Sarcoma Treatment Planning
Following a diagnosis of sarcoma, we work carefully to determine the best treatment options for you and to prepare a treatment plan personalized for your needs. We try to maximize treatment success while minimizing the impact that diagnosis and treatment can have on your life.
WHAT TO KNOW ABOUT SARCOMA TREATMENT PLANNING
1Getting Started In Your Care
2Getting Your Diagnosis
3Planning Your Treatment
Considering Your Options
4Undergoing Treatment & Follow-Up
Select your type of treatment below.
Assessment
Evaluating Options
Choosing Treatment
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Stage of the sarcoma
- Whether it has spread (metastasized) to the lymph nodes (small glands that filter bacteria, viruses, cancer cells, and other impurities from the body) or other parts of the body
- Type of sarcoma you have: invasive or noninvasive
- Markers, such as growth factors, that provide genetic information about the subtype of the cancer
- Your age and overall health
- Whether you have had cancer before
- There are a number of other consideration which may impact your treatment plan.
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. Your doctors may prescribe a treatment plan that combines one or more of the three main types of treatment: surgery, radiation therapy, and drug therapy. The combination of treatment types may need to take place in a specific order to best treat your specific condition.
Learn about treatments for sarcoma
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of sarcoma, from the least to the most severe.
You may be able to choose between therapies, depending on your diagnosis.
Your care team will explain the options and the possible treatment sequence. Your doctors will help you make an informed decision about which options may be right for you.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for sarcoma have different goals, such as:
- Slowing or stopping the growth of cancer
- Destroying cancer cells
- Destroying any cancer cells that may have spread (metastasized) to other areas
- Delaying or preventing cancer from coming back (recurrence)
- Managing symptoms of incurable cancer
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing sarcoma treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Stage of the sarcoma
- Whether it has spread (metastasized) to the lymph nodes (small glands that filter bacteria, viruses, cancer cells, and other impurities from the body) or other parts of the body
- Type of sarcoma you have: invasive or noninvasive
- Markers, such as growth factors, that provide genetic information about the subtype of the cancer
- Your age and overall health
- Whether you have had cancer before
- There are a number of other consideration which may impact your treatment plan.
close Assessment
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. Your doctors may prescribe a treatment plan that combines one or more of the three main types of treatment: surgery, radiation therapy, and drug therapy. The combination of treatment types may need to take place in a specific order to best treat your specific condition.
Learn about treatments for sarcoma
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of sarcoma, from the least to the most severe.
close Evaluating Options
You may be able to choose between therapies, depending on your diagnosis.
Your care team will explain the options and the possible treatment sequence. Your doctors will help you make an informed decision about which options may be right for you.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for sarcoma have different goals, such as:
- Slowing or stopping the growth of cancer
- Destroying cancer cells
- Destroying any cancer cells that may have spread (metastasized) to other areas
- Delaying or preventing cancer from coming back (recurrence)
- Managing symptoms of incurable cancer
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing sarcoma treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
close Choosing Treatment
Every cancer is different, even in the early stages. The best treatment for one person might not be the best treatment for another. Your doctor will help you make an informed decision about which options may be right for you. Your treatment plan may consist of one or any combination of the following:
Surgery
Your care team may recommend surgery to diagnose, stage, or treat cancer:
- Diagnosis: Your doctor may recommend that you have a biopsy, to obtain tissue samples and determine a more precise diagnosis.
- Staging: Surgery can help determine the stage of sarcoma, by showing the size of the tumor and other details.
- Treatment: Surgically removing the tumor may provide the best treatment for you.
Surgery Resources
Should surgery be part of your care plan, we are here to help guide you through the process.
If surgery provides a good treatment option, you will meet with a surgical oncologist to develop a plan. Surgery for sarcoma is different for every patient. Your surgical oncologist (cancer surgeon) will work with you to determine the least invasive and most effective surgery for the type of sarcoma you have.
Combining surgery with other treatments
To achieve the best possible outcome, your care team may recommend combining surgery with other treatments such as radiation therapy or chemotherapy. The additional treatment can be given 1 of 2 ways:
- Neoadjuvant therapy: This treatment occurs before surgery to make it easier and more effective. Undergoing chemotherapy before surgery, for example, may shrink a tumor and make removal more successful.
- Adjuvant therapy: This treatment occurs after surgery to reduce the risk of the cancer coming back. Chemotherapy or radiation therapy after surgery can destroy remaining cancer cells.
Drug Therapy
Drug therapy, also called systemic or medical therapy, is treatment that works throughout the body to fight sarcoma. These drugs slow the growth of cancer cells or destroy them. You can receive drug therapy:
- By mouth (orally) as a pill
- Through the blood vessels (intravenously, or IV) as an injection or infusion
Types of Drug Therapy
At Stanford, our medical oncologists use several types of drug therapy, including:
Chemotherapy: This group of medications stops the growth of rapidly dividing cells in the body, both cancerous and noncancerous. While powerful, chemotherapy can cause more side effects than other medication types, because it cannot distinguish between cancerous and healthy cells. Chemotherapy is a treatment option for almost anyone with cancer.
Chemotherapy Resources
Chemotherapy is a treatment option for most sarcomas. We are here to help you prepare and guide you through the process.
Targeted therapy
Medications that target certain features (including gene mutations) on cancer cells to block their growth, without harming nearby tissues.
For treatment to work, the cancer must have the specific markers a particular medication was designed to target. Some sarcoma cells have certain proteins on the cells that promote growth. These proteins cause cancer to grow quickly and spread. Our pathologists look for the presence of these proteins by examining samples of tissue taken during a biopsy.
Targeted Therapy Resources
Should targeted therapy be part of your care plan, we are here to help you prepare and guide you through the process.
Drug therapy scheduling
If your treatment plan involves drug therapy, you will have routine visits to have lab work done, see your doctor, and receive medication. You may need to come in once or twice per week. If you need an infusion, you will visit one of Stanford’s infusion treatment centers, where a nurse specializing in Sarcoma care will provide your treatment.
Drug therapy side effects
Side effects from drug therapies vary depending on the type of medication you receive. For example, chemotherapy may affect your hair and nails, because it slows their growth as it slows the growth of cancer cells. Fatigue is also possible. Ask your care team – we can help you manage or prevent many symptoms and side effects that can affect your everyday life.
Radiation Oncology
Radiation therapy is painless treatment that uses high-energy X-rays or other types of radiation to destroy cancer cells. Our radiation oncologists have years of experience safely and effectively treating sarcoma with radiation. Using the latest technology, we can precisely target tumors and minimize damage to nearby healthy tissue.
Radiation therapy may provide effective treatment for the type of sarcoma you have. If so, your doctor will speak with you about the best options. The types of radiation therapy we use for sarcoma treatment at Stanford include:
External radiation uses a machine called a linear accelerator (LINAC) to deliver radiation to the area where the cancer cells are found. Some of the types of external radiation we use include:
- 3D (3-dimensional) conformal radiation therapy (3D-CRT)
With this method, 3D images help the doctor better target the tumor. The images are created using a special machine — a computed tomography (CT) or magnetic resonance imaging (MRI) machine. The radiation beams can be aimed from many different angles to match the exact shape of the cancer.
Radiation Therapy Resources
Should radiation therapy be part of your care plan, we are here to help you prepare and guide you through the process.
What to expect during external radiation therapy and how to prepare
- Intensity-modulated radiation therapy (IMRT)
This method is similar to the first method, but the doctor can adjust how much radiation you get from each beam. In certain situations, this enables the doctor to avoid nearby normal cells to reduce the risk for side effects. - Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR)
This method works like the first two methods, and the total amount of radiation you get is similar. But with SBRT, the radiation is given in fewer but stronger doses. This is often used for sarcomas or other cancers. - Intraoperative radiation therapy (IORT)
This type is delivered right after a surgeon removes a tumor. The tissue is still exposed as a radiation oncologist delivers a high dose of radiation in the spot where the tumor was removed.
For each treatment, most of your appointment will be spent getting your body positioned correctly. The actual treatment lasts just a few minutes.
Receiving radiation treatments
Radiation therapy does not cause pain, so you won’t feel anything during your treatments. Radiation does not make you radioactive, and you can safely be around other people, including children.
The exact number and timing of your radiation treatments depends on the type of sarcoma you have and the type of radiation therapy you need:
- Typically, you will be treated once a day, Monday through Friday, over a few weeks.
- Most treatment sessions take 15 to 30 minutes, but some may take up to 1 hour.
- We offer treatment sessions between 8 a.m. and 5 p.m. at our Cancer Centers in Palo Alto, Pleasanton, South Bay, and Turlock.
Radiation therapy side effects
Everyone has a different response to radiation therapy. It may cause short-term side effects during treatment or long-term side effects after treatment ends.
The side effects of treatment depend on the type of radiation you receive, the dose, and your overall health. Common side effects that you may experience after radiation treatment include:
- Fatigue
• Skin color changes, like a tan or sunburn
• Skin irritation
• Coughing
• Trouble swallowing
• Shortness of breath
No matter what you experience, your care team can help ease the side effects of treatment. At least once a week, your radiation oncology team will meet with you to discuss your progress and any side effects that you may have.
Clinical Trials
At Stanford, our doctors are always working to improve care for people with sarcoma. As an academic medical center, we conduct clinical trials to evaluate new medical techniques, devices, medications, and other treatments for safety and effectiveness.
For sarcoma, we study new approaches to preventing, screening, detecting, diagnosing, and treating sarcoma. Some clinical trials look at new methods, while others evaluate new combinations of approved, existing approaches.
Depending on your individual circumstances, a clinical trial may provide a treatment option for you. Like any treatment, clinical trials have possible risks and benefits, including:
Possible benefits of joining a clinical trial:
- Access to a new treatment that isn’t widely available
- Expert care from our world-renowned cancer specialists and their teams
- Low- or no-cost treatment
- Participation in research that can save lives in the future
Possible risks of a clinical trial:
- Treatment that may not work for you
- Side effects that may be unexpected or worse than current standard-of-care treatments
- Additional doctor visits, meaning more time and travel
- Additional tests, which may be uncomfortable or time consuming
- Extra expenses if your health insurance does not cover all patient costs for a trial
When cancer is found, your doctor will study it to assess its stage. Factors that determine the stage include the size of the tumor, whether cancer has spread to other parts of the body, and if so, where.
Stages 1-2b
Stage 3
Stage 4
Recurrent
The stages of sarcoma are:
Stage 1A: The tumor is 5 cm or smaller and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body.
Stage 1B: The tumor is larger than 5 cm and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body.
Stage 2A: The tumor is 5 cm or smaller and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body. The grade is higher than the grade for stage IA.
Stage 2B: The tumor is larger than 5 cm and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body. The grade is higher than the grade for stage IB.
This stage can be described by either of the following:
- The tumor is larger than 5 cm and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body. The grade is higher than the grade for stage 2B.
- The tumor is any size, either superficial or deep, or any grade. However, it has spread to the regional lymph nodes but not to other parts of the body.
The tumor is any size, either superficial or deep, any grade, and may or may not have spread to the regional lymph nodes. However, it has spread to other parts of the body).
Recurrent sarcoma is sarcoma that has come back after treatment.
The stages of sarcoma are:
Stage 1A: The tumor is 5 cm or smaller and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body.
Stage 1B: The tumor is larger than 5 cm and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body.
Stage 2A: The tumor is 5 cm or smaller and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body. The grade is higher than the grade for stage IA.
Stage 2B: The tumor is larger than 5 cm and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body. The grade is higher than the grade for stage IB.
close Stages 1-2b
This stage can be described by either of the following:
- The tumor is larger than 5 cm and either superficial or deep. It has not spread to the lymph nodes or to other parts of the body. The grade is higher than the grade for stage 2B.
- The tumor is any size, either superficial or deep, or any grade. However, it has spread to the regional lymph nodes but not to other parts of the body.
close Stage 3
The tumor is any size, either superficial or deep, any grade, and may or may not have spread to the regional lymph nodes. However, it has spread to other parts of the body).
close Stage 4
Recurrent sarcoma is sarcoma that has come back after treatment.
close Recurrent
We bring together the right experts to create a care plan tailored to your needs. Our sarcoma doctors specialize in several different areas of cancer treatment and work together to create a coordinated and comprehensive plan. This group is known as a multidisciplinary team and includes:
- Surgical oncologists: Cancer surgeons who remove tumors and perform biopsies (small tissue sample to test for cancer)
- Medical oncologists: Cancer doctors who treat cancer with medications such as chemotherapy and targeted therapy
Your treatment plan will address the following:
- Location, size, and stage of the cancer
- Treatment goals
- Treatment options, their possible side effects, and ways to minimize or relieve side effects
- Expected length of treatment
- Follow-up care after treatment
- Radiation oncologists: Cancer doctors who treat cancer with radiation therapy
- Radiologists: Specialists who perform and read imaging tests, such as CT scans, MRI scans, and PET Scans, to diagnose and treat cancer
- Pathologists: Doctors who specialize in reading laboratory tests and evaluating tissue samples to diagnose cancer
- Psychiatrist: Doctor who specializes in diagnosing and treating mental illness, with a background in cancer care
- Genetic counselor: Licensed health care professional with specialized training in cancer genetics, testing, and counseling
If you have metastatic sarcoma
Metastatic sarcoma means that cancer cells have spread to nearby lymph nodes to other parts of the body.
Your appointment timing depends on your treatment goals:
- If you need treatment for a diagnosis of newly recurrent or metastatic Sarcoma, you will see a medical oncologist for drug therapy within 7 days. Newly recurrent describes Sarcoma that has come back and spread to another part of the body.
- If you are interested in clinical trials for metastatic disease, you will see a medical oncologist for drug therapy within 7 days.
- If you need a second opinion of a diagnosis, you will see a medical oncologist within 14 to 21 days.
Learn more about stage IV sarcoma
If you want a second opinion
If you already have a diagnosis of Sarcoma and want a second opinion about treatment options, we can usually schedule you within 14 days. Your reason for seeking a second opinion will help us determine which specialist(s) you should see:
- If you are still deciding where you will receive treatment, you will see a medical oncologist and a surgeon.
- If you need a second opinion about drug therapy, you will see a medical oncologist.
- If you need a second opinion about surgery, you will see our core doctors.