Treatment for soft tissue sarcomas
As sarcomas are rare cancers, you should always be referred for treatment at a specialist sarcoma unit where a team of specialist doctors and others work together.
This is known as a multidisciplinary team (MDT) and will include:
a surgeon who specialises in sarcomas
an oncologist who specialises in cancer treatments such as chemotherapy, radiotherapy and biological therapy
a pathologist who specialises in diagnosing disease by looking at body tissue and cells
a radiologist who analyses x-rays and scans
a specialist nurse who gives information and support.
The multidisciplinary team may also include other healthcare professionals such as a dietitian, physiotherapist, therapy radiographer, occupational therapist and a psychologist or counsellor.
In order to plan the best treatment for you, your doctors will take into account your general health, and the type, stage and grade of the sarcoma.
Surgery is the most common treatment. If the soft tissue sarcoma is small and it’s possible to remove it completely, surgery may be used on its own.
For larger sarcomas, and where there may be a possibility of cancer cells being left behind, radiotherapy is usually used as well as surgery. Radiotherapy may be given before the operation to shrink the tumour and make it easier to remove. It may also be used afterwards to try to destroy any cancer cells that may not have been removed.
Sometimes, radiotherapy is used on its own or in combination with chemotherapy to treat more advanced sarcomas that can’t be removed.
Chemotherapy may sometimes be given before surgery to shrink the tumour. For some types of sarcoma it may also be given after surgery to try to destroy any cancer cells that have not been removed. Chemotherapy may also be used if the sarcoma has already spread or comes back after initial treatment.
For gastrointestinal stromal tumours a targeted therapy called imatinib (Glivec®) may be used before or after surgery.
Your multidisciplinary team (MDT) uses national treatment guidelines to decide the most suitable treatment for you. Even so, you may want another medical opinion. If you feel it will be helpful, you can ask either your specialist or GP to refer you to another specialist for a second opinion. Getting a second opinion may delay the start of your treatment, so you and your doctor need to be confident that it will give you useful information. If you do go for a second opinion, it may be a good idea to take a relative or friend with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.
Before you have any treatment, your doctor will explain its aims. They will ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form, you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations.
It’s a good idea to have a relative or friend with you when the treatment is explained, to help you remember the discussion. You may also find it useful to write a list of questions before your appointment.
People sometimes feel that hospital staff are too busy to answer their questions, but it’s important for you to know how the treatment is likely to affect you. The staff should be willing to make time for your questions.
You can always ask for more time if you feel that you can’t make a decision when your treatment is first explained to you.
You are also free to choose not to have the treatment. The staff can explain what may happen if you don’t have it. It’s essential to tell a doctor or the nurse in charge, so they can record your decision in your medical notes. You don’t have to give a reason for not wanting treatment, but it can help to let the staff know your concerns so they can give you the best advice.
The advantages and disadvantages of treatment
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Many people are frightened by the idea of having cancer treatments, particularly because of the side effects that can occur. However, these can usually be controlled with medicines. Treatment can be given for different reasons and the potential benefits will vary depending upon your individual situation.
In people with early-stage sarcoma, surgery is often done with the aim of curing the cancer, and additional treatments may also be given to reduce the risk of it coming back.
Advanced-stage sarcoma (metastatic)
If the cancer is at a more advanced stage, the treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some people, the treatment will have no effect on the cancer and they will get the side effects of treatment with little benefit.
If you have early-stage cancer and have been offered treatment that aims to cure it, it may be easy to decide whether to accept the treatment.
However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead. Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.
It’s important that you ask your doctors and nurses any questions you have about your treatment. The more you understand about your treatment, the easier it will be for you.