Locomotive system or Sarcoma
The term “sarcoma” refers to cancers that develop from bones or supporting tissues, which surround bones and organs and include, among others, muscles, cartilage, fat or blood vessels.
Sarcomas are rare (1% of all cancers). Their treatment is complex and very specialised, requiring the experience of diagnosticians (radiologists, pathologists etc) and therapists (surgeons, radiotherapists and medical oncologists) who discuss the best treatment for patients on the basis of up-to-date scientific information, at multidisciplinary meetings.
About one hundred bone and supporting tissue tumours are treated at the Cliniques Universitaires Saint-Luc Cancer Centre each year. This accounts for about one fifth of all sarcomas treated in Belgium.
Diagnosis of sarcoma is complex, principally because of the wide variety of cancer locations and types. Sarcomas, in fact, are a highly varied group of cancers.
The variable nature and infrequent occurrence of sarcomas mean that there are still only a few teams with the experience necessary to care for them optimally.
Sarcomas are classified according to origin. Osteosarcoma indicates a sarcoma that develops from bone; liposarcoma indicates a sarcoma that develops from the fatty tissue that surrounds bone and muscles, and rhabdomyosarcoma, commoner in children, develops from the striated muscles.
Sarcoma most often appears as a mass, a “ball” that increases in volume. This mass is often located around the thigh or knee, but can occur anywhere in the body.
Osteosarcoma can cause persistent pain. Its presence is revealed through an X-ray taken to determine the cause of the pain. Less frequently, a fracture can also reveal bone sarcoma.
More rarely, pain is a warning sign of other types of sarcoma. In these cases, it can show itself in arching or other disabling deformities. Any unusual mass in soft tissue may appear in an ultrasound for superficial locations or in a magnetic resonance image for deep locations.
The cause of sarcoma is not well understood. There is a genetic influence in some cases.
Imaging, microscope examinations and genetic analysis guide the treatment strategy
The strategy to be followed during the treatment is finely balanced. Diagnosis must usually be confirmed through a biopsy, in which a sample of abnormal tissue is taken for microscope examination. This allows the type of sarcoma, and therefore the required treatment, to be determined. A very strict assessment of the extent of the tumour, using imaging techniques (conventional radiology, magnetic resonance imaging, scans etc) also allows helps identify the mass and locate it in relation to anatomical landmarks, thus avoiding drastic surgical procedures. This tumour mapping is essential for extended examination and planning of treatment.
Finally, identifying genetic characteristics of sarcoma is very useful. It defines the type of disease and determines the behaviour of the tumour more accurately, allowing adaptation of the treatment.
Genetic analysis is also useful in assessing the risk of cancer in a patient’s descendants.
Examining a tumour sample under the microscope, and extended examination through imaging, are essential to prevent insufficient or excessive surgery.
Identifying the genetic characteristics of certain sarcomas helps predict their development and adjust the treatment accordingly.
Specific surgery
Surgery is the cornerstone of treatment. Operations to remove sarcomas are generally complex, involving removal of the cancer and sometimes reconstruction through bone transplants or artificial joints, or a combination of the two. This sophisticated approach helps preserve limb function as far as possible.
Modern imaging techniques allow a choice of transplant best suited for the reconstruction process to be made from the bone bank.
Progress in sarcoma treatment has considerably reduced the number of amputations; this is now only needed in less than 5% of all cases.
Radiotherapy and chemotherapy
Radiotherapy will be indicated according to type of surgery and size, location and grade of tumour.
For some tumours, radiotherapy is sometimes planned in addition to an operation. It makes the operation less drastic, while providing an equivalent rate of localised control.
Chemotherapy is also a treatment tool. Indeed, it is the basic treatment for childhood tumours.
In adults, chemotherapy is reserved for specific types of tumour or for more advanced stages.
In some cases, however, chemotherapy has to be administered before the operation to ease surgical removal of the tumour. Treatment with chemotherapy also reveals how sensitive the sarcoma is to chemotherapy; this can then be taken into account when determining the treatment to follow the surgery.
New types of treatment are continually being assessed in the international studies in which the Cancer Centre plays an active part.
Much progress has therefore been made in treatment of sarcoma, on many sides. Diagnosis has been refined, tumour behaviour is better understood, more effective surgery can be given, and additional treatments, such as radiotherapy and chemotherapy, have been optimised.
Sarcomas are rare (1% of all cancers). Their treatment is complex and very specialised, requiring the experience of diagnosticians (radiologists, pathologists etc) and therapists (surgeons, radiotherapists and medical oncologists) who discuss the best treatment for patients on the basis of up-to-date scientific information, at multidisciplinary meetings.
About one hundred bone and supporting tissue tumours are treated at the Cliniques Universitaires Saint-Luc Cancer Centre each year. This accounts for about one fifth of all sarcomas treated in Belgium.
Diagnosis of sarcoma is complex, principally because of the wide variety of cancer locations and types. Sarcomas, in fact, are a highly varied group of cancers.
The variable nature and infrequent occurrence of sarcomas mean that there are still only a few teams with the experience necessary to care for them optimally.
Sarcomas are classified according to origin. Osteosarcoma indicates a sarcoma that develops from bone; liposarcoma indicates a sarcoma that develops from the fatty tissue that surrounds bone and muscles, and rhabdomyosarcoma, commoner in children, develops from the striated muscles.
SYMPTOMS AND DIAGNOSIS
Sarcoma most often appears as a mass, a “ball” that increases in volume. This mass is often located around the thigh or knee, but can occur anywhere in the body.
Osteosarcoma can cause persistent pain. Its presence is revealed through an X-ray taken to determine the cause of the pain. Less frequently, a fracture can also reveal bone sarcoma.
More rarely, pain is a warning sign of other types of sarcoma. In these cases, it can show itself in arching or other disabling deformities. Any unusual mass in soft tissue may appear in an ultrasound for superficial locations or in a magnetic resonance image for deep locations.
The cause of sarcoma is not well understood. There is a genetic influence in some cases.
Imaging, microscope examinations and genetic analysis guide the treatment strategy
The strategy to be followed during the treatment is finely balanced. Diagnosis must usually be confirmed through a biopsy, in which a sample of abnormal tissue is taken for microscope examination. This allows the type of sarcoma, and therefore the required treatment, to be determined. A very strict assessment of the extent of the tumour, using imaging techniques (conventional radiology, magnetic resonance imaging, scans etc) also allows helps identify the mass and locate it in relation to anatomical landmarks, thus avoiding drastic surgical procedures. This tumour mapping is essential for extended examination and planning of treatment.
Détection d'un ostéosarcome : la TDM (à gauche) montre l'extension de la destruction osseuse, l'IRM (à droite) montre l'extension de la tumeur elle-même.
Finally, identifying genetic characteristics of sarcoma is very useful. It defines the type of disease and determines the behaviour of the tumour more accurately, allowing adaptation of the treatment.
Genetic analysis is also useful in assessing the risk of cancer in a patient’s descendants.
Examining a tumour sample under the microscope, and extended examination through imaging, are essential to prevent insufficient or excessive surgery.
Identifying the genetic characteristics of certain sarcomas helps predict their development and adjust the treatment accordingly.
TREATMENT
Specific surgery
Surgery is the cornerstone of treatment. Operations to remove sarcomas are generally complex, involving removal of the cancer and sometimes reconstruction through bone transplants or artificial joints, or a combination of the two. This sophisticated approach helps preserve limb function as far as possible.
Modern imaging techniques allow a choice of transplant best suited for the reconstruction process to be made from the bone bank.
Progress in sarcoma treatment has considerably reduced the number of amputations; this is now only needed in less than 5% of all cases.
Radiotherapy and chemotherapy
Radiotherapy will be indicated according to type of surgery and size, location and grade of tumour.
For some tumours, radiotherapy is sometimes planned in addition to an operation. It makes the operation less drastic, while providing an equivalent rate of localised control.
Chemotherapy is also a treatment tool. Indeed, it is the basic treatment for childhood tumours.
In adults, chemotherapy is reserved for specific types of tumour or for more advanced stages.
In some cases, however, chemotherapy has to be administered before the operation to ease surgical removal of the tumour. Treatment with chemotherapy also reveals how sensitive the sarcoma is to chemotherapy; this can then be taken into account when determining the treatment to follow the surgery.
Delimitation précise du volume tumoral à irradier
Epargner au maximum les tissus sains environnants
Epargner au maximum les tissus sains environnants
Much progress has therefore been made in treatment of sarcoma, on many sides. Diagnosis has been refined, tumour behaviour is better understood, more effective surgery can be given, and additional treatments, such as radiotherapy and chemotherapy, have been optimised.
