A patient presents with a lump in the muscle of his calf. It’s not particularly painful and he’s not complaining about feeling ill. The mass doesn’t move upon palpation, but the patient tells you it has grown from the size of a pea to that of a peach pit in just a few weeks. Because your patient could have a soft tissue sarcoma — which can be life-threatening as well as debilitating — it’s time for a referral to a surgeon who specializes in orthopedic oncology.

Soft tissue sarcomas are cancers that develop in connective tissues such as muscle, fat, blood vessels and nerves, tendons and ligaments, joint linings, deep skin tissues and fibrous tissues. Relatively rare, soft tissue sarcomas are diagnosed in about 14,000 people each year in the U.S., with undifferentiated pleomorphic sarcoma, liposarcoma and leiomysarcoma being the most common, according to the American Cancer Society.

“It’s imperative that we see and examine the patient to determine the correct treatment,” said Giovanni Paraliticci, M.D., an orthopedic surgeon with Baptist Health Orthopedic Care and Baptist Health Miami Cancer Institute. “Too often, without any evaluation such as advanced imaging and without biopsy, patients are told they just need to have the mass removed. Patients should be referred to a tertiary institution that specializes in orthopedic oncology and musculoskeletal oncology to decrease the chance of complications.”

Dr. Paraliticci spoke recently at a Baptist Health Orthopedic Care symposium, educating other physicians about soft tissue sarcomas and the latest advances in care. Although many masses are benign, those that aren’t require the input of a multidisciplinary team. Dr. Paraliticci works closely with radiologists, radiation oncologists, medical oncologists, plastic surgeons, pathologists, rehabilitation specialists and other healthcare professionals. In addition, a tumor board meets regularly to discuss patient cases to ensure the best course of treatment.

Red flags that prompt urgent attention include:

• Lumps that grow rapidly over a period of weeks or months
• Growths that are larger than 5 cm in diameter
• Masses that are fixed upon palpation and have a hard or firm consistency
• Growths that occur in a patient with a prior history of cancer
• Masses that are present in patients who have other symptoms, such as night sweats, fever, unexplained weight loss and pain that is worsening, especially at night

Doctors develop a personalized treatment plan for each patient. Many patients undergo imaging studies such as MRI, X-ray, CT or ultrasound, as well as biopsy. “People think that biopsies are simple, but the reality is that they are not,” Dr. Paraliticci said. One study he highlighted evaluated centers that performed core needle biopsy for sarcoma. It showed that there was nearly a 20 percent chance of a complication at centers that were not specialized in oncology. “The result of this complication can be devastating and lead to amputation,” he added.

Resection is the gold standard for soft tissue sarcomas, with the goal of complete removal of the tumor with negative margins, which provides the best chance for local control and cure. 

For some patients, neoadjuvant therapy that includes chemotherapy and/or radiation is recommended before surgery to reduce the size of the tumor, prevent metastatic disease and decrease local recurrence. Others may need chemotherapy or radiation after surgery (adjuvant therapy) to lower the risk of recurrence. 

“We want to provide our patients with the best surgical, oncological and functional outcome,” Dr. Paraliticci said. 

 

To refer a patient to Dr. Paraliticci or Baptist Health Orthopedic Care, call 786-596-8020.