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Originally published July 29, 2024
Last updated August 9, 2024
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Sarcomas are rare types of cancer that can develop in soft tissues or bone and can occur anywhere in the body. Because they are rare, often they are harder to diagnose than other cancers, and treatments may be more limited.
“Basically, the way to think about sarcomas is they are cancers that arise from tissues like muscle, nerves, fat, bone and blood vessels, whereas the more common type of cancers are called carcinomas, which are organ-based cancers like lung cancer, breast cancer, etc.,” says Lee Zuckerman, MD, an orthopedic surgeon and orthopedic oncologist specializing in sarcomas at the USC Sarcoma Program, part of Keck Medicine of USC.
Sarcomas are much rarer, he says, making it harder for doctors to diagnose and treat these cancers, because there are not as many doctors who are familiar with them.
“Sarcomas are less common than other cancers, accounting for about 1% of adult cancers and 15% of childhood cancers,” says J. Dominic Femino, MD, chief of musculoskeletal oncology with Keck Medicine and the USC Sarcoma Program. “It is estimated that 3,900 bone sarcomas and 13,500 soft tissue sarcomas will be diagnosed in the United States in 2024, according to the National Cancer Institute’s Surveillance, Epidemiology and End Results Program.”
Sarcomas are generally grouped into two groups: soft tissue sarcomas and bone sarcomas.
Common types of soft tissue sarcoma include:
Common types of bone sarcomas include:
There are over 60 types of soft tissue sarcomas, and they can appear all over the body in skeletal muscle, body fat (adipose tissue), blood, lymphatics (vessels, nodes, the spleen, etc.), connective tissue and peripheral nerves. They also can occur at any age.
Soft tissue sarcomas are rare, accounting for 1% of cancers and 2% of cancer deaths in the United States, according to a StatPearls report.
“Nearly all sarcomas are treated with surgery and radiation therapy, and there are specific chemotherapies, targeted therapies and immunotherapies that may be used as well,” says H. Paco Kang, MD, an orthopedic oncologist and orthopedic surgeon with the USC Sarcoma Program.
“Over time, standard therapies have been established for individual sarcoma subtypes, and clinical trials continue to explore new therapies for our patients,” says Mark Agulnik, MD, a medical oncologist with the USC Sarcoma Program. “We continue to advance the field and improve outcomes for our sarcoma patients.”
Bone sarcomas are even rarer, accounting for 0.2% of malignancies worldwide, according to StatPearls. The most common types of bone sarcoma are osteosarcoma, chondrosarcoma and Ewing sarcoma.
“Bone sarcomas, such as Ewing sarcoma and osteosarcomas, are typically more common in children, although they can happen at any age,” Dr. Zuckerman says. The USC Sarcoma Program, which is also affiliated with the USC Norris Comprehensive Cancer Center, will operate on patients aged 14 and up. If a child is younger than that, a USC Sarcoma Program specialist can see them through a partnership with Children’s Hospital Los Angeles.
“The rarity of these tumors continues to highlight the need for an experienced team of sarcoma specialists who will understand the type of bone sarcoma being treated and who will be able to recommend a comprehensive treatment plan that will provide patients with the best possible outcomes,” says Dr. Agulnik.
Soft tissue sarcomas are usually found by feeling a lump, Dr. Zuckerman says. Some people initially feel the lump after an injury and attribute it to that, but if you have a lump that does not go away in a few weeks or starts to get bigger, it would be time to see a specialist, he says. “Bone sarcomas are typically painful and can hurt like a toothache or wake people up at night,” he says. If the bone is constantly aching, it would be time to see a specialist to get a biopsy.
Soft tissue sarcomas, on the other hand, are often asymptomatic.
“I would encourage any patient concerned about a new bump to get it evaluated as soon as possible,” says Dr. Kang.
Sarcomas are aggressive and can be deadly, Dr. Zuckerman says. That is why it is so important to be seen at a center that specializes in sarcomas.
“Within the last 10 to 15 years, we have had a lot more treatments that work on different sarcomas, so survival rates have continued to improve over time,” he says. “Thirty or 40 years ago, you might have had a 20% chance of survival. Now, there is a 60% to 80% survival rate.”
Typically, in the past someone with sarcoma might have had to have their leg or arm amputated. “But the reality is, even in extreme circumstances, we can save someone’s arm or leg 90% to 95% of the time now,” Dr. Zuckerman says. “There are also surgeries we can do to save someone’s joint.”
One option is a process called distraction osteogenesis during which doctors use the patient’s own bone to create more bone. This process can also be used for survivorship issues like limb-length discrepancies and bone loss. Another option is to use bone from an organ donor or a metal replacement that preserves the joint. “At Keck Medicine, we are one of the few centers in the country performing these cutting-edge surgeries,” Dr. Zuckerman says.
“Generally speaking, with modern techniques, amputations do not offer survival advantages and therefore we avoid them as much as possible,” Dr. Kang says. “When amputations are unavoidable, we have a team of specialists who employ the newest techniques to maximize function and reduce pain.”
One such option is called a rotationplasty during which the leg is flipped around and the ankle joint becomes the knee, Dr. Zuckerman says. This can provide the patient with a below-the-knee amputation when normally they would need an amputation above the knee. Another option is called osseointegration during which a metal implant is placed into the bone and connects directly with a prosthesis through the skin and allows for easier and more comfortable prosthetic fitting as well as better function.
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