Most sarcoma patients in Oregon and many from the wider region choose the OHSU Knight Cancer Institute for our skill, expertise and technology. You'll find:

• Weekly tumor board meetings, where surgeons, oncologists and other experts discuss patients one by one. This gives you the benefit of our entire team's knowledge.
• Advanced 3D technology for replacing bone removed in surgery.
• MRI scanning that gives us detailed information to find the most effective treatment for bone sarcomas.
• A treatment plans tailored to your needs.
• Access to pioneering treatments through our research and clinical trials.

Diagnosing sarcoma

OHSU uses advanced tests and deep experience to diagnose sarcoma. Tests may include:

Imaging

X-ray: This can show a bone cancer and whether it has spread.

CT scan: A computed tomography scan uses X-rays to produce detailed cross-sectional images. A CT scan can also guide your doctor in using a needle to extract a tiny piece of tumor so it can be looked at under a microscope (biopsy).

MRI scan: Magnetic resonance imaging scans use radio waves, magnets and a computer to produce detailed images. We also offer advanced MRI technology for very early detection and crucial insights into a specific tumor. This includes seeing how a treatment is working or predicting whether a treatment might work.

PET scan: A positron emission tomography scan uses a small amount of injected radioactive material to highlight any cancer cells on a scan.

Radionuclide bone scans: This can show whether bone sarcoma has spread to other bones. The patient is injected with a very low dose of radioactive material, which is attracted to diseased bones. These areas show on the scans.

Biopsy

Your care team removes tissue so a pathologist can look at it under a microscope to check for cancer and any spread. Exceptional skill — such as on our team — is important because improper technique can spread the tumor or complicate later removal.

Core needle biopsy: Doctors use a hollow needle to remove tissue to see if cancer is present.

Surgical biopsy: The surgeon removes part of a tumor (incisional biopsy) or all of a tumor (excisional biopsy).

Treatments

Surgery is the most common treatment for most sarcomas. Your care team will base recommendations on the type of sarcoma, where it is and whether it has spread. In some cases, radiation therapy, chemotherapy or both might be used.

Surgery

Surgery for soft tissue sarcomas: The surgeon's goal is to remove the entire tumor, plus a little healthy tissue around it to make sure all the cancer is taken out. Your care team will inspect the tissue under a microscope to make sure no cancer cells are present.

Surgery for bone sarcomas: Most bone cancers are treated with surgery. A first surgery may be needed to biopsy the cancer. At the Knight Cancer Institute, we plan this carefully to make sure later surgery is successful and to offer the best chance to preserve a limb.

Lung surgery: If sarcoma has spread to only a few spots in the lung, those tumors can sometimes be removed.

Limb salvage surgery and reconstruction: More than 90 percent of patients with sarcoma in a limb have surgery that spares the limb. Our surgeons are experts at reconstructing a limb or part of the pelvis even after removing a large amount of bone or tissue. We may use bone from another part of the body or advanced 3D printing technology to produce synthetic bone.

Radiation therapy

Radiation therapy simulator: We offer patients and families use of our radiation therapy simulator. It uses 3D glasses and 3D video technology to give an idea of how radiation therapy works.

Radiation therapy for soft tissue sarcomas: High-energy rays, such as X-rays, are aimed at cancer cells to kill them. It may be the main treatment if surgery would do too much damage to vital tissues or if a patient is in poor health. Most radiation treatments for sarcoma use external beam radiation therapy, or rays delivered from outside the body. Your care team might recommend one of these types:

• Stereotactic radiosurgery: This usually delivers the whole dose in one session, though it may be repeated if needed. Despite its name, it’s not surgery. It’s precisely targeted radiation therapy. It is used mostly for tumors inside the head. The head is secured in a frame, and CT or MRI scans are used to pinpoint the tumor.
• Stereotactic body radiation therapy: This is similar to stereotactic radiosurgery but is given in five sessions. It’s sometimes called fractionated radiosurgery or stereotactic radiotherapy.
• Three-dimensional conformal radiation therapy: This type, sometimes called 3D-CRT, targets the cancer from different directions with shaped energy beams. You will be fitted with a mold or cast to keep the body part still and to limit damage to healthy tissue.
• Intensity modulated radiation therapy: IMRT is a newer method in which energy beams match the shape of the tumor. Your care team can change the strength of beams in some areas to spare healthy tissue and possibly reduce side effects.
• Intraoperative radiation therapy: IORT gives one large dose of radiation during surgery to the “tumor bed” where the tumor was removed. It allows for a high dose while protecting healthy tissue.

Radiation therapy for bone sarcomas: Radiation therapy is used less often for most bone sarcomas because they require high doses that could damage other tissue. It is used for Ewing tumors, though, and for bone cancers that can’t be completely removed with surgery.

Chemotherapy

Chemotherapy — medications taken by mouth or in a slow drip into a vein — is used for some sarcomas, often in combination with radiation. It can be part of treatment before or after surgery.

Chemotherapy for soft tissue sarcomas: Medicines, often in combination, circulate through the body to kill cancer cells. They also affect normal cells, often causing side effects. The U.S. Food and Drug Administration has approved several new sarcoma medications in recent years.

Chemotherapy for bone sarcomas: Chemotherapy is often an important part of treating Ewing sarcoma and osteosarcoma. It’s seldom used for other bone cancers because it has little effect on them.

Targeted therapy for sarcomas

Targeted therapy uses medications that focus on a cancer cell’s traits while doing little damage to healthy cells. We use targeted therapies for both soft tissue and bone sarcomas.

Follow-up care

Extensive rehabilitation and physical therapy can be essential after surgery on sarcoma in a limb. Without it, a limb may lose function. A patient who had leg-sparing surgery for sarcoma, for example, may need a year to relearn how to walk.

At OHSU, our expert rehabilitation specialists can help you regain function, manage short- and long-term side effects, and work toward your full potential.

Learn more:

• Adult Soft Tissue Sarcoma Treatment, National Cancer Institute
• Treating Soft Tissue Sarcomas, American Cancer Society
• Treating Bone Cancer, American Cancer Society
• Ewing Sarcoma Treatment, National Cancer Institute
• Patient Resources, Sarcoma Treatment, Sarcoma Foundation of America