Care pathway for soft-tissue sarcoma

Soft-tissue sarcomas are malignant cancers that originate in the body’s soft tissues, such as muscle or fat cells. Soft tissue sarcomas are rare. Approximately 220 new cases are diagnosed in Finland each year.

A suspicion of a soft-tissue sarcoma usually arises when you notice a growing lump. The lump is usually asymptomatic and is typically located on the limb. Sarcoma can also be diagnosed due to symptomatic metastases.

The most common area of spread of soft-tissue sarcomas is the lungs, in which case the symptom may be coughing or shortness of breath.

The first additional examination performed in primary health care is usually an ultrasound examination. If worrying features such as hyperemia or an abnormal structure are detected in the lump, examinations will continue in specialist medical care. 

If sarcoma is suspected during the examinations, the physician will make a referral to the HUS Soft Tissue Sarcoma Group. 

Sarcomas are rare, which is why we treat each patient’s case in a multiprofessional sarcoma team. The sarcoma group meets at the Comprehensive Cancer Center once a week.

After the sarcoma group has reviewed your case, you will be invited to a specialist’s appointment where your treatment will begin. You will receive an invitation letter by mail and in the Maisa Portal.

Most sarcomas are located in the limbs or abdominal cavity. Imaging studies provide additional information about the cancer subtype and its potential link to bones, nerves, and blood vessels.

• We examined the tumor in the limb using magnetic resonance imaging.
• We examine tumors in the abdominal cavity using computed tomography or magnetic resonance imaging.

A biopsy will be taken at your treatment unit. A pathologist will examine the tissue specimen and make a diagnosis. Often we also need genetic tests of the tumor, as some sarcomas have a genetic defect that can confirm the diagnosis.

If sarcoma is detected in the sample, we examine the spread of the disease using a CT scan of the lungs. Most sarcomas first spread to the lungs. In certain subtypes of sarcoma, metastases may also occur elsewhere in the body. 

At the appointment, we will draw up an individual treatment plan for you, taking into account your age, underlying diseases, tumor size, location, and degree of malignancy. In addition, we take into account other features of the tumor that may indicate aggressive behavior and also the planned surgery. 

The primary treatment for soft-tissue sarcoma is surgery.

We supplement the surgery with radiation therapy if a sufficiently large healthy tissue margin cannot be obtained around the tumor in the surgery.

In soft-tissue sarcoma with an aggressive nature and a high degree of malignancy, we can also give chemotherapy.

A multiprofessional treatment team is in charge of the treatment of soft-tissue sarcoma. You can reach your treatment team in the Maisa Portal and by phone. You will find the contact information for the unit treating you on the invitation letter.

• The Comprehensive Cancer Center helpline at 09 471 74900 is open Monday through Friday from 7:30 a.m. to 4:00 p.m.
• If your condition deteriorates suddenly or your fever rises above 38 degrees Celsius, contact the 24-hour emergency Medical Helpline at 116 117 (toll-free) or the nearest hospital with on-call services.
• In an emergency, always call 112.

Soft-tissue sarcoma can recur locally, so we regularly monitor the area where the tumor has been removed. In the area of the limbs, the most suitable examination is usually magnetic resonance imaging, and in the area of the body, computed tomography. We also regularly monitor lung scans, because metastases often occur in the lungs during the disease.

After the treatment of a tumor with a high degree of malignancy, follow-up usually continues at HUS for five years and after the treatment of a tumor with a low malignancy, for ten years.

In most patients, the cancer is cured with initial treatments, and the disease does not recur.

After HUS’s follow-up, no further follow-up in primary healthcare is necessary.

Surgery for sarcomas of the limbs is often extensive, and we use tissue grafts to repair tissue defects. Recovering from surgery can take time. As a result of radiation therapy, tissues may become stiff even years after treatment has ended.

Regular exercise and maintaining muscle strength and joint mobility in the surgically treated limb are essential after treatment has ended. If necessary, you can ask a physiotherapist for advice on exercises that are suited for you. Some people develop a tendency toward swelling in the operated limb, which can be prevented and treated with support products.

If the sarcoma has been surgically removed from the abdominal area, you may experience changes in bowel function for a while. However, recovery is usually quick and takes place within a few weeks.