Depending on the site and stage of a sarcoma, surgery may 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 of the specimen. If it is, it is said to have positive margins, which means that cancer cells may have been left behind. When cancer cells remain, the patient may need treatment with radiation or another surgery. If cancer isn't growing into the edges of the specimens, 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 may be difficult because the tumor may be next to vital organs that can't be taken out.

In the past, many of the sarcomas in an arm or leg were treated by amputating the limb. Amputations are done much less often now (about 5% of the time). 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 overall survival rates as those who have amputations.

Currently, amputations are only done when they can't be avoided. Sometimes amputation is 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 leave a limb that can’t function well or 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), the entire 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 amputation is not often done. Sometimes chemotherapy (chemo), radiation, or both is given before surgery. This can shrink the tumor and allow it to be removed completely. Chemo or radiation may also be given before surgery to treat high-grade sarcomas when there is a high risk of the cancer spreading.

Once a sarcoma has spread, most of the time surgery will not cure it. However, if it has only spread to the lung, the metastatic tumor can sometimes be removed. This can cure many patients, or at least lead to long-term survival. Up to 30% of these patients survive at least 5 years.

Last Medical Review: 03/03/2009
Last Revised: 05/14/2009