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Sarcomas, which are cancers that start in bones, fat or muscle, are rare and can be challenging to treat. Historically, amputation was the only option for treating patients who had a sarcoma in an arm or leg. In the early 1990s, doctors began to prove that surgical removal of tumors without amputation was just as effective in controlling sarcomas or promoting overall survival as radical amputation.
Today’s doctors continue to see similar results and this has resulted in huge leaps in limb-sparing sarcoma treatments. If we can treat a patient’s sarcoma just as effectively without amputation, it certainly makes sense to save the limb and maintain function.
We’ve gotten to this point in sarcoma care through a better understanding of how these cancers behave. We have superior imaging technologies than we had in the 1990s, meaning we can better see where a tumor sits on a bone relative to nearby muscles and other tissues, as well as additional technologies that show us how tumors develop on a molecular level. These advancements let us plan for treatments more precisely and get a better grasp on which body structures will be affected.
Advanced limb-sparing sarcoma treatments
Sarcoma treatments have improved in a relatively short time. By being able to look at the molecular characteristics of a sarcoma, we can choose medications that are more effective against a patient’s particular type of cancer. Rather than removing the entire limb, orthopedic surgical oncologists remove significant portions of bone and soft tissues and reconstruct them with internal implants, often called endoprostheses.
Treating sarcomas also may involve chemotherapy and/or radiation therapy. Both of these treatments kill cancer cells, and they can be used in several ways:
- On their own if surgery is unsafe for a patient
- To shrink a tumor before it is removed surgically
- To keep sarcomas from coming back after treatment
- Some combination of these
We constantly study emerging chemotherapy treatments and new ways to deliver them with fewer side effects. Many techniques today also minimize patients’ radiation exposure.
Of course, new technologies and better treatments can only do so much. As with all cancers, early detection is key. Pain in a bone or joint is the most common symptom that gets patients in to see the doctor, but if a sarcoma starts in a muscle or another soft tissue, it often is painless. That’s why it’s important to see the doctor if you have a bump, lump or swollen area that doesn’t go away on its own within four to six weeks. Too often, patients who tell us they were busy with work or school and were hopeful that a painless bump would go away on its own. Instead, it grew much larger and resulted in a cancer that was more difficult to treat.
Other potential signs of a sarcoma include:
- An unexplained broken bone
- An enlarged arm or leg muscle when compared to the other side
- A sudden swelling without any injury
- A worsening bony pain that wakes you up at night
Why we lead the way in sarcoma treatment
In one major study of limb salvage for sarcoma, 22.1 percent of the study’s patients needed to have an amputation at some point. Our rates are significantly better: 95 to 98 percent of our patients with sarcomas won’t need an amputation.
What makes our limb-saving outcomes better? One advantage is that we’re one of the few centers nationwide dealing with these rare sarcomas every day. Our orthopedic surgical oncologists perform more than 350 major surgeries per year, and the vast majority of these are to treat sarcomas. Most doctors may see one patient with a sarcoma in a 30-year practice. We keep a database of all our surgical cases, so we can evaluate our techniques and continuously find ways to improve the care we provide.
Patients are referred to us from all over the country and the world, and my colleagues and I are internationally recognized for our limb-salvage efforts. In fact, we have a training program in which we teach young surgeons to do the work we do and use that knowledge to care for patients in their home states or countries.
Our work to help patients with sarcomas doesn’t stop after surgery or radiation therapy. Our patients work closely with physical and occupational therapists to get up and moving after treatment, with customized exercises designed to improve strength and range of motion. Our surgical procedures aid this process as well, because we preserve as much muscle and other healthy tissue as possible.
New techniques, improved technology and a better understanding of sarcomas have all come together in the last two decades, and we continue to expand our knowledge about these rare cancers. As we continue to research and learn more, I’m confident that we’ll be able to provide even better care and outcomes for our patients.