Surgery for soft tissue sarcomas
As soft tissue sarcomas are rare, surgery is usually carried out by a surgeon who specialises in treating them.
The surgeon will often be part of a multidisciplinary team (MDT) and be based In a specialist bone (orthopaedic) hospital, or in a large cancer hospital.
Sometimes, people have a lump removed and only find out it’s a soft tissue sarcoma after the surgery. In this situation, you will be referred to a sarcoma specialist who is part of an MDT after your initial surgery.
The aim of most sarcoma surgery is to remove the tumour completely without leaving anything behind. Usually, an operation called a wide local excision is done. This means removing the cancer along with a border (margin) of healthy, cancer-free tissue all around it. The border of healthy tissue is removed to reduce the risk of the cancer coming back in that area. If the tumour is in the abdomen, it can sometimes be difficult to remove it with enough normal tissue to get clear margins. This is because the tumour may be very close to vital organs.
It’s difficult to give general information about sarcoma surgery because the type of operation you have will depend on where in your body the sarcoma is. Many sarcomas are in the arm or leg, but they can grow anywhere. Your surgeon will discuss your operation with you in detail.
Surgery to the chest or abdomen
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Surgery is usually the main treatment for soft tissue sarcomas of the trunk (the chest and abdomen). The extent of the operation will depend on the exact position of the sarcoma in the body. Your doctor will discuss this fully with you before the operation.
After your surgery, you will have a tube (drip) going into a vein in your arm. This will give you fluids and nutrients for 2-3 days until you can eat and drink properly again. The nurses on the ward will then take the drip out. Your doctor will let you know when you can start to eat again.
Radiotherapy may also be used after operations for sarcomas in the chest or abdomen to try to make sure that any remaining cancer cells are destroyed.
Surgery to the arms or legs
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Over the past few years, major improvements have been made in surgery for soft tissue sarcomas of the arms and legs. In the past, an operation to remove the limb (amputation) was usually needed if cancer was found. A false limb (prosthesis) would then be made to replace the limb that had been removed. Amputation is still sometimes needed, but it’s now usually possible to remove just the cancer and some of the tissue around it. This is known as limb-sparing surgery and is done by using a combination of surgery, radiotherapy and occasionally chemotherapy.
Depending on the size and position of your tumour, the surgeon may have to remove a large area of tissue. So you may need to have some reconstructive/cosmetic (plastic) surgery to repair the area. If this is needed, it will be done at the same time as your operation.
The aim of plastic surgery is to make the area look and function as naturally as possible. The exact surgery you have will depend on where in your body the sarcoma is and how much tissue the surgeon needs to remove. If only a small area has been removed, the surgeon may be able to join the two edges together again. But for larger areas, a skin graft may be needed. This involves taking some skin from a different part of the body (known as the donor site) and using it to repair the operation site. Both sites will gradually heal over a few weeks after the operation.
Occasionally, surgeons need to repair the operation site with a specialist technique using skin and tissue. This is known as a tissue flap and there are several different types. The surgeon will explain your operation to you and answer any questions you have.
Surgery is sometimes used to remove sarcoma that has spread to other parts of the body. An operation is usually only possible if the secondary tumours are small and there are only a few of them. It’s mainly done when the sarcoma has spread to the lungs, but may be considered for tumours in other parts of the body. If this operation is necessary in your case, your doctor will discuss it with you fully.