SARCOMAS TREATMENTS

Since the 1960s, when amputation was the only treatment for bone cancer, new chemotherapy drugs and innovative surgical techniques have improved survival with intact limbs. Because osteosarcoma is so rare, patients should consider undergoing treatment at a major cancer center staffed by specialists familiar with the disease.

A treatment plan for bone cancer, developed after the tumor has been diagnosed and staged, may include:

• Amputation. Amputation may be the only therapeutic option for large tumors involving nerves or blood vessels that have not responded to chemotherapy. MRI scans indicate how much of the diseased limb must be removed, and surgery is planned to create a cuff, formed of muscles and skin, around the amputated bone. Following surgery, an artificial (prosthetic) leg is fitted over the cuff. A patient who actively participates in the rehabilitation process may be walking independently as soon as three months after the amputation.
• Chemotherapy. Chemotherapy is usually administered in addition to surgery, to kill cancer cells that have separated from the original tumor and spread to other parts of the body. Although chemotherapy can increase the likelihood of later development of another form of cancer, the American Cancer Society maintains that the need for chemotherapeutic bone-cancer treatment is much greater than the potential risk.
• Surgery. Surgery, coordinated with diagnostic biopsy, enhances the probability that limb-salvage surgery can be used to remove the cancer while preserving nearby blood vessels and bones. A metal rod or bone graft is used to replace the area of bone removed, and subsequent surgery may be needed to repair or replace rods that have loosened or broken. Patients who have undergone limb-salvage surgery need intensive rehabilitation. It may take as long as a year for a patient to regain full use of a leg following limb-salvage surgery, and patients who have this operation may eventually have to undergo amputation.
• Radiation therapy. Radiation therapy is used often to treat Ewing's sarcoma.
• Rotationoplasty. Rotationoplasty, sometimes performed after a leg amputation, involves attaching the lower leg and foot to the thigh bone, so that the ankle replaces the knee. A prosthetic is later added to make the leg as long as it should be. Prosthetic devices are not used to lengthen limbs that remain functional after amputation to remove osteosarcomas located on the upper arm. When an osteosarcoma develops in the jaw bone, the entire lower jaw is removed. Bones from other parts of the body are later grafted on remaining bone to create a new jaw.

Follow-up treatments

After a patient completes the final course of chemotherapy, CAT scans, bone scans, x rays, and other diagnostic tests may be repeated to determine if any traces of tumor remain. If none are found, treatment is discontinued, but patients are advised to see their oncologist and orthopedic surgeon every two or three months for the next year. X rays of the chest and affected bone are taken every four months. An annual echocardiogram is recommended to evaluate any adverse effect chemotherapy may have had on the heart, and CT scans are performed every six months.

Patients who have received treatment for Ewing's sarcoma are examined often - at gradually lengthening intervals - after completing therapy. Accurate growth measurements are taken during each visit and blood is drawn to be tested for side effects of treatment. X rays, CT scans, bone scans, and other imaging studies are generally performed every three months during the first year. If no evidence of tumor growth or recurrence is indicated, these tests are performed less frequently in the following years.

Some benign bone tumors shrink or disappear without treatment. However, regular examinations are recommended to determine whether these tumors have changed in any way.

SARCOMAS ALTERNATIVE TREATMENTS

Alternative treatments should never be substituted for conventional bone-cancer treatments or used without the approval of a physician. However, some alternative treatments can be used as adjunctive and supportive therapies during and following conventional treatments.

Dietary adjustments can be very helpful for patients with cancer. Whole foods, including grains, beans, fresh fruits and vegetables, and high quality fats, should be emphasized in the diet, while processed foods should be avoided. Increased consumption of fish, especially cold water fish like salmon, mackerel, halibut, and tuna, provides a good source of omega-3 fatty acids. Nutritional supplements can build strength and help maintain it during and following chemotherapy, radiation, or surgery. These supplements should be individually prescribed by an alternative practitioner who has experience working with cancer patients.

Many cancer patients claim that acupuncture alleviates pain, nausea, and vomiting. It can also be effective in helping to maintain energy and relative wellness during surgery, chemotherapy, and radiation. Massage, reflexology, and relaxation techniques are said to relieve pain, tension, anxiety, and depression. Exercise can be an effective means of reducing mental and emotional stress, while increasing physical strength. Guided imagery, biofeedback, hypnosis, body work, and progressive relaxation can also enhance quality of life.

Claims of effectiveness in fighting cancer have been made for a variety of herbal medicines. These botanical remedies work on an individual basis and should only be used when prescribed by a practitioner familiar with cancer treatment.

Treating cancer is a complex and individual task. It should be undertaken by a team of support practitioners with varying specialities who can work together for healing the person with cancer.