Proactive Measures and a Multidisciplinary Approach Are Key for Diagnosis and Management of Sarcoma

Adam C. Berger, MD, FACS

The challenges currently associated with the diagnosis and treatment of patients with sarcomas highlight the importance of awareness regarding these rare malignancies and proactive screening when patients flag potential symptoms, according to Adam C. Berger, MD, FACS, who is the chief of Melanoma for the Melanoma and Soft Tissue Surgical Oncology Program at the Rutgers Cancer Institute of New Jersey and a professor of surgery at Rutgers Robert Wood Johnson Medical School in New Brunswick.

In an interview with OncLive® during Sarcoma Awareness Month, Berger discussed the challenges associated with diagnosing sarcoma at an early stage and the importance of a multidisciplinary approach when treating these patients. In a previous article, Berger detailed the common symptoms associated with sarcoma and how to approach diagnosis.

OncLive: What key aspects should clinicians be aware of regarding the diagnosis of sarcomas?

Berger: Because we often diagnose sarcomas at a later stage since they may not cause symptoms [early on], it's important to have awareness about what they are, where they happen, and what some of the subtle symptoms can be. Maybe we can try to find [a path toward] an earlier diagnosis, when [sarcomas] are smaller, easier to treat, and easier to remove.

It's also important to be aware of what the latest research shows, what ongoing clinical trials are [available], and if we have a research study that focused on a particular sarcoma [subtype]. It's important for [patients and clinicians] to understand where the state of the science is and where state-of-the-art care is going.

We cannot ignore some of these subtle symptoms [of sarcoma], and [patients and clinicians] should take them seriously. I tell patients that if they have something that is nagging them and it goes away, it's probably nothing; however, if you have something that is bothering you and keeps bothering you, then it's probably something worth investigating.

There are low-cost ways to start evaluating things. You can do an ultrasound of an area to see whether there's an inkling of something going on. If there's no inkling, then maybe it just stops there. However, it's important that we don't ignore some of these symptoms.

When a patient presents with sarcoma, what are some of the key steps for determining a treatment plan?

If patients are being treated in a cancer center or a hospital where there is a multidisciplinary team available to treat that patient, [it’s vital] that those patients are discussed in a multidisciplinary tumor board, which is what we do [at Rutgers Cancer Institute]. Our tumor board [meets] every 2 weeks to discuss patients with surgeons, radiation oncologists, medical oncologists, and radiologists. We also have orthopedic oncologists who work with us and who will also be available to talk about some of those [sarcoma] cases.

How do you discuss the complex process of diagnosing and identifying the subtype of sarcoma when speaking with patients?

It is important to acknowledge that the [sarcoma] field is so complicated because of the various tumor types and all the molecular testing that's done. What we see a lot is that patients will have a biopsy or have surgery for a sarcoma, and it sometimes takes 3 or 4 weeks to get the results back because of all the complicated testing that is [being done] to figure out exactly what kind of sarcoma it is.

I preach to these patients that we've done everything we can; we're just trying to get as much information as possible so we [can determine] the best way to treat them. I can't rush the pathologist to give me the answer, as I want them to do the best they can to determine what kind of sarcoma it is to give the patients what they need to know and how best to advise them.