Patients diagnosed with stage I soft tissue sarcoma (STS) have a low grade or unknown grade cancer that can be superficial or deep and does not involve any lymph nodes. Stage I STS is further distinguished by the size of the tumor:
- Stage IA primary tumor is 5cm or smaller
- Stage IB primary tumor is larger than 5cm.
The majority of stage I STSs are curable with surgical removal of the sarcoma. Some patients with stage IA and many patients with stage IB should consider the risks and benefits of radiation following surgery to avoid a recurrence.
Surgery is the mainstay of treatment for stage I STS and the following surgical techniques may be utilized:
- Wide Local Excision (WLE): WLE involves removal of the sarcoma with some surrounding normal tissue to ensure complete excision can be used to treat sarcomas of the trunk, abdomen, head, and neck.
- Mohs microsurgery: This type of surgery is designed to remove as little normal tissue as possible and is typically used where a good cosmetic result is desired, such as the face or skin. The sarcoma is cut from the skin in thin layers, examining each layer under a microscope during the surgery until no more cancer cells are present.
- Limb-sparing surgery: Arms and legs are common sites for STS and surgical procedures that avoid amputation are important. Radiation is often given prior to wide excision to avoid amputation.
- Lymphadenectomy: Lymph nodes are often sampled or removed during surgery to ensure the sarcoma has not spread.
In appropriate individuals, radiation therapy may be given before surgery to shrink the cancer or after surgery to reduce the risk of cancer recurrence. Treatment given prior to surgery is called neoadjuvant therapy and after surgery is referred to as adjuvant therapy.Radiation therapy uses high-energy x-rays to kill cancer cells and is considered a local therapy. It can only kill cancer cells within the exact area it is delivered. Learn more about various radiation techniques here.
Li-Fraumeni syndrome is a hereditary cancer predisposition syndrome associated with soft tissue sarcoma. Genetic assessment may be suggested for some patients with STS. Learn more about genetic testing here.
Sarcoma Centers & Second Opinions
Because sarcomas are uncommon it is important to find physicians who have experience with this disease. In the United States there are several locations that have physicians and teams dedicated to advancing the treatment of sarcoma. Patients with sarcoma should at least consider getting a second opinion at one of these centers. Click here to learn more about second opinions and click here to view a comprehensive list of sarcoma centers in the United States.
Strategies to Improve Soft Tissue Sarcoma Treatment
The development of more effective treatment for STS requires that new and innovative therapies be evaluated with cancer patients. Future progress in the treatment of STS will result from the continued evaluation of new treatments in clinical trials. Patients may gain access to better treatments by participating in a clinical trial. Participation in a clinical trial also contributes to the cancer community’s understanding of optimal cancer care and may lead to better standard treatments. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Learn more about clinical trials here.
Care after Treatment
Appropriate follow-up care is important following treatment for stage I STS. Speak with your doctor to discuss your follow-up care plan which may include rehabilitation, physical exams and imaging.