Sarcoma is a type of cancer that arises from connective tissue. Connective tissue includes bone, fat, muscle, cartilage, and all the stuff that connects or holds organs together. It is everywhere, and hence sarcoma is a tumour that can arise just about anywhere. It can arise in the thigh, in the abdomen behind all the organs and even in the uterus or breast.
Sarcomas usually represent <1 % of cancers in adults and an alarming 15 % of childhood cancers. There are more than 100 different subtypes, but Sarcomas are broadly divided into two major groups. Cancers that arise from the bone, and cancers that arise from other tissues like muscles, nerves, blood vessels, etc.
It usually presents as a painless lump that gradually grows in size. Sarcomas in the thigh and abdomen grow considerably before they get noticed or start causing symptoms. In the abdomen, it usually causes symptoms because of occupying space and pressing on the surrounding organs. It can rarely cause pain.
A lump that has developed recently, a lump that is larger than 5 cm, or one that is increasing in size should be evaluated by a specialist. It is always ideal for patients to get evaluated at a cancer centre.
As an oncosurgeon, I like to do the biopsy of the tumour myself, so as to plan the surgical incision accordingly. Surgery is the cornerstone of treatment for sarcoma. In the case of abdominal (retroperitoneal) sarcomas, the surgery might include the removal of certain organs, such as the kidney, spleen, etc., for complete removal of the tumour. Multi-organ resections are challenging and ideally should be done in higher centres with specialists.
Molecular diagnostics and targeted therapy are paving new pathways of treatment. Perhaps the most encouraging development in the treatment of sarcomas is the evolution of limb-sparing surgeries. About twenty years ago, most bone cancers were treated with amputation of limbs. While this was an effective cure of the cancer, it left patients, many of them children, to face a life of disability. With the advent of limb-sparing surgeries and newer forms of prosthesis, we are able to perform excellent reconstructions and minimise the disability. It is endearing to see our young sarcoma survivors go ahead and become cyclists and football players.
As a society, we need to be more supportive of patients and survivors. Treatment for sarcomas might not end with surgery; many patients do require radiotherapy and sometimes even chemotherapy. All of them need follow-up for many years. Survivors often have to undergo rehabilitation and require a lot of motivation and psychological support. Sensitising people and making schools, parks and other public areas more accessible will be paramount to maintain inclusivity.
At the end of the day, sarcomas are a rare cancer that cannot be ignored. To the many people who ask me, “ Doctor, is every lump cancerous?” I say. “Perhaps not. But any lump that has developed recently, or is growing in size, is definitely something that needs our attention”. Health practitioners should refer patients to expert centres for the best outcomes.
July is Sarcoma Awareness Month. Awareness can dramatically alter the outcome. Timely consultation makes all the difference.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
