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Sarcoma: Myths & Facts

Island Orthopaedics’ Consultant Orthopaedic Surgeon Dr Leon Foo addresses some myths surrounding this rare disease at a recent public webinar.

Myth: Superfoods can prevent sarcoma.

Fact: While there are foods that may be able to enhance a body’s immunity to some degree, there is no single or specific food that can prevent sarcoma.

The best advice is to have a balanced diet. As each food has different and often unique nutrients, taking a little of everything will ensure that you receive the wide range of vitamins, minerals, and other nutrients that your body needs.

Consume less fats, oils, sugar and salt; moderate amounts of meat; and more of fruits and vegetables. Eating a “rainbow” of fruits and vegetables – that is, taking all colours of these foods – will also ensure that you get different nutrients.

Myth: My lump is not painful, so it cannot be sarcoma.

Fact: The vast majority of malignant lumps (cancerous or sarcomatous) are painless. Unfortunately, by the time you feel pain, it is usually a sign that the sarcoma is already at an advanced stage. For example, with bone sarcomas, about a third of the bone has to be destroyed before you feel significant pain. In soft tissue sarcomas, there is also usually no pain unless a tumour is pressing onto or eroding into the nerves.

Here are some important signs to look out for in evaluating or monitoring a lump. Should it exhibit any of these features, see an orthopaedic oncologist early:

• Increasing size
• Change in character
• Change in colour
• Increase in warmth
• Deep location
• Development of pain
• Multiple lumps forming

Another word of caution is with children. Young children seldom lie or malinger. If your child complains about constant aches and pains, do not dismiss the symptoms as due to sports injuries or growing pains. Do bring him or her to see an orthopaedic oncologist for further assessment who may order radiological imaging such as an X-ray and/or MRI scan if needed.

Myth: My tumour marker blood tests are normal, so I cannot have sarcoma.

Fact: There are at the moment, no tumour marker blood tests to detect sarcomas. The current executive health screen tumour marker tests are actually very limited in their scope of what they can check for, namely some liver cancer (AFP), ovarian cancer (CA125), pancreatic cancer (CA19-9), breast cancer (CA15-3), colorectal cancer (CEA) and prostate cancer (PSA), but there is none for sarcomas.

Myth: A biopsy will cause my sarcoma to spread.

Fact: This belief had arisen because in the past, doctors often did whole-body staging investigations such as PET scans after a biopsy. When this revealed that the sarcoma had already spread, it gave the wrong impression that the sarcoma spread as a result of the procedure. Sarcomas do not spread so fast. The malignant cells take time to mutate before they can spread from one part of the body to another. These days, doctors often do staging investigations before a biopsy if the initial suspicion of the lump being a sarcoma is high.

On a side note, biopsies are hugely important because doctors need to know the exact type of cancer, what grade it is, and for sarcomas in particular immunostains and cytogenetics, to determine which treatment to give for best clinical response and outcome. Now, most biopsies can be performed via percutaneous/minimally invasive core needle techniques. Percutaneous core needle biopsies are also often performed under radiology guidance for increased accuracy and to avoid injuring important organs and structures nearby.

Myth: There is no hope with Stage 4 sarcoma.

Fact: With new developments in surgery, chemotherapy, radiation therapy, as well as clinical trials in new drugs, gene and stem cell therapy, sarcoma patients today have a greater chance of survival even when they are diagnosed at advanced stages.

Myth: Sarcoma treatment hurts more than it cures.

Fact: Most of these fears are related to chemotherapy because of potential side effects, such as hair loss and nausea. This is not entirely true. For example, not all patients will suffer hair loss, and even if there is hair loss, the hair often grows back well. There are also more drugs available to address side effects like nausea which the doctors often give prophylactically to ensure a more pleasant treatment experience.

Myth: Sarcoma surgery means amputation.

Fact: While amputations may be required in some cases, doctors today make limb preservation a priority when doing any surgery. There are also more and newer methods to reconstruct limbs using allografts (from donated bones) and megaprosthetic implants, which enable patients to lead active lives. Implants that adapt to the growth of a body are also available, though these are currently very expensive.

Some patients believe that amputation indicates that the treatment was a failure. This is not true. While doctors will do their best to preserve patients’ limbs, sometimes this is not possible as the tumour is too big, or it is not possible to preserve or reconstruct the blood vessels and nerves for the limb to survive. Many amputees actually have fruitful, active lives and depending on their type of amputation and motivation, can enjoy running, swimming and various sports.