Despite being rare, a type of tumor that can affect bones, muscles, cartilage, and nerves is often only discovered in advanced stages; Oncologist comments on symptoms and treatment.
July is Sarcoma Awareness Month, a crucial period to raise awareness about the variations of this type of tumor that can affect any part of the body and all age groups. Sarcomas are rare cancers, with an incidence of about 5 people per 100,000. Combined with the set of subtypes, which exceeds 100, they represent about 1% of all cancer cases.
Sarcomas are a heterogeneous group of cancers originating from soft tissues, including the digestive tract and bones. Due to their rarity, they are often poorly characterized in terms of their epidemiology, biology, natural history, prognostic and predictive factors, and sensitivity to standard treatment, which poses challenges for diagnosis and clinical decision-making.
“There are several types of sarcoma, which are defined by the cells of origin and their degree of aggressiveness. In general terms, it is a cancer that affects bones and soft tissues such as fat cells, muscles, cartilage, and nerves. It is estimated that about 60% of tumors develop in the arms and legs,” explains Bruna David, an oncologist from the Oncoclínicas Group.
Due to being a group of rare cancers with no environmental risk factors, there are no Brazilian statistics on its incidence and clinical data, resulting in limited knowledge among healthcare professionals. “Most sarcomas occur without a predefined cause, meaning they are sporadic. Some risk factors such as hereditary genetic syndromes and previous radiation therapy treatments are associated with the development of the disease in some cases,” comments the doctor.
Main types and warning signs
Despite the variety of subtypes, Bruna David emphasizes that among soft tissue sarcomas, the most common are called liposarcomas (originating from fat cells), leiomyosarcomas (from muscle cells), and pleomorphic sarcomas. There are also gastrointestinal sarcomas, with the most common being called GIST (gastrointestinal stromal tumor).
In the group of bone sarcomas, osteosarcomas are particularly noteworthy, as they are one of the most common types of childhood and adolescent cancers. “Some sarcomas predominate in certain age groups. This is the case with osteosarcomas, a type of cancer that begins in bone-forming cells, more common in pediatric patients but can also affect adults on a smaller scale,” emphasizes the specialist.
According to the oncologist from Oncoclínicas, since sarcomas can arise in any part of the body, the symptoms vary depending on the location of the lesion and the affected neighboring structures. Generally, the signs of the disease include the presence of a mass, edema, or changes in sensitivity in the affected area of the body. “Rarely does the disease present signs such as fever, weight loss, or fatigue. What may suggest a health problem is a progressively growing tumor, with or without local discomfort,” she says.
More evident symptoms may arise in the advanced stage of the disease, precisely when it begins to press on important adjacent structures such as organs, blood vessels, or nerves. “The signs, which can be confused with those of other common diseases, deserve attention and a detailed investigation. Therefore, it is important to be alert to painless lumps or masses. Small lumps that reach almost the size of ping-pong balls should be seen as possible sarcomas and require attention due to the complexity of the diagnosis. Vomiting, abdominal pain that intensifies over time, dark stools, and blood in the stool can also be alarm signs,” adds Bruna David.
Being a rare and heterogeneous disease, there is no routine test capable of early detection. For sarcoma diagnosis, imaging tests such as ultrasound, X-ray, and computed tomography are performed, along with a biopsy that removes a fragment for anatomopathological evaluation. “The recommended procedure for the patient will depend on factors such as the tumor’s size, subtype, and location,” reinforces the specialist.
After analyzing each case, the treatment for sarcomas may involve various combinations of surgery, radiation therapy, and chemotherapy, with surgery being the most commonly performed option.
- Chemotherapy and/or radiation therapy can be combined with surgery in the following ways:
- Neoadjuvant: before the operation, to reduce the tumor’s size and facilitate the procedure, while preserving healthy tissues as much as possible. Adjuvant: after surgery, to decrease the chance of the disease reappearing.
When surgery is not indicated, chemotherapy and radiation therapy can be used alone, depending on the histological subtype and the patient’s profile.
Advances in science
In addition to chemotherapy, radiation therapy, and surgery, new options are being developed and studied. One of the alternatives is targeted molecular drugs directed at specific tumor subtypes and alterations.
“This is a major step in cancer treatment. However, it is crucial for the diagnosis to be precise and individualized for the correct use of these therapies,” comments the oncologist.
Is prevention possible?
The vast majority of sarcomas are not linked to a specific cause, making it impossible to define a way to prevent the tumor. When there is an associated genetic syndrome, specific recommendations are instituted. However, Bruna David emphasizes the importance of being attentive to the signs. “A continuously growing tumor in any part of the body deserves evaluation by a specialist. It is important to remember that, as they are rare and composed of many subtypes within rarity, they should be seen and treated by professionals trained in this type of disease. It has been proven that this also impacts the prognosis. And of course, the earlier the diagnosis, the greater the chance of success in treatment,” she concludes.