Sarcomas Area

It is the most common childhood bone cancer, although its incidence is very low (1-2 cases per million inhabitants per year). That is the reason why it is important to carry out such treatments in experienced centres.

It usually affects children and adolescents, and the most frequent location is around the knee. Pain (mainly nocturnal) is the most frequent symptom, sometimes accompanied by an increase in volume of hard consistency.

Early diagnosis and treatment is of crucial importance to achieve the best survival rates and preservation of the limb.

Treatment consists of chemotherapy (at the Clinic we use intra-arterial chemotherapy to improve the response of the tumour) and surgery. The best results are achieved when the response to treatment is good and during surgery the tumour is completely removed. This requires the experience of a multidisciplinary team of radiologists, pathologists, oncologists, paediatricians, orthopaedic surgeons...

We have developed techniques such as epiphysiolysis prior to resection that manage to optimise the result, and which today have been spread worldwide via professionals who have trained at the Clinic.

It is the second most common bone sarcoma that also affects children and adolescents. Part of them are located in the axial skeleton (pelvis, spine, scapula, clavicle, ribs...) and the rest can appear in any bone.

Like osteosarcoma, nighttime pain in a child or adolescent is usually the initial symptom, with or without the appearance of a lump. The sooner treatment begins, the better the chance of cure.

Also in this tumour, the response to chemotherapy treatment is very important (although the drugs used are different from osteosarcoma) and good surgery which, in locations such as the pelvis or spine, is much more demanding than in the extremities. In some cases radiotherapy is also used.

In 80% of our cases, preoperative chemotherapy achieves rates of necrosis of the tumour close to 100%, which greatly facilitates its surgical resection.

An adult bone tumour can arise from a previous benign lesion (osteochondroma or chondroma) of childhood, or appear "exnovo". It can also produce night pain and the appearance of a hard lump of rapid growth.

It usually does not respond to chemotherapy or radiotherapy and therefore the main treatment is surgical. Some low-grade chondrosarcomas can be treated with very mild surgery, while high grade (II and III) require extensive surgery. Axial location chondrosarcomas require complex surgery.

It is a tumor of the epiphyses (the joint area) of the long bones. The most frequent locations are the knee and the wrist, in young adults (20-40 years old). It is a benign tumour, although locally aggressive.

The treatment was exclusively surgical until a decade ago, when a useful medication (Denosumab) was discovered in this tumour. Nowadays we use it as a previous treatment to facilitate surgery.

In most cases they are treated with curettage surgery (preserving the joint) and some adjuvant (liquid nitrogen, phenol, etc) to avoid recurrence.

This is a very heterogeneous group of tumours affecting the "non-bone" part of the locomotor system of the extremities and trunk. There are more than 60 different types, although the most common are those of the fatty lineage (liposarcomas), fibrous lineage (fifrosarcoma or fibrohistiocytoma), synovial sarcoma, neural lineage (schwanosarcomas), etc.

These are typical of adults and they are usually not very painful. The most frequent is the appearance of a lump of elastic consistency on a limb. The criteria for suspecting soft tissue sarcoma (when a lump appears) are:

• Lump with a diameter greater than 4-5 cm (like a golf ball).
• Painful.
• Rapid growth (weeks).
• Deep to the fascia.
• Even without having any of the previous characteristics, a lump that is removed and reappears.

Diagnosis requires imaging techniques (MRI and PET are especially useful). A biopsy is necessary to confirm clinical suspicion.

The pathologist must also be an expert to be able to distinguish between some sarcomas and others, and to classify them according to their aggressiveness (high grade or low grade).

The most effective therapeutic weapon is complete resection of the tumour. Radiotherapy is indicated in most large and deep tumours of the fascia, whereas chemotherapy is occasionally applied to high grade sarcomas. The prognosis depends on the extension at the beginning, the size of the tumour and the histological grade.

In hands of expert, the cure rate is around 80%, with the limb being preserved in the vast majority of cases.

Experienced surgeons must operate them on. Radiotherapy is effective in large or deep fascia tumours, whereas chemotherapy has little efficacy, although it is used in high grade metastatic tumours or as prevention of possible metastasis.

They are 3 times more frequent than bone sarcomas and are often under-diagnosed and treated by inexperienced doctors from different specialities. This means that in countries where these cases are not treated in experienced centres, the cure rate is much lower.