Sarcomas are cancers originating in the muscles, bones or other types of connective tissue. There are many subtypes of sarcoma, which vary in their histology, location and degree of malignancy.
Types of bone sarcoma include:
- Osteosarcoma – the most common form of bone cancer
- Chondrosarcoma – cancer originating from the cartilage
- Ewing sarcoma – a form of bone and soft tissue cancer most often affecting children and young adults
Types of soft tissue sarcoma include:
- Rhabdomyosarcoma – originating from skeletal muscle
- Leiomyosarcoma – originating from smooth muscle cancer
- Liposarcoma – originating from adipose (fat) tissue
- Synovial sarcoma – originating from soft tissues around the joints
- Angiosarcoma – originating from the blood and lymph vessels
- Kaposi’s sarcoma – cancer caused by human herpesvirus 8, most often seen in patients with end-stage HIV, causing typical red/purple raised skin lesions but also affecting other parts of the body
The prognosis depends greatly on the type, location, size and stage of the sarcoma. It can range from a greater than 90% 5-year survival for well-differentiated and resectable liposarcoma, to less than 10% for angiosarcoma affecting the liver.
Presentation
The presenting symptoms of sarcoma will vary dependent on the location and size of the lesion. The key features that should raise suspicions are:
- A soft tissue lump, particularly if growing, painful or large
- Bone swelling
- Persistent bone pain
Investigations
X-ray is the initial investigation for bony lumps or persistent pain.
Ultrasound is the initial investigation for soft tissue lumps.
CT or MRI scans may be used to visualise the lesion in more detail and look for metastatic spread (particularly a CT thorax, as sarcoma most often spreads to the lungs).
Biopsy is required to look at the histology of the cancer.
Staging
Staging is either with the TNM staging system or a number system that grades the cancer from stage 1 (earliest) to stage 4 (most advanced).
The most common location for sarcoma to metastasise to is the lungs.
Management
Management will be guided by the sarcoma multidisciplinary team (MDT). There are specialist sarcoma centres in various locations in the UK that specialise in managing sarcoma. This concentrates the expertise about these relatively rare and often challenging cancers to ensure patients get the best care.
Sarcoma treatment will depend on the type, location, size and stage of the sarcoma. This may involve:
- Surgery (surgical resection is the preferred treatment)
- Radiotherapy
- Chemotherapy
- Palliative care
Last updated August 2021