup of sarcomas, we can work out why some patients survive and others don’t and why only some people respond well to chemotherapy, radiotherapy and surgery. The future for sarcoma care is likely to be individualised treatment based on the genetic sub-type of these tumours and that’s where all research needs to go.

Novel treatment

Surgery for bone sarcomas involves removing a large section of bone and reconstructing the arm or leg with metal implants. Often that involves replacing a hip, knee or shoulder joint. At The Princess Grace Hospital, we have started using custom-made implants and this means we can sometimes save joints, where previously we were unable to. This leads to much better functional outcomes following surgery. This has become possible using computer 3D modelling of the tumour based on a patient’s pre-operative MRI and CT scans. We can then create custom-made cutting guides, which bolt onto the area of bone to be removed. This novel technique improves safety as the bone containing the tumour can be cut much more accurately, guaranteeing a clear margin and also save a joint that previously would have had to have been removed.

With the advent of 3D printing, we can make cutting guides quickly so there is no delay in patient care. We’re also hoping to develop robotic-arm assisted surgery within sarcoma treatment and that’s definitely going to be the next step. That is the future.

This article was first published on The Princess Grace Hospital’s LinkedIn account, July 2021

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