NCCN Guidelines for Patients
Soft Tissue Sarcoma, Version 1.2014
Treatment of sarcoma takes a team of experts
who have experience with this cancer. If you have
sarcoma, it is important that all the experts meet
before your treatment is started to create the best
treatment plan. Your treatment team will also meet
while you are going through treatment and afterward
to discuss the treatment results and the next steps of
care. Your team of experts may include a:
In most cases
• Pathologist—an expert in testing cells and
tissue to find disease,
• Radiologist—an expert in imaging tests,
• Oncology surgeon—an expert in operations
that remove cancer,
• Medical oncologist—an expert in cancer
• Radiation oncologist—an expert in radiation
treatment, and a
• Nurse—an expert trained to care for the sick.
In some cases
• Thoracic surgeon—an expert in operations
within the chest,
• Gastroenterologist—an expert in digestive
• Plastic surgeon—an expert in operations to
improve function and appearance,
• Social worker—an expert in meeting social
and emotional needs,
• Occupational therapist—an expert in helping
people live life unaided or with devices,
• Physical therapist—an expert in helping
people move better,
• Nutritionist—an expert in healthy foods and
drinks, and a
• Genetic counselor—an expert in explaining
testing for hereditary diseases.
Medical history and physical exam
Your medical history includes any health events in
your life. It also includes any medications you’ve
taken or are taking. Since some health problems run
in families, your doctor will ask about the medical
history of your blood relatives.
Doctors often perform a physical exam along with
taking a medical history. A physical exam is a review
of your body for signs of disease. During this exam,
your doctor will listen to your lungs, heart, and gut.
Parts of your body will likely be felt to see if organs
are of normal size, are soft or hard, or cause pain
when touched. Your lymph nodes may feel large if
cancer has spread to them.
GISTs are soft and fragile tumors. Thus, a biopsy
called a EUS-FNA (
spiration) is recommended. A biopsy is
removal of tissue or fluid samples to test for disease.
The samples will be studied under a microscope by a
pathologist in order to confirm if there’s cancer.
EUS is a better choice of biopsy for GISTs than
a biopsy through the skin (percutaneous). With a
percutaneous biopsy, there is a chance that the
tumor may leak blood (hemorrhage) and spread. A
percutaneous biopsy guided to the tumor by imaging
may be okay for metastatic tumors.
A biopsy of the tumor should be done for three
reasons. First, a biopsy is needed for a stomach
tumor smaller than 2 cm. The biopsy can help your
doctors know if it is a GIST and decide the best care.
Such small tumors may not be an aggressive cancer
that needs more treatment.
The second reason for a biopsy is for other GISTs
that receive other treatment before surgery. Likewise,
a biopsy is recommended when you can’t have
Gastrointestinal stromal tumors Treatment planning