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    Silent But Deadly - How To Spot A Sarcoma: Craig Gerrand Consultant Orthopaedic Surgeon Freeman Hospital, Newcastle

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    Afriade yolanda
    Sarcomas are rare malignant tumors that arise from connective tissues like bone and soft tissue. While soft tissue masses are common, sarcomas specifically are very uncommon, with a GP expected to see 1-2 cases in their career. Early detection and referral to a multidisciplinary specialist team is important for the best treatment outcomes, as sarcomas can metastasize if the tumor is large. Biopsies of suspected sarcomas require careful planning to avoid complications for later definitive surgery. The standard treatment involves a combination of surgery, radiation therapy, and chemotherapy depending on the specific sarcoma type and location.

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    Silent But Deadly - How To Spot A Sarcoma: Craig Gerrand Consultant Orthopaedic Surgeon Freeman Hospital, Newcastle

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    Afriade yolanda
    64 views31 pages
    Sarcomas are rare malignant tumors that arise from connective tissues like bone and soft tissue. While soft tissue masses are common, sarcomas specifically are very uncommon, with a GP expected to see 1-2 cases in their career. Early detection and referral to a multidisciplinary specialist team is important for the best treatment outcomes, as sarcomas can metastasize if the tumor is large. Biopsies of suspected sarcomas require careful planning to avoid complications for later definitive surgery. The standard treatment involves a combination of surgery, radiation therapy, and chemotherapy depending on the specific sarcoma type and location.

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    Sarcomas are rare malignant tumors that arise from connective tissues like bone and soft tissue. While soft tissue masses are common, sarcomas specifically are very uncommon, with a GP expected to see 1-2 cases in their career. Early detection and referral to a multidisciplinary specialist team is important for the best treatment outcomes, as sarcomas can metastasize if the tumor is large. Biopsies of suspected sarcomas require careful planning to avoid complications for later definitive surgery. The standard treatment involves a combination of surgery, radiation therapy, and chemotherapy depending on the specific sarcoma type and location.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    64 views31 pages

    Silent But Deadly - How To Spot A Sarcoma: Craig Gerrand Consultant Orthopaedic Surgeon Freeman Hospital, Newcastle

    Uploaded by

    Afriade yolanda
    Sarcomas are rare malignant tumors that arise from connective tissues like bone and soft tissue. While soft tissue masses are common, sarcomas specifically are very uncommon, with a GP expected to see 1-2 cases in their career. Early detection and referral to a multidisciplinary specialist team is important for the best treatment outcomes, as sarcomas can metastasize if the tumor is large. Biopsies of suspected sarcomas require careful planning to avoid complications for later definitive surgery. The standard treatment involves a combination of surgery, radiation therapy, and chemotherapy depending on the specific sarcoma type and location.

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    Download as ppt, pdf, or txt
    of 31

    Silent but deadly –

    how to spot a sarcoma


    Craig Gerrand

    Consultant Orthopaedic Surgeon


    Freeman Hospital, Newcastle
    Introduction
    • What is a sarcoma, and why does it
    matter?
    • Who gets sarcomas?
    • What is the best treatment for a
    sarcoma?
    • How can I tell a sarcoma from a
    ganglion?
    What is a lipoma?
    Benign tumour of mature
    adipose tissue
    What is a ganglion?
    A simple fluid filled cyst usually
    arising from a joint or tendon.
    What is a sarcoma?
    Bone and soft tissue sarcomas
    • Are rare malignant tumours arising
    from connective tissues
    • Heterogenous in type and location
    • Most are mesenchymal in origin
    How rare is rare?
    • Soft tissue masses are common (many
    hundreds in a GP lifetime)
    • Malignant soft tissue sarcomas are
    uncommon (1 or 2 in a GP lifetime)
    • England and Wales
    - 400 primary bone tumours per annum
    - 1500 soft tissue sarcomas per annum
    How malignant 1?
    • Survival of all patients with bone sarcomas
    How malignant 3?
    • Survival of all patients with soft tissue sarcomas
    Primary bone tumours
    Morphological classification

    • Over 30 variants

    Histological type Benign Malignant


    Haemopoetic Myeloma
    Lymphoma
    Chondrogenic Osteochondroma Chondrosarcoma
    Chondroblastoma
    Chondromyxoid
    fibroma
    Osteogenic Osteoid osteoma Osteosarcoma
    Unknown Giant cell tumour Ewing’s tumour
    Fibrogenic Benign fibrous Malignant fibrous
    histiocytoma histiocytoma
    Notochordal Chordoma
    Soft tissue sarcoma
    Morphological classification

    • Over 100 variants

    Mesenchymal Other differentiation, No specific


    differentiation consistent pattern differentation, variable
    pattern
    Liposarcoma Synovial sarcoma MFH
    Leiomyosarcoma Epithelioid sarcoma Sarcoma NOS
    Rhabdomyosarcoma Clear cell sarcoma
    Angiosarcoma Ewing sarcoma/PNET
    MPNST Alveolar soft parts
    Osteosarcoma sarcoma
    Chondrosarcoma
    Fibrosarcoma
    Aetiology
    • Most are sporadic
    • Predisposing factors
    - inherited predisposition
    - immunosuppression
    - irradiation
    - specific chemicals
    • Genetic changes within cells lead to
    tumours
    Age distribution of primary bone tumours
    Age distribution of soft tissue sarcomas
    Soft Tissue Sarcoma
    Distribution
    • 55% extremities
    • 35% retroperitoneum and viscera
    • 10% head and neck
    What is the best
    treatment for
    sarcomas?
    Best treatment
    • Early detection and referral
    • Multidisciplinary team management
    Why refer early?
    • Delays in diagnosis are common
    • Risk of metastasis relates to size of
    tumour
    Where do delays occur?
    • Patient (7 months)
    • GP (7 months)
    • Hospital
    Biopsy of sarcomas

    Sarcomas are implantable

    Therefore

    Careful planning is mandatory


    The Whoops! procedure
    • Excision without regard to principles of
    tumour surgery and usually without
    imaging
    • ie tumour “shelled out” without considering
    the possibility of malignancy
    • Further treatment complicated
    Principles of biopsy
    • Image first
    • Careful planning with regard to definitive
    surgery
    • If in doubt, discuss!
    • Excise the biopsy track during definitive
    surgery
    • Extensile incisions
    • Avoid neurovascular structures
    • Good haemostasis
    • Drain through or close to the wound
    Treatment of sarcomas

    • Multidisciplinary team
    • Combined approach with radiotherapy,
    surgery and chemotherapy
    • Specialist centre
    Patient perspective
    • Rare tumour
    • Often incorrectly reassured
    • May have to travel for treatment
    Low grade fatty tumours
    • Low risk of local recurrence
    • Low risk of metastatic disease
    • Treatment by planned marginal
    excision
    Indications for amputation

    • Adequate margins not possible with limb salvage


    • Major complications of radiotherapy would follow
    • A below knee amputation may be more
    serviceable than a salvaged distal extremity
    • Some cases of local recurrence may not be
    treatable by standard surgery and radiotherapy
    The future
    • Changes in administrative structure
    (NICE, NSCAG, NCRI)
    • Better identification of risk groups
    • Better chemotherapy
    • Better radiotherapy
    • Tissue engineering
    • Gene therapy
    • New imaging modalities
    Who to refer 1?
    • Soft tissue masses
    - Size >5cm
    - Painful
    - Increasing in size
    - Deep to fascia
    - Recurring after previous excision
    Who to refer 2?
    • Undiagnosed bone pain needs an x-ray!
    • Bone abnormalities on X-ray
    - Bone destruction
    - New bone formation
    - Associated soft tissue swelling
    - Periosteal elevation
    North of England Bone and Soft Tissue
    Tumour Service

    • Orthopaedics • Clinical Oncology • Radiology


    - Shona Murray - Helen Lucraft - Geoff Hide
    - Craig Gerrand - Charles Kelly - Chris Baudoin
    - Mike Gibson
    • Medical Oncology • Pathology
    • Plastic Surgery
    - Mark Verrill - Petra Dildey
    - Rick Milner
    - Ruth Plummer
    • General Surgery
    - Derek Manus • Paediatric • Macmillan
    - Paul Hainsworth Oncology nurse
    • Thoracic surgery - Juliet Hale - Joy Dowd
    - Sion Barnard - Quentin Campbell
    Hewson
    - Alan Craft
    Thank you

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