VOL: 102, ISSUE: 18, PAGE NO: 21
WHAT IS IT?
WHAT IS IT?
- Sarcomas are a rare kind of malignant tumour. There are two types: soft tissue sarcomas and non-soft tissue sarcomas.
- Soft tissue sarcomas develop in the soft tissues of the body such as fat, muscles, nerves, tendons, and blood and lymph vessels. There are many different kinds of soft tissue sarcoma but they are categorised together because they share characteristics, symptoms and treatment.
- Non-soft tissue sarcomas develop in the bones or cartilage.
- The causes of sarcomas are mostly unknown.
- Most are not thought to have a genetic component but some rare genetic conditions can predispose people to develop them, including neurofibromatosis and Gardner’s syndrome.
- Bone sarcomas are more common in young adults as they develop in growing bone tissue.
- Soft tissue sarcomas can develop in areas of the body treated with radiotherapy. In these cases the sarcoma may not develop until 10 years after the initial treatment.
- Exposure to chemicals such as vinyl chloride, some herbicides and dioxins may be linked to the development of some sarcomas.
- Soft tissue sarcomas can develop in any part of the body. In the limbs the first symptom will be a painless lump. In the trunk symptoms depend on the organs affected. For example, a sarcoma in the gastrointestinal tract could result in bloody stools or constipation, whereas a sarcoma in the lung could result in a persistent cough. As the tumour grows it will cause pain when it comes into contact with nerve and muscle tissue.
- Symptoms of bone sarcomas include:
- Pain in the bone;
- Swelling at the site of the pain;
- Fractures through normal movement.
- The area affected by a soft tissue sarcoma will be identified from the pain. Then an X-ray, ultrasound, CT or MRI scan can be used to locate it more accurately.
- A biopsy follows. There are two types:
- Core needle biopsy. A needle is directed into the tumour and a sample taken;
- Open biopsy. This is performed if a core needle biopsy is impossible. The tumour is surgically exposed and a sample taken. If the tumour is small enough it may be removed.
- A number of tests can be used to diagnose bone sarcomas:
- CT scan of bone tissue;
- CT scan of the chest to look for metastases in the lungs;
- Blood tests.
- Treatment of soft tissue sarcomas partly depends on where the tumour is in the body and how large it is:
- Surgery to remove the tumour if it is small enough;
- Radiotherapy can reduce the tumour before surgery;
- Chemotherapy can also reduce the tumour before surgery or destroy metastasising cells;
- Imatinib can be used in gastrointestinal stromal tumours as an adjunct to surgery.
- Treatment for bone sarcomas involves surgery, radiotherapy or chemotherapy, depending upon the size and location of the tumour and whether or not it has metastasised.
- NICE has just issued guidance on improving health services for patients with sarcomas (NICE, 2006). This makes a number of recommendations including:
- Diagnostic services should be set up to identify potential sarcoma patients;
- Anyone with a provisional diagnosis should have it reviewed by a sarcoma specialist;
- Any surgery should be undertaken by a surgeon who is a member of a sarcoma multidisciplinary team.