The Farber Center: For Radiation Oncology

The term, Sarcoma, comes from a Greek word meaning "fleshy growth". It is a general class of uncommon cancers* arising in connective tissues. Connective tissues include fat, muscle, blood vessels, deep skin tissues, nerves, bones and cartilage. They are subdivided into two main categories: soft-tissue sarcomas (such as leiomyosarcoma) and non soft-tissue sarcomas (such as the bone cancer, osteosarcoma). Ewing's bone sarcoma contains both soft-tissue and non soft-tissue elements. There are over 50 subtypes of sarcoma. About 1% of all adult cancers are sarcomas and between 15-20% of all children's cancers are sarcomas. There are hundreds of thousands of patients and families struggling with sarcoma worldwide.

• Completely dependent upon their site of origin.
• Slow-growing, painless mass
• Eventually, pain, numbness and swelling due to invasion of bone and nerves.

Risk Factors

• Immunologic
• Chronically swollen (edematous) arm after breast surgery (Stewart-Treves syndrome)
• AIDS (leiomyosarcoma)
• Environmental
• Previous radiation exposure
• Chemicals such as Agent orange, vinyl chloride and herbicides
• Trauma


• Genetic syndromes
• Li Fraumeni
• Neurofibromatosis
• Tuberous sclerosis
• Werner’s syndrome
• Intestinal polyposis
• Gardner’s syndrome (desmoids)
• Retinoblastoma mutation

Complete history and physical examination a physician may take a complete medical history. When doing this, the physician will ask questions about the suspicious symptoms, when they began and how they have changed over time.  Family history may also be discussed to help track diseases or medical conditions in your family tree.  A complete physical examination will also be performed, which will include analyzing and feeling the area where there is pain and swelling.

MRI is a scan that uses radio waves and strong magnets.  The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases.  A computer will translate the pattern of radio waves given off by the tissues into very detailed cross-sectional images of parts of the body.

Chest X-rays allow physicians to get a one dimensional image of internal body structures using a low dose of radiation to take  pictures of the body.  Additionally, X-ray imaging of the chest may be done to determine if any cancer has spread to the lungs.

Consider PET/CT scan is an x-ray procedure that produces detailed cross-sectional images of the body.  Instead of taking one picture to produce a one dimensional image, as does a usual x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body, and then produces multiple slices of the body part that is being studied.  Often, after the first set of pictures is taken, another set may be taken after you receive an intravenous injection of a “dye,” or contrast agent, that helps better outline internal structures.
PET is a type of imaging test that uses glucose (a form of sugar) that contains a radio-active atom.  The substance is injected into a vein, and a special camera is used that can detect the radioactivity in the body.  Cancer cells of the body absorb large amounts of the radioactive sugar because of their high rate of metabolism. These scans may be done prior to and throughout treatment to evaluate your response to it.

Grade
Differentiation - on a scale of 1 to 3
Mitotic count - how many cancer cells are seen dividing (under the microscope) -- given a score from 1 to 3
Tumor necrosis - how much of the tumor is made up of dying tissue -- given a score from zero to 2.
The scores for each factor are added up to determine the grade for the cancer. Higher grade cancers tend to grow and spread faster than lower grade cancers.
GX: the grade cannot be assessed (because of incomplete information).
Grade 1 (G1): total score of 2 or 3
Grade 2 (G2): total score of 4 or 5
Grade 3 (G3): total score of 6 or higher

Tumor
T1: The sarcoma is 5 cm (2 inches) or less across
T1a: The tumor is superficial -- near the surface of the body.T1b: The tumor is deep in the limb or abdomen.
T2: The sarcoma is greater than 5 cm across.
T2a: The tumor is superficial -- near the surface of the body.T2b: The tumor is deep in the limb or abdomen.

Lymph nodes
N0: The sarcoma has not spread to nearby lymph nodes.
N1: The sarcoma has spread to nearby lymph nodes.

Metastasis
M0: No distant metastases (spread) of sarcoma are found.
M1: The sarcoma has spread to distant organs or tissues (such as the lungs).

Stage grouping

Stage IA
T1, N0, M0, G1

Stage IB
T2, N0, M0, G1

Stage IIA
T1, N0, M0, G2 or G3

Stage IIB
T2, N0, M0, G2

Stage III
T2, N0, M0, G3 or Any T, N1, M0, any G

Stage IV
Any G, Any T, Any N, M1

SURGERY
is the primary treatment modality

RADIATION THERAPY
is often necessary depending on the features of the tumor

RADIATION THERAPY
can be done before surgery (neoadjuvant or pre-operatively) or it can be done after surgery (adjuvant or post-operatively).

CHEMOTHERAPY
may be used depending on the type of tumor.

Possible Treatment Side Effects
Dr. Farber, Dr. Spierer, and their staff at The Farber Center for Radiation Oncology will discuss potential side effects with you before, during, and after treatment, and ensure that your experience is personalized.