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Silent but deadly – how to spot a sarcoma

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Presentation on theme: "Silent but deadly – how to spot a sarcoma"— Presentation transcript:

1 Silent but deadly – how to spot a sarcoma
Craig Gerrand Consultant Orthopaedic Surgeon Freeman Hospital, Newcastle

2 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? Aetiology Classification Management

3 Benign tumour of mature adipose tissue
What is a lipoma? Benign tumour of mature adipose tissue

4 A simple fluid filled cyst usually arising from a joint or tendon.
What is a ganglion? A simple fluid filled cyst usually arising from a joint or tendon.

5 What is a sarcoma?

6 Bone and soft tissue sarcomas
Are rare malignant tumours arising from connective tissues Heterogenous in type and location Most are mesenchymal in origin

7 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

8 How malignant 1? Survival of all patients with bone sarcomas

9 How malignant 3? Survival of all patients with soft tissue sarcomas

10 Primary bone tumours Morphological classification
Over 30 variants

11 Soft tissue sarcoma Morphological classification
Over 100 variants

12 Aetiology Most are sporadic Predisposing factors
inherited predisposition immunosuppression irradiation specific chemicals Genetic changes within cells lead to tumours

13 Age distribution of primary bone tumours

14 Age distribution of soft tissue sarcomas

15 Soft Tissue Sarcoma Distribution
55% extremities 35% retroperitoneum and viscera 10% head and neck

16 What is the best treatment for sarcomas?

17 Best treatment Early detection and referral
Multidisciplinary team management

18 Why refer early? Delays in diagnosis are common
Risk of metastasis relates to size of tumour

19 Where do delays occur? Patient (7 months) GP (7 months) Hospital

20 Biopsy of sarcomas Sarcomas are implantable Therefore
Careful planning is mandatory

21 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

22 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

23 Treatment of sarcomas Multidisciplinary team
Combined approach with radiotherapy, surgery and chemotherapy Specialist centre

24 Patient perspective Rare tumour Often incorrectly reassured
May have to travel for treatment

25 Low grade fatty tumours
Low risk of local recurrence Low risk of metastatic disease Treatment by planned marginal excision

26 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

27 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

28 Who to refer 1? Soft tissue masses Size >5cm Painful
Increasing in size Deep to fascia Recurring after previous excision

29 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

30 North of England Bone and Soft Tissue Tumour Service
Orthopaedics Shona Murray Craig Gerrand Mike Gibson Plastic Surgery Rick Milner General Surgery Derek Manus Paul Hainsworth Thoracic surgery Sion Barnard Clinical Oncology Helen Lucraft Charles Kelly Medical Oncology Mark Verrill Ruth Plummer Paediatric Oncology Juliet Hale Quentin Campbell Hewson Alan Craft Radiology Geoff Hide Chris Baudoin Pathology Petra Dildey Macmillan nurse Joy Dowd

31 Thank you

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