What types of treatment are used?

The doctors involved in your care will take into account your age, general health and the type, stage and grade of the sarcoma in order to plan the best treatment for you. As sarcomas are rare cancers, you are likely to be referred for treatment at a specialist sarcoma unit where a group of specialist doctors and others work together. Known as a multidisciplinary team, this includes a surgeon, radiotherapy specialist (clinical oncologist) and chemotherapy specialist (medical oncologist), together with specialist nurses, social workers and physiotherapists.

What treatments are given

Surgery is the most common treatment. If the soft tissue sarcoma is small and it is possible to remove it completely, surgery may be used on its own.

For larger sarcomas, and where it is thought there is a possibility of cancer cells being left behind, radiotherapy is usually used as well as surgery. Radiotherapy may be given before the operation to shrink the tumour and make it easier to remove, or afterwards to try to destroy any tiny cancer cells that may not have been removed.

Chemotherapy may sometimes be given before surgery, to shrink the tumour, or sometimes after surgery, to try to destroy any cancer cells that have not been removed or which may have spread to other parts of the body.

For gastrointestinal stromal tumours a drug called imatinib (Glivec®) may be used before or after surgery.

You may find that other people at the hospital with soft tissue sarcomas are having different treatment from you. This may be because they have a different type of sarcoma and therefore have different needs.

If you have any questions about your own treatment, don’t be afraid to ask your doctor or nurse

It often helps to make a list of the questions you want to ask your doctor, and to take a close friend or relative with you.

Some people find it reassuring to have another medical opinion to help them decide about their treatment. Most doctors will be pleased to refer you to another specialist for a second opinion if you feel this will be helpful.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are
  advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need several explanations. You can also ask for the conversation to be tape-recorded so that you can replay it later.
It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, should you feel that you can’t make a decision when it is first explained to you. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.

It is important to tell a doctor, or the nurse in charge, immediately so that he or she can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

The benefits and disadvantages of treatment

Many people are frightened at the prospect of cancer treatments, particularly because of the potential side effects that can occur. Some people ask what would happen if they did not have any treatment.
Although many of the treatments can cause side effects, knowledge about how these treatments affect people and improved ways of reducing or avoiding many of these problems, have made most of the treatments much easier to cope with.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. In people with early-stage sarcoma, surgery is often done with the aim of curing the cancer, and additional treatments may also be given to reduce the risks of it coming back.

If the cancer is at a more advanced stage the treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. However, for some people the treatment will have no effect upon the cancer and they will get the side effects without any of the benefit.

If you have been offered treatment that will hopefully cure your cancer, the decision whether to accept the treatment may not be a difficult one. However, if a cure is not possible and the treatment is being given to control the cancer for a period of time, it may be more difficult to decide whether to go ahead with treatment or not.

Making decisions about treatment in these circumstances is always difficult, and you may need to discuss in detail with your doctor whether you wish to have treatment. If you choose not to, you can still be given supportive (palliative) care, with medicines to control any symptoms.

It is important that you ask your doctors and nurses any questions that you have about your treatment. It is true that the hospital staff are busy, but the more you understand about your treatment, the easier it is for you and them.