Sarcomes

1 – Notez tous les symptômes que vous rencontrez, y compris ceux qui peuvent sembler sans rapport avec la raison pour laquelle vous avez programmé le rendez-vous.

2 – Faites une liste de tous les médicaments, vitamines ou compléments alimentaires que vous prenez.

3 – Demandez à un membre de votre famille ou à un ami de venir avec vous. Parfois, il peut être difficile de se souvenir de toutes les informations qui vous ont été fournies lors d’un rendez-vous. Quelqu’un qui vous accompagne peut se souvenir de quelque chose que vous avez oublié.

4 – Notez les questions à poser à votre médecin. Votre temps avec votre médecin est limité, et la préparation d’une liste de questions peut vous aider à optimiser votre temps ensemble. Énumérez vos questions du plus important au moins important dans le cas où le temps s’écoule. Dans le cas d’un diagnostic suspecté de sarcome, voici quelques questions fondamentales à poser à votre médecin:

• Est-ce que j’ai un cancer ?
• Y a-t-il d’autres causes possibles de mes symptômes ?
• De quels types d’examens ai-je besoin pour confirmer le diagnostic ? Ces examens nécessitent-ils une préparation spéciale ?
• De quel type de sarcome suis-je atteint ?
• Quels traitements sont disponibles et le(s)quel(s) recommandez-vous ?
• Quels sont les effets secondaires du traitement ?
• J’ai d’autres problèmes de santé. Comment puis-je au mieux gérer cela ?
• Y a-t-il des restrictions alimentaires ou d’activités que je dois suivre ?
• Quel est mon pronostic ?
• Y a-t-il des brochures ou d’autres documents imprimés que je pourrais consulter ? Quels sites internet recommandez-vous ?

Le médecin que vous verrez en consultation est susceptible de vous poser un certain nombre de questions.

Être prêt à y répondre permettra de gagner du temps pour couvrir plus largement d’autres points que vous voulez discuter. Votre médecin peut ainsi vous demander :

• Quand avez-vous remarqué vos signes et symptômes pour la première fois ?
• Avez-vous mal ?
• Est-ce que quelque chose semble améliorer vos symptômes ?
• Existent-ils des éléments ou situations qui semblent aggraver vos symptômes ?
• Avez-vous des antécédents familiaux de cancer? Si oui, savez-vous quel type de cancer ?

Les examens complémentaires utilisés pour diagnostiquer les sarcomes comprennent :

• Examens d’imagerie : Des examens d’imagerie, tels que les radiographies, l’échographie la tomodensitométrie (scanner), l’imagerie par résonance magnétique (IRM) et la tomographie par émission de positons (TEP) peuvent être utilisés pour évaluer la zone qui pose problème ainsi que le reste du corps.
• Prélèvement d’un échantillon de tissu (biopsie) : Votre médecin peut demander une procédure de biopsie pour retirer un échantillon de la zone suspecte pour une analyse en laboratoire d’anatomo-pathologie. Pour réaliser cette biopsie, un médecin (radiologue ou chirurgien) peut utiliser une aiguille longue et fine. Un médecin formé à l’analyse des tissus corporels (anatomo-pathologiste) examine l’échantillon de tissu pour détecter les signes de cancer. Le pathologiste analyse également l’échantillon pour déterminer le type de tumeur (bénigne ou maligne : cancer), et son agressivité.

You have been referred to Institut Bergonié for the diagnostic workup of a soft-tissue or bone lesion. Such lesions may be a sarcoma but only an histological assessment of a biopsy would allow confirmation of diagnosis.

Because appointments can be brief, and there’s often a lot of ground to cover, it’s a good idea to arrive well-prepared. Here’s some information to help you get ready.

What you can do

• Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, vitamins or supplements that you’re taking.
• Ask a family member or friend to come with you. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For a sarcoma, some basic questions to ask your doctor include:

• Do I have cancer?
• Are there other possible causes for my symptoms?
• What kinds of tests do I need to confirm the diagnosis? Do these tests require any special preparation?
• What type of sarcoma do I have?
• What stage is it?
• What treatments are available, and which do you recommend?
• Can the cancer be removed?
• What types of side effects can I expect from treatment?
• I have other health conditions. How can I best manage these conditions together?
• Are there any dietary or activity restrictions that I need to follow?
• What’s my prognosis?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to cover other points you want to discuss. Your doctor may ask:

• When did you first notice your signs and symptoms?
• Are you experiencing pain?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do you have any family history of cancer? If so, do you know what type of cancer?

Tests and procedures used to diagnose  sarcoma include:

• Imaging tests. Imaging tests, such as X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET), may be used to evaluate the area of concern.
• Removing a sample of tissue for testing. Your doctor (radiologist or surgeon) may perform a biopsy procedure to remove a sample of the suspected sarcoma for testing in a lab. To remove the sample, your doctor may use a long, thin needle.

In the lab, a doctor trained in analyzing body tissues (pathologist) examines the tissue sample for signs of cancer. The pathologist also analyzes the sample to understand the type of cancer and to determine whether the cancer is aggressive.

Your doctor has confirmed you the diagnosis of sarcoma. Your treatment options for sarcoma will depend on the size, type and location of your tumor.

Surgery

Surgery is a common treatment for soft tissue sarcoma. Surgery generally involves removing the cancer and some healthy tissue surrounding it.

When  sarcoma affects the arms and legs, it may be necessary to amputate the affected arm or leg. Doctors try their best to avoid amputation. One option to achieve this may be using chemotherapy and radiation to shrink the tumor before surgery, which increases the likelihood that an amputation will be unnecessary.

When sarcoma spreads to another area of the body, surgery has a limited role but can be proposed in some cases.

Radiation therapy

Radiation therapy involves treating cancer with beams of energy, such as X-rays or protons.

Your doctor may suggest using radiation therapy before surgery to shrink a tumor to make it easier to remove with surgery. Radiation is also used after surgery to kill any cancer cells that remain.

Chemotherapy and radiation may be combined.

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy can be administered by pill, through a vein (intravenously), or both methods may be used.

Some forms of sarcoma respond better to chemotherapy than do others. For instance, chemotherapy is often used to treat rhabdomyosarcoma.

Targeted drug treatment

Targeted drugs block specific abnormal signals present in sarcoma cells that allow them to grow.

Some of the targeted drugs used to treat one type of sarcoma include:

• Imatinib (Gleevec)
• Sunitinib (Sutent)
• Regorafenib (Stigvara)
• Pazopanib (Votrient)

Many new targeted drugs are being studied.

As an international reference center, the sarcoma group of Institut Bergonié is leading an ambitious research program. Together, sarcoma disease-oriented team members do research to improve understanding and management of these rare cancers. Our main goals are to:

• Describe inherited factors that confer risk for sarcoma
• Identify and avoid defective cellular functions that result in these cancers
• Develop effective treatments
• Develop new imaging approaches and diagnostics for detecting and characterizing sarcomas

Pr Antoine ITALIANO is leading a pre-clinical team (Unité INSERM Action). One of the project developed by this team is to make it possible to create “personal” mouse models of cancer, called xenografts, from an individual’s cancer cells. To make a xenograft, researchers implant tumor tissue from patients into mice. The grafted tumors grow, looking and behaving like the original human tumors. They even spread to the same places in the bodies of mice as in patients. Our researchers have created mouse models for different types of sarcomas and use these to pursue new and improved cancer treatments.

We lead also several clinical trials to improve on current standards for treatment and to enhance quality of life. Clinical trials are research studies that evaluate the safety and effectiveness of new ways to diagnose and treat sarcoma. These studies can also help doctors compare the effectiveness of prevention strategies or other aspects of your care.

Institut Bergonié trials for  sarcomas are listed below. Isntitut Bergonié has one of the largest phase I oncology unit in France which uniquely affords access to first in-man and early clinical trials for appropriate sarcoma patients. Therefore, there may be additional trials that are appropriate for your cancer. We recommend that you consult with your physician, who can inquire on your behalf as to whether a trial is appropriate for you.