Sarcoma Awareness Month highlights the critical need to recognize and address sarcomas, a rare group of cancers affecting connective tissues, which are often diagnosed late due to their non-specific symptoms mimicking common ailments like sports injuries or benign lumps. With over 70 subtypes, sarcomas can develop anywhere in the body, posing diagnostic and treatment challenges, as exemplified by 16-year-old Atif Shaikh's delayed diagnosis of Ewing sarcoma, which required extensive treatment including chemotherapy and managing a relapse. Experts stress that persistent, growing, or deep lumps, along with unexplained bone pain, especially at night, warrant prompt medical evaluation and referral to specialized multidisciplinary centers for tailored treatment involving surgery, chemotherapy, radiation, and supportive care, emphasizing that early diagnosis and specialized care significantly improve outcomes, while the absence of population-based screening makes public awareness and physician suspicion paramount.

Sarcoma Awareness Month highlights the critical need to recognize and address sarcomas, a rare group of cancers affecting connective tissues, which are often diagnosed late due to their non-specific symptoms mimicking common ailments like sports injuries or benign lumps. With over 70 subtypes, sarcomas can develop anywhere in the body, posing diagnostic and treatment challenges, as exemplified by 16-year-old Atif Shaikh's delayed diagnosis of Ewing sarcoma, which required extensive treatment including chemotherapy and managing a relapse. Experts stress that persistent, growing, or deep lumps, along with unexplained bone pain, especially at night, warrant prompt medical evaluation and referral to specialized multidisciplinary centers for tailored treatment involving surgery, chemotherapy, radiation, and supportive care, emphasizing that early diagnosis and specialized care significantly improve outcomes, while the absence of population-based screening makes public awareness and physician suspicion paramount.

Sarcoma Awareness Month highlights the critical need to recognize and address sarcomas, a rare group of cancers affecting connective tissues, which are often diagnosed late due to their non-specific symptoms mimicking common ailments like sports injuries or benign lumps. With over 70 subtypes, sarcomas can develop anywhere in the body, posing diagnostic and treatment challenges, as exemplified by 16-year-old Atif Shaikh's delayed diagnosis of Ewing sarcoma, which required extensive treatment including chemotherapy and managing a relapse. Experts stress that persistent, growing, or deep lumps, along with unexplained bone pain, especially at night, warrant prompt medical evaluation and referral to specialized multidisciplinary centers for tailored treatment involving surgery, chemotherapy, radiation, and supportive care, emphasizing that early diagnosis and specialized care significantly improve outcomes, while the absence of population-based screening makes public awareness and physician suspicion paramount.

A painless lump that refuses to go away. Persistent bone pain dismissed as a sports injury. A swelling that gradually grows over months. These seemingly innocuous symptoms could, in rare cases, point to sarcoma—a group of cancers that arise from the body's connective tissues and are often diagnosed late because of their rarity and non-specific presentation.

Observed every July, Sarcoma Awareness Month seeks to raise awareness about a cancer that accounts for less than one per cent of all adult cancers but poses significant diagnostic and treatment challenges. Experts say that while sarcomas are uncommon, timely recognition and referral to specialised centres can dramatically improve outcomes.

Sarcomas are cancers that develop in connective tissues such as bone, muscle, fat, cartilage, blood vessels, nerves and tendons. They are broadly classified into soft tissue sarcomas and bone sarcomas, with more than 70 recognised subtypes, each behaving differently and requiring tailored treatment.

Unlike many common cancers that affect a specific organ, sarcomas can develop almost anywhere in the body. Certain types, such as osteosarcoma and Ewing sarcoma, are more common in children and adolescents, while others are predominantly seen in adults.

Take the case of 16-year-old Atif Shaikh from Mumbai, an avid cricket enthusiast who first noticed a persistent pain in his right thigh in 2023. Like many teenagers, he and his family assumed it was a sports injury. Painkillers offered temporary relief, but the pain worsened, swelling developed, and walking became increasingly difficult. An MRI and biopsy eventually revealed Ewing sarcoma, a rare and aggressive bone cancer that primarily affects children and adolescents. By then, his life had been turned upside down.

Over the past three years, Shaikh has undergone intensive chemotherapy, repeated hospitalisations and treatment for a relapse after the cancer spread to his lungs. 

One of the biggest challenges with sarcoma is that its symptoms often mimic far more common conditions.

A soft tissue sarcoma may initially appear as a painless lump, leading patients to ignore it or mistake it for a benign fatty tumour. Bone sarcomas may present with persistent pain, swelling or even fractures after minor trauma, symptoms that are often attributed to sports injuries, arthritis or growing pains in children.

Because most primary care physicians encounter very few sarcoma cases during their careers, diagnosis can sometimes be delayed until the tumour has grown significantly or spread to other parts of the body.

Doctors advise that certain symptoms should never be ignored, including a lump larger than 5 cm roughly the size of a golf ball, a lump that continues to grow, a deep-seated lump beneath the muscle, persistent or worsening bone pain, particularly at night, swelling that does not resolve, recurrent fractures following minor injuries, experts caution against removing suspicious lumps without proper imaging and biopsy, as incorrect initial surgery can complicate future treatment. 

Dr Sangeeta Mudaliar, Head, Department of Haematology-Oncology, Bai Jerbai Wadia Hospital for Children, explains Ewing sarcoma. "One of the biggest challenges with Ewing sarcoma is that its early symptoms often resemble common sports injuries or growing pains. Persistent bone pain, especially when it worsens at night, is associated with swelling or does not improve with routine treatment, and should never be ignored. Early diagnosis allows us to begin treatment before the disease spreads, significantly improving the chances of a cure."

She further explains that treating sarcoma goes beyond chemotherapy or surgery. "Children and adolescents are at a crucial stage of their education and emotional development. Helping them continue their schooling, preserving their mental well-being and involving the family in care are equally important components of treatment."

Given the rarity and complexity of sarcomas, treatment is best delivered at centres with dedicated multidisciplinary teams.

Management typically involves surgical oncologists, orthopaedic oncologists, medical oncologists, radiation oncologists, pathologists and radiologists working together to develop an individualised treatment plan.

Surgery remains the cornerstone of treatment for most localised sarcomas, while chemotherapy, radiation therapy, targeted therapies and, in select cases, immunotherapy may also be used depending on the subtype and stage of disease.

For many patients, surviving sarcoma is only part of the journey. Depending on the location of the tumour, treatment may involve complex reconstructive surgeries, limb-sparing procedures, rehabilitation and long-term follow-up to monitor for recurrence.

Unlike breast, cervical or colorectal cancers, there are currently no population-based screening programmes for sarcoma. Early diagnosis, therefore, depends largely on public awareness and a high index of suspicion among healthcare providers, say doctors.

As Sarcoma Awareness Month is observed around the world, oncologists emphasise a simple but potentially life-saving message, that while most lumps are harmless, any persistent, enlarging or unexplained lump deserves prompt medical evaluation.

Meanwhile, Shaikh refused to let the disease derail his education. He attended online classes, watched YouTube lectures from his hospital bed, revised with intravenous lines attached to his arms, and even appeared for examinations in a wheelchair. This year, while still undergoing treatment at Bai Jerbai Wadia Hospital for Children, Atif scored an impressive 92 per cent in his SSC examinations.

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