Sarcoma

The Sarcoma Program at Smilow Cancer Hospital is a multidisciplinary team of physicians specialized in the diagnosis, treatment, and care of patients with both soft tissue sarcomas and sarcomas of the bone.

The Program includes orthopedic physicians, dermatologists, diagnostic radiologists, medical oncologists, pediatric oncologists, radiation oncologists, and pathologists, all with specific expertise in the treatment and care of patients with sarcoma. A dedicated patient coordinator facilitates patient appointments and communication, coordinates services, and supports each patient and their family.

Clinical trials are also available to patients through Yale Cancer Center, bringing the latest treatment options for sarcomas to our clinics to benefit our patients.

Diagnostic tools at Smilow Cancer Hospital used to detect sarcomas include basic X-ray; CT scanning, excellent at seeing both bone and soft tissues; MRI, which has the ability to “view” the tissue in and around bone with exquisite detail; and PET scanning that is able to look at the cancer’s biological activity at the cellular level. In addition, a bone scan can be performed to check if there are cancer cells in the bone. A very small amount of radioactive material is injected into the patient’s vein and travels through the bloodstream. The radioactive material collects in the bones with the cancerous cells and is then detected by a scanner.

Most patients receive a course of multi-drug chemotherapy and/or radiation frst, followed by limb-sparing surgery for sarcomas of the bone, which removes the tumor without amputation, and more chemotherapy. Your treatment plan will be tailored to your individual diagnosis in collaboration with your referring physician.

Surgical Care

Surgery is often an option for patients with sarcomas of the bone. After consultation with the care team and patient, the following types of surgery may be considered:

• Wide local excision: Surgery to remove the cancer and some healthy tissue around it.
• Limb-sparing surgery: Removal of the tumor in an arm or leg without amputation, so the use and appearance of the arm or leg is saved. Most patients with sarcoma of the bone, or osteosarcoma, in a limb can be treated with limb-sparing surgery. The tumor is removed and the tissue and bone that are removed may be replaced with a graft using tissue and bone taken from another part of the patient’s body, or with an implant such as artificial bone.
• Amputation: In some instances, it is not possible to remove the entire tumor in limb-sparing surgery and therefore amputation may be considered to remove part or all of an arm or leg. The patient may be fitted with a prosthesis, an artificial limb, after amputation.

Following successful surgery to remove the tumor, patients are also given chemotherapy to kill any remaining cancer cells that are left in the area where the tumor was removed or that may have spread to other parts of the body. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation

Radiation therapy is often prescribed to patients before or after surgery for sarcoma to kill cancerous cells. Some patients may have radiation therapy before surgery to shrink a tumor to improve the success of the surgery. Radiation therapy is also often used after surgery in an attempt to eliminate any remaining cancerous cells.

Therapeutic Options

In the treatment of sarcomas of the bone, chemotherapy is usually given before and after surgery to remove the primary tumor. For soft tissue sarcomas, chemotherapy may be used before or after surgery and radiation. There are several approved chemotherapy options for patients and their oncologists to consider. In addition, clinical trials offering the latest treatment combinations and new therapies are available for our patients through Yale Cancer Center, a comprehensive cancer center designated by the National Cancer Institute. Smilow Cancer Hospital and Yale Cancer Center are also members of the Sarcoma Alliance for Research through Collaboration (SARC). SARC is a collaboration of distinguished research institutions throughout the country that work together to design and evaluate clinical trials, with the ultimate goal of ending sarcoma. New trials are available for patients using targeted therapies, kinase inhibitors, and monoclonal antibodies for the treatment of advanced and recurrent sarcomas.

Radiology

The Yale Department of Radiology and Biomedical Imaging employs state-of-the-art CT, MRI, and ultrasound exams to better diagnose and stage sarcomas and assist with treatment decisions. They have extensive experience in imaging and are dedicated to providing the best patient care possible. They routinely consult with the physicians in the Sarcoma Program and review all available imaging to ensure that the best diagnosis is made, which will translate to the most appropriate treatment for your disease.

Pathology

Our Pathology team is a fundamental component in the prevention, diagnosis, and treatment of soft tissue sarcomas and sarcomas of the bone at Smilow Cancer Hospital. In this highly specialized practice setting, our pathologists have extensive diagnostic experience and a passion for patient care. In the era of precision medicine, in addition to tissue diagnosis, team members actively participate in the real-time decision making process for patient management, including daily operative consultations, weekly tumor board conferences, and many ongoing clinical trial programs.