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 200 new cases are diagnosed annually in Finland.

A suspicion of a soft-tissue sarcoma usually arises when you notice a growing lump. The lump is usually asymptomatic and is typically located in a 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 specialized medical care.

If sarcoma is suspected during the examinations, the physician will refer you to the HUS Soft Tissue Sarcoma Group.

Sarcomas are rare, which is why we treat each patient’s case in a multi-professional 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.

Most sarcomas are located in the limbs or abdominal cavity. A tumor in a limb is examined with magnetic resonance imaging, and tumors in the abdominal cavity with computed tomography or magnetic resonance imaging. Imaging studies provide additional information about the cancer subtype and its potential connections to bones, nerves, and blood vessels.

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 metastasize first 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 surgical treatment.

The primary treatment for soft-tissue sarcoma is surgery.

The surgery is supplemented with radiation therapy if a sufficiently large healthy tissue margin cannot be obtained around the tumor.

In soft-tissue sarcoma with an aggressive nature and a high degree of malignancy, you can receive chemotherapy as adjuvant therapy.

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.

Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the cancer treatments. We help treat difficult symptoms and offer conversational support. 

A decision on palliative, i.e. symptomatic, treatment is made when the focus of your treatment shifts from slowing down the progression of cancer to managing the symptoms. In this case, treatment aims to alleviate symptoms and, as far as possible, to ensure a good and active life with the illness until death. Typically, at this stage, your care responsibility is transferred to the palliative care unit or to the palliative outpatient clinic or a hospital-at-home unit in your area.

After the follow-up at HUS, follow-up is no longer needed in primary health care.