Sarcomas are uncommon cancers that develop in your body’s connective tissues, including bone, cartilage, fat, muscle, nerves, blood vessels and lymph vessels. Sarcomas are typically divided into two main types, bone cancer (osteosarcoma) and soft tissue sarcoma, the latter of which has over 50 classifications, depending on tissue type affected.
Listen in as Brooke Crawford, MD explains that at City of Hope, our dedicated team of health professionals take a patient-centered approach to diagnosing and treating sarcomas, which include tumors and cancers of the bone, cartilage, muscle, fat, nerves, blood and lymph vessels, deep skin tissue, joint tissue.
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Sarcoma or Musculoskeletal Cancer Treatment Options
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Learn more about Brooke Crawford, MD
Brooke Crawford, MD
Brooke Crawford, M.D., is an Assistant Clinical Professor in the Department of Surgery, specializing in orthopedic surgery. Dr. Crawford earned her undergraduate degree magna cum laude from Santa Clara University. She received her medical doctorate from Oregon Health & Science University, where she also completed an internship in general surgery. Dr. Crawford continued her post graduate education with a residency and fellowship in orthopedics at Saint Louis University Hospital, followed by a musculoskeletal oncology fellowship at Massachusetts General Hospital.Learn more about Brooke Crawford, MD
Transcription:
Sarcoma or Musculoskeletal Cancer Treatment Options
Melanie: (Host): If you've been diagnosed with a sarcoma or musculoskeletal cancer, there may be treatment options you haven't considered. My guest today is Dr. Brooke Crawford. She's an Assistant Clinical Professor in the Department of Surgery, specializing in orthopedic surgery at City of Hope. Welcome to the show. Dr. Crawford, what is a sarcoma?
Dr. Brooke Crawford (Guest): Sarcoma is a tumor of the connective tissue, so muscle or bone, but it's not your typical cancer that we think of when we think of lung cancer or liver cancer. Those tend to be the glandular organ. So, sarcoma is a tumor of connective tissue.
Melanie: Are there certain risk factors that are linked to sarcomas?
Dr. Crawford: The biggest one is the history of radiation exposure. Someone who may have worked in a nuclear power plant or gets a lot of x-ray exposure and didn't wear the appropriate safety protection like the leaded aprons and things that we have. The other risk with radiation is sometimes patients who have had radiation to a bone cancer, like a lung cancer that's traveled to bone and things like that. They can be at risk for a secondary sarcoma.
Melanie: How would somebody know? Is this a lump that you would feel on some of that musculoskeletal tissue? What are some of the symptoms?
Dr. Crawford: The symptoms, typically, if it's a bone, then you will feel pain because it tends to weaken the bone, or it can grow into sort of a lump that you feel that's hard because sometimes the sarcoma can actually create more bone than it eats away bone. The other option is a soft tissue sarcoma or a muscular sarcoma. Then, you would feel a lump and, typically, those are again painless. They tend to be slow growing and people sometimes find them accidentally if they do a certain kind of stretch or they put their clothes on and say, "Oh! This fits my leg a little funny today compared to what it has been before."
Melanie: Then, how do you diagnose a sarcoma?
Dr. Crawford: We do several things, we image it. X-rays help for the bone tumors. For the soft tissue tumors, we oftentimes need an MRI. Most importantly, we need a biopsy. We need a little piece of that issue to analyze under a microscope because there are a lot of both bony tumors and soft tissue tumors that are benign that still require treatment but are not actually a malignant cancer.
Melanie: If somebody is diagnosed and you detect a sarcoma. People hear the word “cancer” and right away, Dr. Crawford, they get really nervous about it. Is this a type of cancer that is able to be treated successfully?
Dr. Crawford: This is a curable cancer. The mainstay of treatment for all sarcomas is surgical resection. For some of the bone tumors, we also actually add chemotherapy, and for some of the soft tissue tumors, we will often add some radiation therapy, especially if it's around something like a vital structure, like a big nerve or a big blood vessel and we can't take it out without injuring that nerve or blood vessel, we will often use radiation to take care of the microscopic cells. But, yes, people do survive sarcomas for many years and they are treatable and they are curable, in fact.
Melanie: Do they tend to recur?
Dr. Crawford: Yes. So, you do have a local recurrence rate which would be that it comes back in the same place. The biggest risk factor for that would be your negative margins and the biology of the tumor. So, there are different ones that are more aggressive than others; and, then, they can also recur systematically which means somewhere else in the body. For sarcomas, the place they tend to crop up most often is in the lung.
Melanie: Dr. Crawford, are you using targeted therapies or immunotherapies to target sarcomas?
Dr. Crawford: Yes, we do. We do a lot of gene testing and this sarcoma is a very broad term. There are many even in a certain category of sarcoma, like osteo-sarcoma, they're very diverse even among patients on what they're susceptible to. There are many genes, many antigens on these tumors, and we test them for all of them so that we can narrow down our chemotherapy to a specific person and a specific tumor. Not all of them have that but many of them do which is very promising for us when we can find a specific genetic defect or a specific antigen that we can target.
Melanie: Tell us about your team at City of Hope and what's exciting on the horizon for sarcoma and other musculoskeletal cancers?
Dr. Crawford: I think the exciting thing about sarcoma surgery, in general, is that we can take somebody who probably 30 years ago, with this diagnosis, would require an amputation just to get the tumor off and we can reconstruct their limbs most of the time--over 90-95% of the time, we are reconstructing limbs that previously would require an amputation to get the tumor out. I think that's always very exciting. There are multiple ways to do that, either with metal for bone tumors; or, for soft tissue tumors, we have some laps and things like that our plastic surgeons will help us with. In terms of some innovations that we're doing for some of the benign bone tumors I was talking about, we tend to go into the bone for those tumors and scoop them out and replace them with bone graft or bone cement. We're trying to develop a method of making that surgery for these benign tumors a little bit smaller, using maybe robotics because City of Hope was a place where DiVinci robot for prostate surgery was really first looked at as a real possibility, first sort of held out as the tool that it is now. And so, we're trying to stick with theme and use it in an orthopedic indication now. We're very excited about that because you can imagine if you have a big tumor in your bone and you have to scrape it out, even if it's benign it still requires a large incision and a big recovery time. So, if we can make that smaller and better for the patient to recover from, I think that would be an amazing advance.
Melanie: What's life like for someone who has really gone through sarcoma or other musculoskeletal cancer treatment and then afterwards how often do you like to see them to give them a recheck and see if there's any recurrence?
Dr. Crawford: We usually see people every three months for the first three to four years and then you can start lengthening it a little bit to maybe every four months or even every six months, and about after five years we start doing it pretty regularly at every six months. Then, a couple of years after the five year, your recurrence rate actually after five years goes down quite a bit. And so, then, we start doing six months and maybe two years. After that we would start seeing the person yearly. They always will end up with imaging of their chest because that's where sarcoma likes to go if it's not going to show up back in the same place, and then they usually have an x-ray or an MRI of the location that the tumor originally showed up. In terms of what life is like for them, it's very stressful. I think even if you are successfully treated, they still have to go in and think about the possibility of every time you have one of those tests that maybe they see something abnormal, or maybe you're going to be told this time it came back. I think even when you're successfully treated, it's something that never leaves you. That anxiety that maybe this will be back and maybe we'll have to do more.
Melanie: Tell us about your team at City of Hope.
Dr. Crawford: My team in includes Dr. Dominic Femino, who is my partner and our nurse practitioner Helen Morman. They are just wonderful to work with. I'm relatively new here, so they've made it very, very easy to come join their team. We also have a very big team of multi-disciplinary general surgeons and oncologists, plastic surgeons. So, it's been a very cohesive group. I think that is one of the best part about it and one of the reasons I was so excited to be able to join the team.
Melanie: Thank you so much for being with us today, Dr. Crawford. You're listening to City of Hope Radio. For more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie:. Thanks so much for listening.
Sarcoma or Musculoskeletal Cancer Treatment Options
Melanie: (Host): If you've been diagnosed with a sarcoma or musculoskeletal cancer, there may be treatment options you haven't considered. My guest today is Dr. Brooke Crawford. She's an Assistant Clinical Professor in the Department of Surgery, specializing in orthopedic surgery at City of Hope. Welcome to the show. Dr. Crawford, what is a sarcoma?
Dr. Brooke Crawford (Guest): Sarcoma is a tumor of the connective tissue, so muscle or bone, but it's not your typical cancer that we think of when we think of lung cancer or liver cancer. Those tend to be the glandular organ. So, sarcoma is a tumor of connective tissue.
Melanie: Are there certain risk factors that are linked to sarcomas?
Dr. Crawford: The biggest one is the history of radiation exposure. Someone who may have worked in a nuclear power plant or gets a lot of x-ray exposure and didn't wear the appropriate safety protection like the leaded aprons and things that we have. The other risk with radiation is sometimes patients who have had radiation to a bone cancer, like a lung cancer that's traveled to bone and things like that. They can be at risk for a secondary sarcoma.
Melanie: How would somebody know? Is this a lump that you would feel on some of that musculoskeletal tissue? What are some of the symptoms?
Dr. Crawford: The symptoms, typically, if it's a bone, then you will feel pain because it tends to weaken the bone, or it can grow into sort of a lump that you feel that's hard because sometimes the sarcoma can actually create more bone than it eats away bone. The other option is a soft tissue sarcoma or a muscular sarcoma. Then, you would feel a lump and, typically, those are again painless. They tend to be slow growing and people sometimes find them accidentally if they do a certain kind of stretch or they put their clothes on and say, "Oh! This fits my leg a little funny today compared to what it has been before."
Melanie: Then, how do you diagnose a sarcoma?
Dr. Crawford: We do several things, we image it. X-rays help for the bone tumors. For the soft tissue tumors, we oftentimes need an MRI. Most importantly, we need a biopsy. We need a little piece of that issue to analyze under a microscope because there are a lot of both bony tumors and soft tissue tumors that are benign that still require treatment but are not actually a malignant cancer.
Melanie: If somebody is diagnosed and you detect a sarcoma. People hear the word “cancer” and right away, Dr. Crawford, they get really nervous about it. Is this a type of cancer that is able to be treated successfully?
Dr. Crawford: This is a curable cancer. The mainstay of treatment for all sarcomas is surgical resection. For some of the bone tumors, we also actually add chemotherapy, and for some of the soft tissue tumors, we will often add some radiation therapy, especially if it's around something like a vital structure, like a big nerve or a big blood vessel and we can't take it out without injuring that nerve or blood vessel, we will often use radiation to take care of the microscopic cells. But, yes, people do survive sarcomas for many years and they are treatable and they are curable, in fact.
Melanie: Do they tend to recur?
Dr. Crawford: Yes. So, you do have a local recurrence rate which would be that it comes back in the same place. The biggest risk factor for that would be your negative margins and the biology of the tumor. So, there are different ones that are more aggressive than others; and, then, they can also recur systematically which means somewhere else in the body. For sarcomas, the place they tend to crop up most often is in the lung.
Melanie: Dr. Crawford, are you using targeted therapies or immunotherapies to target sarcomas?
Dr. Crawford: Yes, we do. We do a lot of gene testing and this sarcoma is a very broad term. There are many even in a certain category of sarcoma, like osteo-sarcoma, they're very diverse even among patients on what they're susceptible to. There are many genes, many antigens on these tumors, and we test them for all of them so that we can narrow down our chemotherapy to a specific person and a specific tumor. Not all of them have that but many of them do which is very promising for us when we can find a specific genetic defect or a specific antigen that we can target.
Melanie: Tell us about your team at City of Hope and what's exciting on the horizon for sarcoma and other musculoskeletal cancers?
Dr. Crawford: I think the exciting thing about sarcoma surgery, in general, is that we can take somebody who probably 30 years ago, with this diagnosis, would require an amputation just to get the tumor off and we can reconstruct their limbs most of the time--over 90-95% of the time, we are reconstructing limbs that previously would require an amputation to get the tumor out. I think that's always very exciting. There are multiple ways to do that, either with metal for bone tumors; or, for soft tissue tumors, we have some laps and things like that our plastic surgeons will help us with. In terms of some innovations that we're doing for some of the benign bone tumors I was talking about, we tend to go into the bone for those tumors and scoop them out and replace them with bone graft or bone cement. We're trying to develop a method of making that surgery for these benign tumors a little bit smaller, using maybe robotics because City of Hope was a place where DiVinci robot for prostate surgery was really first looked at as a real possibility, first sort of held out as the tool that it is now. And so, we're trying to stick with theme and use it in an orthopedic indication now. We're very excited about that because you can imagine if you have a big tumor in your bone and you have to scrape it out, even if it's benign it still requires a large incision and a big recovery time. So, if we can make that smaller and better for the patient to recover from, I think that would be an amazing advance.
Melanie: What's life like for someone who has really gone through sarcoma or other musculoskeletal cancer treatment and then afterwards how often do you like to see them to give them a recheck and see if there's any recurrence?
Dr. Crawford: We usually see people every three months for the first three to four years and then you can start lengthening it a little bit to maybe every four months or even every six months, and about after five years we start doing it pretty regularly at every six months. Then, a couple of years after the five year, your recurrence rate actually after five years goes down quite a bit. And so, then, we start doing six months and maybe two years. After that we would start seeing the person yearly. They always will end up with imaging of their chest because that's where sarcoma likes to go if it's not going to show up back in the same place, and then they usually have an x-ray or an MRI of the location that the tumor originally showed up. In terms of what life is like for them, it's very stressful. I think even if you are successfully treated, they still have to go in and think about the possibility of every time you have one of those tests that maybe they see something abnormal, or maybe you're going to be told this time it came back. I think even when you're successfully treated, it's something that never leaves you. That anxiety that maybe this will be back and maybe we'll have to do more.
Melanie: Tell us about your team at City of Hope.
Dr. Crawford: My team in includes Dr. Dominic Femino, who is my partner and our nurse practitioner Helen Morman. They are just wonderful to work with. I'm relatively new here, so they've made it very, very easy to come join their team. We also have a very big team of multi-disciplinary general surgeons and oncologists, plastic surgeons. So, it's been a very cohesive group. I think that is one of the best part about it and one of the reasons I was so excited to be able to join the team.
Melanie: Thank you so much for being with us today, Dr. Crawford. You're listening to City of Hope Radio. For more information, you can go to www.cityofhope.org. That's www.cityofhope.org. This is Melanie:. Thanks so much for listening.