Step 5: Communication

Objective :

Communication with a specialist centre and the patient is important

The radiologist reporting the MRI scan calls and tells you this looks like a soft tissue sarcoma. You get the patient back, and he keeps asking why you are not simply taking the lump out.

You tell him that your plan at this point is:

Referral to a local general surgeon

Tip 1

No. These tumours need to be seen by a multidisciplinary team specialized in treating sarcoma. Improper biopsy or resection without prior appropriate workup can severely compromise future treatment.

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Send patient to the Emergency Department

Tip 1

No. While this gets the patient in hospital, it is not the most efficient way to have them seen by a specialist. This tumour is urgent, but not an emergency.

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Ask a local radiologist to do a biopsy

Tip 1

No. The biopsy must be done in consultation with the treating surgeon as these tumours are very transplantable. Improper biopsy can severely compromise future treatment and result in amputation being necessary.

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Referral to a multidisciplinary center

Tip 1

Yes. The best outcomes for these complex tumours are achieved when they are managed by the appropriate subspecialists in a multidisciplinary setting.

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The patient asks you what you think is going on, and what is going to happen to him?

It is important to make sure the patient understands the gravity of the situation, but also that these are usually treatable tumours.

Survival rates

Tip 1

With modern treatment, non-metastatic soft tissue sarcomas have a survival rate of about 70%.

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Chemotherapy

Tip 1

Chemotherapy is not usually used for treatment of soft tissue sarcomas.

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Radiation Therapy

Tip 1

Radiation therapy is often used preoperatively before proceeding with resection of the soft tissue sarcoma.

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Surgery

Tip 1

Surgical resection with wide margins is essential to achieve cure. Modern techniques have led to greatly increased rates of successful limb salvage rather than amputations.

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Next Step More Info

Patients should be reassured that cure is often achievable, and amputations are rare. Good function can usually be achieved. Counselling for these patients is very important, and these services are provided by most cancer centres. Don’t be afraid to refresh your memory about these uncommon tumours.