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NCCN Guidelines for Patients


Soft Tissue Sarcoma, Version 1.2014


Multidisciplinary team

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