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Madrid, March 2, 2022.- Sarcomas are a broad group of malignant tumors that can appear almost anywhere on the body and affect both young people and the elderly. Soft tissue sarcomas, with a prevalence of around 3 to 5 cases per 100,000 inhabitants1 can start in all types of soft tissue in the body, including nerves, fat, muscles and blood vessels, and are mainly located on the limbs. On the other hand, bone sarcomas, with a prevalence of around 1 to 2 cases per 100,000 inhabitants2 can start in bone or cartilage tissue.

This great diversity of tumors, around a hundred different histological and molecular subtypes, is what makes multidisciplinarity necessary, since each subtype can have variable clinical behavior that requires the utmost specialization.

“Sarcoma is a rare disease (less than 6 new cases a year per 100,000 inhabitants) and for that reason, it must be treated by expert groups trained in this tumor. In the diagnostic phase, the biopsy must be performed by expert radiologists and the anatomic pathology diagnosis by experienced pathologists. The treatment should not be carried by just any traumatologist or any medical oncologist”, says Dr. Eduardo Jose Ortiz Cruz, head of the Orthopedic Surgery and Oncologic Traumatology Service at MD Anderson Cancer Center Madrid, who has 25 years of experience in the field. “It can be said that all medical specialties are involved in the treatment of sarcomas”, adds Dr. Ortiz and each of them contributes a different, but complementary vision which means we can improve the prognosis for patients.

Among the most common specialties are Traumatology, Medical Oncology, Radiotherapy Oncology, Anatomic and Molecular Pathology, Radiodiagnosis, Rehabilitation and Plastic Surgery. Sometimes, depending on the type of sarcoma, Nuclear Medicine, Otorhinolaryngology, Neurosurgery, General Surgery or Gynecology may also be involved. It is essential to stress that "all the diagnostic and therapeutic decisions we make are made by multidisciplinary sarcoma committees," states Dr. Ortiz.

More than half of soft tissue sarcomas, about 60%, appear on the arms and legs, and other common sites for sarcoma are the torso (20% of cases), the abdomen (15%) and the head and neck. Although this type of soft tumor is more common in adults, on the contrary, a peculiarity of bone sarcomas is that it is one of the most common cancers in children and adolescents and is considered a rare tumor in adults.

Communication and organization to offer a rapid response

One of the most important aspects in dealing with sarcoma effectively is to establish an ideal communication channel. According to Dr. Ricardo Cubedo, head of the Multidisciplinary Sarcoma Unit at MD Anderson Madrid, who also has extensive experience in the field, "communication with the patient is essential and that he/she can communicate with us rapidly". Once again, the Nursing team plays a key role in this regard. "Nurses must also specialize in this type of tumor and therefore know how to prioritize what is urgent, since time is often a determining factor," says Dr. Cubedo.

Once the call is received, whether from patients undergoing treatment, follow-up or second opinions, another relevant factor is the speed of the response. “It is important to see patients quickly, especially second opinion patients”, Ricardo Cubedo clarifies, and reiterates the importance of the multidisciplinary committee: “There should always be a professional from the team who can make that first contact with the patient and find out about their pathology”.

In this context, the expansion of telemedicine has facilitated much of the work. It has become clear that certain aspects must be maintained in person, since sometimes "the ideal thing is to do a perfect physical exam and be able to palpate the tumor, as well as being able to observe the patient and their family face to face", says Dr. Ortiz, but there are many others that can be transferred to digital format by means of a video call, which helps to speed up the response.

Primary care, a fundamental role in early diagnosis

Although having coordinated access to various disciplines is key, the role of the primary care physician or specialists without specific training in sarcomas is also essential in early diagnosis. "Any specialist who sees a patient two or three times for the same persistent symptomatology must order imaging tests", warns Dr. Ortiz. The most common symptoms in soft tissue sarcomas are usually masses or lumps that grow progressively without there having been any trauma, or pain that is not constant but not related to strain either.

On the other hand, the most common symptoms in bone sarcomas range from bone pain to inflammation and pain when the affected area is palpated, weakness in the bones resulting in fractures or fatigue. So, it is essential that both the doctor and the patient, in the event of any warning signs, can be in contact and discuss the symptomatology.