Sarcoma is a type of cancer arising from tissues like Muscle, Bone, Fat, Nerves, Blood vessels, Fibrous tissue and deep skin tissue. They can be found in any part of the body. Most common site is legs and arm. Sarcomas can be widely classified as Bone and Soft tissue sarcoma.
Sarcomas are rare tumors that accounts to less than 1% of all cancers. Incidence is 1.5 to 5 per lakh population.
Soft Tissue Sarcoma
Bone Sarcoma
Idiopathic (Reason not known is the most common cause)
Previous Radiation
Chronic long standing Lymphoedema
Genetic Syndromes
Chemical industry
Swelling any where in the body
History and examination.
MRI scan or CT scan
Core needle Biopsy
PET scan in very selected situation.
The primary modality of treatment for sarcoma varies from case to case based on the sub type of sarcoma , location and size of tumor and whether spread to distant site or not.
Extremity-
Limb conserving Surgery
Amputations
Abdominal
Wide excision with or without Multiorgan resection.
Metastasis – Metastatectomy.
Extremity
The tumors involving the limbs may be situated away or close to the blood vessels and nerves in the limb. If they are located away, then the excision of tumor with wide margins and conserving the limb becomes easy. If the tumor is located close, even then the conservation of limb is possible with the advances in cancer treatment. Amputation has a very limited role in sarcoma treatment now a days and is indicated mostly in painful and non functional limb.
Abdominal
Tumors in the abdominal cavity are located in the deeper most part of the abdomen called the retroperitoneum where it can be close to lot of important structures. These tumors need wide excision which may result in multiorgan resection with preservation of important structures.
Metastatectomy
Some of these sarcoma have tendency to metastasis to lung and other sites. If the disease biology is favorable these lung lesions can be considered for surgical excision called the metastatectomy. Which can be done by key hole or minimally invasive surgery called the thorascopic surgery or VATS.
Radiotherapy may be given before or after surgery and the sequence will be decided case to case basis. Generally radiotherapy will be needed for any high grade tumor that is greater than 5 cms or in margins of excision are positive.
There are 2 types of Radiotherpay
Chemotherapy is usually included in the treatment protocol if the tumor is chemoresponsive. Whether to be given before or after surgery depends on the hisopathological type of tumor on biopsy specimen.
| Type of anaesthesia | : General Anaesthesia |
|---|---|
| Surgery time | : 2 - 4 hours |
| Hospital stay | : 3 - 5 days |
| Mobilisation | : 2nd day |
| Suture removal | : 12th day |
| Self-care | : 1 - 2 days |
| Full recovery | : 4 - 6 weeks |
| Return to work | : 4 weeks |
Bleeding
Infection
Seroma
Lymphoedema
Deep venous thrombosis
Small bowel Obstruction( Retroperitoneal)
Lot of these complications may be reduced by careful planning and meticulous surgical technique.
Drain tubes will be placed in the surgical bed and will be removed once the volume comes down. After discharge the patient might feel difficulty in walking or using the limb based on the muscle removed during surgery. Hence the patient will be advised to do regular physiotherapy to train the other muscle to improve the outcomes.
