Surgery for Soft Tissue Sarcomas
Depending on the site and stage of a sarcoma, surgery might be able to remove the cancer and some of the nearby tissue. The goal of surgery is to remove the entire tumor along with at least 1 to 2 cm (less than an inch) of the normal tissue surrounding the tumor. This is to make sure that no cancer cells are left behind. When the removed tissue is looked at under a microscope, the doctor will check to see if cancer is growing in the edges (margins) of the specimen. If cancer cells are present at the edges, the tissue removed is said to have positive margins. This means that cancer cells may have been left behind.
When cancer cells are left after surgery, the patient may need more treatment − such as radiation or another surgery. If cancer isn’t growing into the edges of the tissue removed, it is said to have negative or clear margins. The sarcoma has much less chance of coming back after surgery if it is removed with clear margins. When the tumor is in the abdomen, removing the tumor with enough normal tissue to get clear margins could be difficult because the tumor could be next to vital organs that can’t be taken out.
In the past, many of the sarcomas in the arms and legs were treated by removing the limb (amputation). Now, this rarely is needed. Instead, most patients can be treated with surgery to remove the tumor without amputation (called limb-sparing surgery). This is usually followed by radiation therapy. These patients have the same survival rates as those who have amputations.
Sometimes, an amputation can’t be avoided. It might be the only way to remove all of the cancer. Other times, critical nerves, muscles, bone, and blood vessels would have to be removed along with the cancer. If removing this tissue would mean leaving a limb that can’t function well or would result in chronic pain, amputation may be the best option.
If the sarcoma has spread to distant sites (such as the lungs or other organs), all of the cancer will be removed if possible. That includes the original tumor plus the areas of spread. If it isn't possible to remove all of the sarcoma, then surgery may not be done at all.
Sometimes chemotherapy (chemo), radiation, or both is given before surgery. This, called neoadjuvant treatment, can shrink the tumor and allow it to be removed completely. Chemo or radiation can also be given before surgery to treat high-grade sarcomas when there is a great risk of the cancer spreading.
Most of the time, surgery cannot cure a sarcoma once it has spread. But if it has only spread to a few spots in the lung, the metastatic tumor can sometimes be removed. This can cure many patients, or at least lead to long-term survival.
You can read more about surgery for cancer in A Guide to Cancer Surgery.
Last Medical Review: December 29, 2014 Last Revised: February 9, 2016