Soft-tissue sarcoma
Sarcomas are rare tumours which can occur anywhere in the body. Soft-tissue sarcomas arise in tissues such as fat, muscles, nerves, tendons, and blood and lymph vessels – the soft tissues that connect, support, and surround other parts of the body.
There are more than 50 different types of soft-tissue sarcomas, each with a different behaviour, management and outcome. Patients are best treated in a specialist hospital by a team of experts with a dedicated interest and vast experience in the management of all types of soft-tissue sarcomas.
The Royal Marsden offers a full range of soft-tissue sarcoma diagnosis, treatment and care services for patients at its hospitals in Chelsea, London, and Sutton, Surrey:
| Diagnosis, tests and investigations |
Primary assessment and diagnosis (Chelsea only)
Second opinions |
| Cancer genetics |
Yes |
| Surgery |
Yes |
| Chemotherapy |
Yes |
| Radiotherapy |
Yes |
| Critical care |
Yes |
| Rehabilitation |
Yes |
| Palliative and supportive care |
Yes |
The Royal Marsden's Sarcoma Unit has more than ten sarcoma clinics every week dedicated to the assessment, diagnosis, treatment, rehabilitation and follow-up treatment of patients with soft-tissue sarcomas.
Our patients are referred from a large geographical area (nationally and internationally) on suspicion of having a soft-tissue sarcoma or after a diagnosis has been confirmed by their local doctors..
Diagnosis and assessment
Most lumps and bumps will not be cancer. A lump is more likely to be a sarcoma if it is increasing in size or if it is big - more than 5 cm across. Lumps that are deep in the body tissues are also more likely to be sarcoma. Pain is uncommon in sarcoma unless it is advanced or in a site close to a nerve or bone.
We are happy for patients to be referred to the Royal Marsden Hospital on the suspicion that a lump may be a sarcoma. We will arrange appropriate scans and perform tissue biopsy when possible at your first appointment. We aim to provide a one-stop service when possible, where any imaging and previously performed histology is reviewed before the initial consultation. Further biopsy, additional imaging and anaesthetic pre-assessment can be performed on the day of first consultation.
Patient care
The Royal Marsden Soft Tissue Sarcoma Multidisciplinary Team includes specialists in sarcoma surgery, medical oncology, radiation oncology, diagnostic radiology, nursing, soft tissue pathology, rehabilitation and support. The team sees more than 1000 new patients with possible soft tissue tumours for consultation or treatment each year. In 2012 our team have managed more than 600 new patients with confirmed soft tissue sarcomas. Patients’ cases are discussed in a weekly multidisciplinary team meeting where the sarcoma specialist team meet and decide on the best treatment for every individual patient, to consider possible clinical trials and to identify additional expertise that may be needed to achieve the best possible outcome.
At The Royal Marsden, patients are at the centre of care. We believe that treating the whole person, not just the disease, guarantees the best outcome for patients and family members. Every patient is assigned a key worker experienced in the management of soft-tissue sarcoma. Key workers are available to provide personal and professional advice and support, in person or over the telephone, to patients and their families throughout the journey of initial consultation, surgery, cancer treatment and during the long-term follow-up.
Second opinions
The Sarcoma Unit also provides a second opinion service to local, national and international patients and physicians for any diagnostic or management issue in the treatment of soft-tissue sarcomas.
Treatment
Surgery
Surgery often plays an important part of treatment of soft-tissue sarcomas and is provided by three dedicated sarcoma surgeons. The main goal of surgery is to remove the whole tumour with a margin of healthy tissue while preserving good function in the part of the body where the tumour developed.
Surgery is performed at The Royal Marsden’s Chelsea and Sutton hospitals, where surgeons, anaesthetists, nursing staff and postoperative care are dedicated to the management of soft-tissue sarcoma patients. In sarcoma surgery, the first operation is often the best opportunity to achieve cure.
Limb soft tissue sarcomas
Sarcomas are unusual in that they can occur in any site of the human body, although about 50 percent occur in the limbs. Surgery remains the primary treatment for most soft tissue sarcomas. It is very specialised treatment taking into account factors such as an accurate diagnosis and staging, tumour subtype and grade, treatment side-effects, complete tumour resection and limb-function preservation.
The majority of limb sarcomas when greater than five centimetres in size or high grade are managed by a combination of surgery and radiation therapy. Radiation therapy may be used before or after surgery. The Royal Marsden Hospital is on of the large dedicated sarcoma units in the country treating limb soft tissue sarcomas.
Retroperitoneal sarcomas
The Royal Marsden Hospital in London is one of the largest international centres managing retroperitoneal tumours, including retroperitoneal sarcomas. We provide a national and international service for complex retroperitoneal sarcomas and are involved in international trials to improve the outcome of retroperitoneal sarcomas.
Isolated limb perfusion
The Sarcoma Unit has extensive experience in using this technique to treat advanced sarcomas of the limb.
Radiotherapy
At The Royal Marsden we serve patients from London and the South East of England diagnosed with soft tissue sarcomas. The decision whether to use radiotherapy is made on a patient-by-patient basis. There are more than 50 different types of soft tissue sarcomas which respond to radiotherapy in different ways so each patient requires an individualised treatment plan. Radiotherapy may not be suitable for all types of soft tissue sarcomas. The doctor responsible for a patient’s radiotherapy treatment is called a clinical oncologist. The treatment is planned by a team of planning radiographers and physicists.
Radiotherapy is usually given during outpatient visits to Royal Marsden Hospital. Before starting radiotherapy you will usually need to attend the hospital for treatment planning. Radiotherapy is delivered by a machine that directs the high-energy radiation, usually X-rays, at the cancer site whilst keeping the volume of surrounding normal tissue irradiated to a minimum. Treatment takes several minutes and is painless and delivered daily for up to six and a half weeks.
The Royal Marsden offers a truly comprehensive radiotherapy service. Our multidisciplinary team of highly skilled clinical oncologists, medical physicists and therapeutic radiographers has a long tradition of excellence and innovation. Patients at The Royal Marsden have access to the latest radiotherapy machines and techniques, as well as clinical trials for new treatments. Alongside highly conformal radiotherapy, advanced radiotherapy techniques which include intensity modulated radiotherapy (IMRT), rotational arc therapy (Rapid Arc and VMAT), image guided radiotherapy (IGRT) are routinely used to treat soft tissue sarcomas of all body sites.
In addition, brachytherapy and stereotactic radiotherapy facilities including CyberKnife are available for suitable cases. Recent developments have included image fusion with MRI to optimise radiotherapy planning for retroperitoneal sarcomas and limb sarcomas. All these techniques are considered and adapted to deliver a personalised treatment plan for each patient diagnosed with a soft tissue sarcoma.
Rehabilitation and follow-up care
Physiotherapy and rehabilitation, when needed, are provided by dedicated personnel.
Once the surgical treatment has finished, patients are seen and followed up in a joint surgical and oncology sarcoma clinic. Consultation regarding the need for additional treatment in the form of radiotherapy or chemotherapy is made at the first postoperative visit and further treatment, if required, is performed at The Royal Marsden or, if appropriate, at your local hospital.
Once treatment has finished, continued follow-up care is provided at The Royal Marsden for up to ten years after diagnosis. These will include clinical examinations and scans to monitor for a recurrence or spread of the cancer.