Bone & Soft Tissue Cancers

Overview

Sarcomas develop when cells of bone or soft tissues grow uncontrollably and form malignant tumors.

They can occur anywhere in the body, most commonly in the arms, legs, pelvis, chest wall, and retroperitoneum.

Sarcomas behave differently from more common epithelial cancers and require specialized diagnosis and treatment.

Early diagnosis and treatment at experienced cancer centers improve survival, limb preservation, and quality of life.

Management involves coordination between surgical oncologists, orthopedic oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, and rehabilitation specialists.

Risk Factors

Non Modifiable

Inherited genetic syndromes such as Li-Fraumeni syndrome, hereditary retinoblastoma, and neurofibromatosis

Previous radiation therapy (radiation-induced sarcoma)

Certain inherited bone disorders such as Paget’s disease

Increasing age for many soft tissue sarcomas

Modifiable

Chronic lymphedema

Exposure to chemicals such as vinyl chloride, arsenic, or dioxins

Chronic inflammation or long-standing tissue injury

Prevention Tips

Seek evaluation for any persistent or enlarging lump

Avoid unnecessary radiation exposure

Follow-up regularly if you have known genetic risk factors

Symptoms

Early

Painless lump or swelling that slowly increases in size

Mild discomfort in affected area

Common

Persistent or worsening bone pain

Restricted movement of nearby joints

Increasing size of a mass

Swelling or tenderness

Advanced

Severe pain

Pathological fractures after minimal trauma

Nerve compression symptoms

Unexplained weight loss and fatigue

Organ Specific

Limbs

Growing mass in arm or leg

Pain or difficulty using the limb

Abdomen Or Pelvis

Abdominal fullness

Bowel or urinary symptoms due to pressure

Spine

Back pain

Weakness or numbness due to nerve compression

Diagnosis

Approach

Clinical Evaluation

Detailed history and physical examination

Assessment of mass size, depth, and mobility

Tests

Baseline blood investigations

Imaging

X-ray for suspected bone tumors

MRI to assess local extent and relation to nerves and blood vessels

CT scan for bone detail and lung metastasis evaluation

PET-CT in selected cases

Biopsy

Core needle biopsy performed by experienced teams

Incisional biopsy when required

Careful biopsy planning to avoid compromising future surgery

Molecular Tests

Immunohistochemistry for sarcoma subtype

Molecular testing for specific translocations (e.g., EWSR1, SYT-SSX)

Staging

Assessment of tumor size, grade, depth, lymph node involvement, and distant metastasis

Lungs are the most common site of spread

Treatment

Principle

Surgery

Wide local excision with negative margins

Limb-sparing surgery whenever feasible

Amputation only in selected advanced cases

Complex reconstruction using grafts, flaps, or prostheses

Radiation Therapy

Preoperative or postoperative radiotherapy to reduce local recurrence

Advanced techniques such as IMRT or proton therapy in selected cases

Systemic Therapy

Chemotherapy for high-grade sarcomas such as osteosarcoma and Ewing sarcoma

Targeted therapy for specific subtypes (e.g., imatinib for GIST)

Immunotherapy in selected advanced or refractory cases

Clinical trial participation when appropriate

Supportive Care

Pain management

Physiotherapy and occupational therapy

Psychological counseling

Prosthetic and orthotic support if required

Do's and Don'ts

Dos

Seek early medical evaluation for any growing lump or persistent bone pain

Ensure biopsy and treatment are performed at a specialized sarcoma center

Follow rehabilitation and physiotherapy programs

Attend regular follow-up imaging and visits

Seek emotional and social support

Donts

Do not ignore painless lumps

Do not undergo unplanned biopsy or surgery at non-specialized centers

Do not delay treatment for rapidly growing tumors

Avoid unproven alternative therapies