Meet Our M2G Sarcoma Doctor, Dr. Matthew DiCaprio
Dr. Matthew DiCaprio is Director of Orthopaedic Oncology at Albany Medical Center in Upstate New York. He shares the passion of the M2G team for raising awareness and much needed funding to find a cure for this rare cancer. Feel free to contact Dr. DiCaprio if you can’t find the answer to your question below.
What Is Sarcoma?
Sarcomas are malignant tumors (cancers) arising from connective tissues in our body; bone, cartilage,
fat, fibrous tissue, nerves, and blood vessels. They are a rare and diverse type of cancer that can arise in
bone or in soft tissues anywhere in the body.
What are the keys to a cure?
With early detection and aggressive treatment these cancers can be cured in 60-70% of patients. The survival data over the last 20 plus years has been very stagnant and new methods of treatment are needed to increase patient survival rates. Research is the only way to find new treatments and test their effectiveness in battling these rare tumors.
Who is affected?
- All ages are affected.
- There are approximately 3000 people diagnosed with a bone sarcoma per year in the US.
- There are approximately 9000 people diagnosed with a soft tissue sarcoma per year in the US.
- A majority of bone sarcomas are diagnosed in children
- Most soft tissue sarcomas are diagnosed in adults.
- There are many exceptions to this age rule.
What are the most common bone sarcomas?
- Ewing’s sarcoma
What are some common soft tissue sarcomas?
- Undifferentiated pleomorphic sarcoma (previously called malignant fibrous histiocytoma)
- Synovial sarcoma
There are roughly 50 different subtypes of soft tissue sarcomas. The specific type has little bearing on
treatment for a majority of patients. What is more important is the grade of the tumor. A pathologist
who looks at the tumor under a microscope is responsible for the grading. Less aggressive tumors are
low-grade and more aggressive tumors are high-grade. Knowing the grade helps the treating team
determine which treatment methods should be employed.
How do they present? What symptoms do patients with sarcoma have?
Most will present to a doctor with a growing mass.
Bone sarcomas typically present with pain and on occasion as a fracture through the weakened area
of bone involved. The pain starts off very mild and frequently is ignored until it becomes progressively
more severe and frequent. Many will have symptoms for 3-6 months before diagnosis.
In general, sarcoma patients are not sick when they have localized (only present in one location) disease
that has not spread.
Because these tumors are rare, many practicing physicians will never see or diagnose a sarcoma. There
is frequently a delay in diagnosis because of a lack of awareness. Any growing mass (lump or bump)
should be evaluated by a physician. If the mass is deep (below the fascia that covers muscle) and larger
than a golf ball it should be worked up with imaging (MRI, radiographs, etc…) prior to biopsy or removal.
For most cases there is no known exposure, environmental factor or trauma that predisposes people to
sarcomas. The only exceptions to this rule are a history of exposure to radiation or Agent Orange.
How are they diagnosed?
1st step is a careful history and physical examination.
Next step is appropriate use of diagnostic imaging
- Radiographs (XRAY)
- Magnetic resonance imaging (MRI)
- Computerized tomography (CT scan)
- Whole body bone scan
- Positron emission tomography (PET scan)
Biopsy is the Final and most critical step. A sample of the tumor is evaluated by a pathologist under a
microscope. Sometimes special techniques are needed to properly identify the tumor.
It is important for the team to work together in establishing a diagnosis. It often requires a synthesis
of the clinical information (history and physical examination), imaging findings and the microscopic
interpretation to establish a correct diagnosis. For this reason it is best for patients with a suspected
sarcoma to be referred to a center that specializes in their treatment early in the work-up. The biopsy
should be done by or guided by a surgeon experienced in the treatment of sarcomas at a center with a
team of physicians also experienced in the diagnosis and treatment of sarcomas.
Who treats Sarcomas?
A multidisciplinary team of physicians specially trained to diagnose and treat sarcomas. The team is
usually led by an Orthopaedic Oncologist (The Surgeon). The other team members necessary to care for
sarcomas include the following medical specialists:
- Adult Medical Oncologist – Chemotherapy doctor
- Pediatric Medical Oncologist – Chemotherapy doctor
- Radiation oncologist – Deliver radiation to the tumor
- Musculoskeletal Radiologist – Help with diagnostic imaging interpretation
- Musculoskeletal Pathologist – Look at the biopsy or resection specimens under a microscope
- Interventional Radiologists – Sometimes involved in biopsy and treatment techniques with surgeons
- Support staff – Nurses, Physical therapists, Social workers, etc…
What are the treatments for sarcomas?
- Surgical removal (resection), radiation therapy, and chemotherapy.
- Depending on the specific tumor type and patient factors a varying combination of these different
treatments are needed.
- In general pediatric bone sarcomas are treated with chemotherapy and surgical removal
- In general adult soft tissue sarcomas are treated with radiation and surgical removal
What research is being done?
Over the last decade we have learned more details about the genetic basis to many diseases. Malignant
tumors arise from some alteration in normal cell control. Understanding what has changed in the
genetic code of these tumor cells is an active area of ongoing research. By finding changes that are
specific to each tumor type it is hoped that more targeted treatments can be developed in the near
future. Current chemotherapy treatments for most sarcomas employ the use of multiple agents and are
associated with many side effects, some of which are severe and life threatening. By designing more
targeted treatment through a better understanding of the molecular basis of the disease side effects of
current treatments can be avoided and survival rates should improve.