Surgery for sarcoma that has spread
When sarcoma spreads to a different part of the body, it is called secondary or metastatic cancer. Sarcoma spreads most often to the lungs. It might also spread to the liver.
Surgery to remove secondary cancer
It is sometimes possible to operate to remove areas of sarcoma in the lung or liver. But this is only possible for a small number of people who have a limited number of secondary tumours. This is major surgery. Your doctor can explain what is involved and the possible risks.
Other treatment options
Your doctor is unlikely to offer you surgery if the sarcoma has spread anywhere else in your body. They will probably suggest chemotherapy instead. This is because chemotherapy circulates throughout the body and aims to treat all areas of cancer spread.
For certain types of sarcoma, you might have radiotherapy to treat a secondary (metastatic) cancer. You might also have radiotherapy to relieve the symptoms caused by a secondary cancer.
What is specialist surgery?
Your doctor might suggest other more specialised types of surgery. These might be an option if you only have cancer cells in your liver or lung (and not anywhere else in the body).
Your doctor will take several factors into account before deciding whether any of these are possible for you. They will talk to you about the possible benefits and risks of these treatments in your situation.
Types of specialist surgery
There are many different types of specialist surgery for soft tissue sarcomas. These procedures aim to kill off the cancer cells without causing too much bleeding or other side effects.
This treatment is for cancers that have spread to your liver. The spread is called secondaries or metastases. The doctor will inject small beads containing chemotherapy medication into the small arteries feeding the tumour. The beads block these blood vessels.
During surgery
You may have a medicine to make you feel drowsy. The surgeon then injects a local anaesthetic into the skin over a blood vessel at the top of your leg.
While using x-ray pictures, the surgeon slides a thin plastic tube into the blood vessel. Next, they push the tube gently upwards until the tip is in the artery that takes blood to the liver. When the tube is in position, the surgeon injects small beads containing chemotherapy medication into the small arteries feeding the tumour. The surgeon then removes the tube.
High levels of chemotherapy stay in the tumour for a few hours. This kills some of the cancer cells and shrinks the tumour. The treatment takes between 1 and 2 hours.
After surgery
You may have some flu like symptoms or feel tired for a few weeks.
Radiofrequency ablation uses radio waves to destroy cancer cells that have spread into your liver or lung by heating them to high temperatures.
During surgery
You usually have radiofrequency ablation under a general anaesthetic. But you might be able to have a sedative too. If you have a sedative, your doctor will inject a local anaesthetic into the skin of your tummy (abdomen) or chest to numb it. They then push a thin needle through the skin and into the centre of each tumour.
They use a CT or ultrasound scan to make sure the needles are in the right place. Then they pass radio waves through the needle to heat the tumours and destroy them. Doctors use RFA to treat tumours up to 5cm (2 inches) in size. How long it takes depends on the size of the tumour.
After surgery
Usually, you can go home a few hours afterwards. But some people might stay overnight. You may need to have the treatment repeated. The main side effects are pain and a high temperature for a few days. You can have medicines to make you more comfortable.
Radiofrequency assisted surgery uses high frequency radio waves to destroy the cancer, as in radiofrequency ablation. The National Institute for Health and Care Excellence (NICE) says there isn't enough evidence yet to show that it is any better than other ways of removing cancer in the liver. We don't yet know much about how well this treatment may work for lung tumours.
During surgery
You usually have a general anaesthetic for this type of surgery. The surgeon uses an ultrasound scan to see where the radiofrequency probe is. When the probe is in the right place, the surgeon uses it to destroy the cancer and the liver tissue around it. Then they surgically remove the dead tissue along with the cancer.
After surgery
The idea behind this treatment is that heating the tissues seals blood vessels. So there isn't as much bleeding as there would be with a standard operation to remove cancer from the liver.
NICE has issued guidance saying that this procedure appears to be safe and works well enough to be used on cancer in the liver. But there is a higher risk of getting an infection afterwards.
Cryotherapy is also called cryosurgery. It means removing cancer by freezing it. NICE has approved cryotherapy as a treatment for small liver secondary cancers (usually up to 4 cm in diameter). Studies on secondary lung tumours are looking at whether cryotherapy:
- is safe
- work well
So, for secondary lung tumours, you might have it as part of a clinical trial.
During surgery
You may have it as part of open surgery under general anaesthetic or using keyhole techniques under local or general anaesthetic.
The surgeon puts one or more cryotherapy probes (called cryoprobes) through a small cut in the skin and into the cancer. Then, they use a CT or ultrasound scan to make sure each probe is in the right place.
The tip of the cryoprobe is then cooled to below freezing. The probe creates an ice ball within the surrounding tissue that aims to destroy the cancer cells. Sometimes the area is thawed for 10 to 15 minutes and then frozen again.
After surgery
You will have some pain afterwards and possibly a high temperature, but you will have painkillers to help. You usually leave the hospital the next day after the procedure.
Microwave ablation uses microwave energy to produce heat and kill cancer cells. You can have this treatment for more than one secondary liver or lung tumour.
NICE has approved microwave ablation as a treatment for cancer that has spread to the liver. NICE said that it is safe to treat liver tumours and that there is enough research to show that it works.
NICE says that research for how well it works for cancer that has spread to the lung is limited. So before you have this treatment, your doctor must make sure they explain all the risks involved and tell you about other available treatments. NICE also suggests that more research is necessary.
During surgery
You may have a local or general anaesthetic. The doctor puts a thin needle into each tumour. They use a CT scan to make sure the needles are in the right place. Then they connect the needles to a microwave generator. The microwaves are released through the needles to destroy the cancer cells.
After surgery
You usually stay overnight in hospital. You may have some pain and a high temperature. You can have medicines to make you more comfortable.
Laser therapy is also called laser ablation.
During surgery
The surgeon uses a very high powered beam of light to destroy cancer cells in the liver or lung, by heating them to high temperatures. You usually have a sedative to make you drowsy but you may have a general anaesthetic. If you have the sedative, your doctor will inject a local anaesthetic into the skin of your tummy (abdomen) or chest to numb it.
They then push a flexible tube that carries the laser light through the skin and into the centre of each tumour. The doctor uses a CT or ultrasound scan to make sure the tip of the tube is in the right place. Then the laser heats the tumours and destroys them.
Doctors use laser therapy to treat tumours up to 5cm (2 inches) in size. It takes about 10 to 15 minutes.
After surgery
Usually, you can go home a few hours afterwards. You may need to have the treatment repeated. The main side effects are pain and a high temperature for a few days afterwards. You can have medicines to make you more comfortable.
This treatment is for liver tumours. It uses sterile alcohol to destroy cancer cells. It is only suitable for liver tumours smaller than 4 to 5cm (1½ to 2 inches).
During surgery
You may have medicine to make you drowsy. The surgeon then injects local anaesthetic into the skin over the liver. Next they push a thin needle through the skin and into the tumours using a CT or ultrasound scan to ensure the needle is in the right place. Then they inject the alcohol directly into the tumour.
You can have this treatment for more than one tumour in the liver.
After surgery
It can be painful, so you take painkillers for a while afterwards. You might also have a fever or flushing. You usually stay overnight in hospital. You can have the treatment again if the tumours grow back.
This treatment is for lung secondaries, although it is not used very often for people with sarcoma. It is called irreversible electroporation. NICE has said that currently there is not enough evidence to be sure about how well the procedure works or how safe it is. So it should only be carried out as part of research studies.
During surgery
You have a general anaesthetic. Next, the surgeon pushes special needles through the skin of the chest and next to the tumour, using CT guidance. A series of short electrical impulses then pass between the needles over several minutes to destroy the tumour cells.
The needles may then be moved to repeat the process until the whole tumour has been treated, as well as a small area of surrounding tissue.
After surgery
You usually stay in hospital for a few days after the procedure. It may cause temporary changes in the heartbeat for some people, but you will have regular checks for this. You might also have flu like symptoms or a temperature.
