Sarcoma Diagnosis and Treatment

Dr. Kenneth Gundle, an orthopaedic surgeon at OHSU, focuses on treating patients with bone tumors and sarcomas.
Dr. Kenneth Gundle, an orthopaedic surgeon, focuses on treating patients with bone tumors and sarcomas.

The OHSU Knight Cancer Center has outstanding depth of experience in sarcoma. We treat hundreds of patients with sarcoma every year. We offer:

  • A team of experts who discuss your case together at a tumor board. This gives you the benefit of our entire team's knowledge.
  • Treatment that is designed around your needs.
  • Clinical trials for access to promising new treatments.
  • Advanced 3D technology for replacing bone removed in surgery.
  • A full range of support services for you and your family, including physical therapy and rehabilitation.

Diagnosing sarcoma

OHSU uses advanced tests and deep experience to diagnose sarcoma. Tests may include:

Imaging

X-ray: This can show a bone cancer and whether it has spread.

CT scan: A computed tomography scan uses X-rays to produce detailed cross-sectional images. A CT scan can also guide your doctor in using a needle to extract a tiny piece of tumor so it can be looked at under a microscope (biopsy).

MRI scan: Magnetic resonance imaging scans use radio waves, magnets and a computer to produce detailed images. We also offer advanced MRI technology for very early detection and crucial insights into a specific tumor. This includes seeing how a treatment is working or predicting whether a treatment might work.

PET scan: A positron emission tomography scan uses a small amount of injected radioactive material to highlight any cancer cells on a scan.

Radionuclide bone scans: This can show whether bone sarcoma has spread to other bones. The patient is injected with a very low dose of radioactive material, which is attracted to diseased bones. These areas show on the scans.

Biopsy

Your care team removes tissue so a pathologist can look at it under a microscope to check for cancer. Exceptional skill is vital because improper technique can spread the tumor or complicate later removal.

Core needle biopsy: Doctors use a hollow needle to remove tissue to see if cancer is present.

Surgical biopsy: The surgeon removes part of a tumor (incisional biopsy) or all of a tumor (excisional biopsy).

Treating Sarcoma

Surgery is the most common treatment for most sarcomas. It depends on the type of sarcoma, where it is and whether it has spread. In some cases, we may also use radiation therapy, chemotherapy or targeted therapy.

Surgery

Surgery for soft tissue sarcomas: The surgeon's goal is to remove the entire tumor, plus a little healthy tissue around it to make sure all the cancer is taken out. Your care team will inspect the tissue under a microscope to make sure no cancer cells are present.

Surgery for bone sarcomas: Most bone cancers are treated with surgery. A first surgery may be needed to biopsy the cancer. At the Knight Cancer Institute, we plan this carefully to make sure later surgery is successful and to offer the best chance to preserve your arm, leg or joint.

Lung surgery: If sarcoma has spread to only a few spots in the lung, those tumors can sometimes be removed.

Limb salvage surgery and reconstruction: More than 90% of patients with sarcoma in an arm or leg have surgery that spares the limb. Our surgeons are experts at reconstructing a limb or part of the pelvis even after removing a large amount of bone or tissue. We may use bone from another part of the body or advanced 3D printing technology to produce synthetic bone.

Learn more about cancer surgery at the Knight Cancer Institute.

Kristina Golsan, R.N., treats patients at OHSU who have sarcoma and other conditions.
Kristina Golsan, RN, treats patients sarcoma patients at OHSU.

Radiation therapy

Radiation therapy for soft tissue sarcomas: High-energy rays, such as X-rays, are aimed at cancer cells to kill them. It may be the main treatment if surgery would do too much damage to vital tissues or if a patient is in poor health. Most radiation treatments for sarcoma use external beam radiation therapy, or rays delivered from outside the body. Your care team might recommend one of these types:

  • Stereotactic radiosurgery: This usually delivers the whole dose in one session, though it may be repeated if needed. Despite its name, it’s not surgery. It’s precisely targeted radiation therapy. It is used mostly for tumors inside the head. The head is secured in a frame, and CT or MRI scans are used to pinpoint the tumor.
  • Stereotactic body radiation therapy: This is similar to stereotactic radiosurgery but is given in five sessions. It’s sometimes called fractionated radiosurgery or stereotactic radiotherapy.
  • Three-dimensional conformal radiation therapy: This type, sometimes called 3D-CRT, targets the cancer from different directions with shaped energy beams. You will be fitted with a mold or cast to keep the body part still and to limit damage to healthy tissue.
  • Intensity modulated radiation therapy: IMRT is a newer method in which energy beams match the shape of the tumor. Your care team can change the strength of beams in some areas to spare healthy tissue and possibly reduce side effects.
  • Intraoperative radiation therapy: IORT gives one large dose of radiation during surgery to the “tumor bed” where the tumor was removed. It allows for a high dose while protecting healthy tissue.

Radiation therapy for bone sarcomas: Radiation therapy is used less often for most bone sarcomas because they require high doses that could damage other tissue. It is used for Ewing tumors, though, and for bone cancers that can’t be completely removed with surgery.

Learn more about radiation therapy at the Knight Cancer Institute.

Chemotherapy

Chemotherapy — medications taken by mouth or in a slow drip into a vein — is used for some sarcomas, often in combination with radiation. It can be part of treatment before or after surgery.

Chemotherapy for soft tissue sarcomas: Medicines, often in combination, circulate through the body to kill cancer cells. They also affect normal cells, often causing side effects. The U.S. Food and Drug Administration has approved several new sarcoma medications in recent years.

Chemotherapy for bone sarcomas: Chemotherapy is often an important part of treating Ewing sarcoma and osteosarcoma. It’s seldom used for other bone cancers because it has little effect on them.

Targeted therapy

Targeted therapy is a powerful type of treatment that homes in on a “target” located on cancer cells. This knocks out cancer cells while reducing side effects. We use targeted therapy for both soft tissue and bone sarcomas.

Our doctors led the study showing regorafenib, a targeted therapy drug, can help patients with advanced bone sarcoma. Regorafenib, which is taken as a pill, is the first new treatment option for this type of cancer in decades.

Immunotherapy

Immunotherapy harnesses the power of your own immune system to knock out cancer cells. Immune checkpoint inhibitors are a type of immunotherapy. New research suggests that these drugs can be effective against some types of sarcoma. Researchers at the Knight Cancer Institute are currently conducting clinical trials to see if they can help more patients.

Follow-up care

Extensive rehabilitation and physical therapy may be essential after surgery on sarcoma in a limb. Without it, a limb may lose function. A patient who had leg-sparing surgery for sarcoma, for example, may need a year to relearn how to walk.

Our expert rehabilitation specialists can help you regain function, manage side effects, and work toward your full potential.

Learn more

For patients

Call 503-494-7999 to:

  • Request an appointment
  • Seek a second opinion
  • Ask questions

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Parking is free for patients and their visitors.

Center for Health & Healing Building 2
3485 S. Bond Ave.
Portland, OR 97239
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Read more

New treatment for bone sarcoma

Researchers at the Knight Cancer Institute and other hospitals have figured out how to use targeted therapy to treat bone sarcoma. Read more about regorafenib and how it helps patients with advanced  bone sarcoma.

Targeted therapy stops a rare, joint-destroying tumor

A healthy patient takes a break from riding a motorcycle along a country road.

Brian Matakovich was successfully treated with a new drug for tenosynovial giant cell tumor, a rare type of bone cancer. His doctor at the Knight treated him with pexidartinib, a targeted therapy.