“Any mass larger than a golf ball located in the upper arms or legs or a mass larger than a marble in the hands or feet should be considered a sarcoma until proven otherwise,” said Dr. Kelly Homlar, an associate professor in the Department of Orthopaedic Surgery at the Medical College of Georgia at Augusta University.
When it comes to thinking about cancer types, it can help to put them into three broad categories. The first category is organ cancers or solid tumors. These include prostate, breast, lung cancer, etc. The second category is your blood cancers including leukemia, lymphoma, and myeloma. The final category is where we find sarcoma. For those who do not know what sarcoma is, it is a cancer type affecting the connective tissues in the human body.
“The incidence of soft tissue sarcomas is around eight per 100,000 people and for bone sarcomas, around one per 100,000 people,” Homlar said. Because of how rare these cancers are, most people have never heard of or known someone with sarcoma. “And, when it comes to metastasizing, or spreading to other parts of the body, sarcoma cells behave differently from other cancers in that they travel through the blood stream where they often find their way to a person’s lungs.”
According to a recent report from the World Health Organization, there are around 70 different types of sarcomas. For Homlar, she divides the types into two broad categories. The first is bone sarcoma. The three most common types are Ewing Sarcoma, osteosarcoma, and chondrosarcoma. Except for chondrosarcoma, the usual treatment plan for bone sarcomas begins with chemotherapy, followed by surgery, with a second round of chemotherapy to follow. The second category would be soft tissue sarcoma. The treatment plan for soft tissue sarcoma involves radiation and surgery with some patients needing additional chemotherapy for their cancer sub-type.
“Working with sarcoma patients, for me, is like putting puzzle pieces together to form a full picture,” Homlar said. “You get a patient’s medical history, you take advanced imaging such as MRI and CT scans of their problem area, you get biopsies that you review with the pathologist, and all those details start coming together to form the treatment and care path for each patient.”
When it comes to treating both soft tissue and bone sarcomas, Homlar works with a multidisciplinary team with expertise in sarcoma care. Members of this team include a medical oncologist, radiation oncologist, sarcoma pathologist, orthopaedic surgeon, plastic surgeon, and musculoskeletal radiologist among others.
For Homlar, the power of this multidisciplinary approach provides patients with an entire team of physicians with expertise in sarcoma who want to join in the fight with you to have the best outcome possible after this scary diagnosis. There is continuity of care between specialists during the entire treatment process. This approach allows the patient to flow through their care plan effortlessly because the road map is complete with different stops along the way and the specialist at that stop prepared for their role in the patient’s care plan.
Homlar works diligently with Augusta University Health and the Georgia Cancer Center’s physician outreach team to share information with primary care providers and other physicians referring patients to the Cancer Center for care. This training includes clearing up misconceptions such as the notion that soft tissue sarcomas are painful. That is not the case, and in fact, most soft tissue sarcomas are painless. Another common misconception Homlar finds is that soft tissue sarcomas are “spiculated” or “invasive” appearing on imaging, “Whereas in fact, most soft tissue sarcomas look well-marginated or well encapsulated on scans,” she said. “Most are deep, intramuscular and fill the muscle compartment creating a football/fusiform shape, pushing the muscle aside without invading adjacent neurovascular structures.”
Therefore, it is always important to remember to be a strong advocate for your health. Do your research, ask lots of questions, and see other physician opinions when necessary. Like with any form of cancer, the sooner you know what you are dealing with, the better the outcome will be. But, it all begins with being proactive about your health, knowing what is “normal” for your body, and discussing any changes you are concerned about with a primary care provider who can refer you to more specialty care if necessary.