Soft-tissue sarcoma

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.

In this section

Sarcomas are rare tumours which can occur anywhere in 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:

  • Cancer genetics    
  • Surgery    
  • Chemotherapy    
  • Radiotherapy   
  • Critical care    
  • Rehabilitation   
  • Palliative and supportive care

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. 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.

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 5cm 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 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.

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.

We aim to provide a one-stop service where any previously performed imaging and histology is reviewed before the initial consultation. Further biopsy, additional imaging and anaesthetic pre-assessment can be performed on the day of first consultation.

A diagnosis is established through a combination of clinical assessment, needle biopsy and specialised radiological scans.

Biopsy

The most important part of the diagnosis is a biopsy of the tumour. This is mainly performed under local anaesthetic in the clinic, and every biopsy and histological diagnosis is examined and reviewed by a specialist sarcoma pathologist. Histopathologists and scientific researchers at The Royal Marsden have pioneered clinicopathological, immunohistologic and molecular genetic studies in the field of soft tissue sarcomas.

Scans

Radiological investigations of the tumour and systemic staging are performed and reported by specialist soft-tissue sarcoma radiologists. These state-of-the-art scans may include ultrasound, CT scans, MRI scans, bone scans and PET scans.

Prognosis

The prognosis of soft-tissue sarcoma depends on a number of factors:

  • location of the tumour
  • size of the tumour
  • whether it has spread to other parts of the body
  • subtype of the tumour, which can only be determined after biopsy or surgery
  • grade of the tumour, an important term which is determined during the pathologic analysis.

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.

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.

Specialised sarcoma care

Perhaps the most important thing is to be sure you are talking to a doctor who understands, and has experience in, the management of sarcoma. Because the disease is so rare, it is very important to see a doctor who knows about such tumours. This is important to ensure that you get the best treatment.

Sarcoma specialists usually work with a team, so if the primary sarcoma specialist is an expert, you can expect him or her to have the best and most experienced pathologists and radiologists and other allied health professionals to help.

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 is one of the large dedicated sarcoma units in the country treating limb soft tissue sarcomas. 

Retroperitoneal sarcomas

The Royal Marsden 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 The Royal Marsden. 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.

Soft-tissue sarcoma diagnosis and assessment

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.