What is Sarcoma? What You Need to Know about it
Know about the sarcoma, what exactly it is, sarcoma versus carcinoma, recognising the signs and symptoms, diagnosis and more.
Written by Dr. M L Ezhilarasan
Reviewed by Dr. Shaik Abdul Kalam MD (Physician)
Last updated on 17th Sep, 2025
Introduction
You’re diligent about your health. You know the common warning signs for prevalent cancers. But have you ever heard of sarcoma? If not, you're not alone. Sarcoma is a rare and often misunderstood type of cancer that arises in the body's connective tissues—bones, muscles, fat, nerves, tendons, and cartilage. Accounting for just 1% of all adult cancers, its rarity is precisely why public awareness is so low, yet so critical. This lack of awareness can lead to delayed diagnosis, as early symptoms like a painless lump or bone pain are frequently dismissed. This article will demystify sarcoma, exploring its types, symptoms, and why it’s dubbed the "forgotten cancer.
What Exactly is Sarcoma?
Sarcoma isn't a single disease but a broad category of malignant tumours that originate in the mesodermal layer of the body—the tissue that forms our connective structures. Unlike carcinomas, which arise from epithelial cells lining organs like the breast, lung, or colon, sarcomas emerge from the "glue" that holds the body together: bone, muscle, fat, and cartilage. This fundamental difference in origin leads to vastly different behaviours, treatment approaches, and challenges. There are over 70 recognised subtypes of sarcoma, each with its own unique characteristics, making diagnosis and treatment highly complex. Understanding that sarcoma is a cancer of connective tissues is the first step in recognising its potential to appear almost anywhere in the body.
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Sarcoma vs. Carcinoma: Understanding the Difference
The distinction between sarcoma and carcinoma is one of the most important in oncology. Think of it this way:
- Carcinomas are cancers of the organs. They are common, making up about 80-90% of all cancer diagnoses. Examples include breast cancer, prostate cancer, lung cancer, and colon cancer.
- Sarcomas are cancers of the support structures. They are rare, making up about 1% of adult cancers but a significant portion (15-20%) of childhood cancers. Examples include osteosarcoma (bone) and liposarcoma (fat).
This difference dictates everything from how the cancer spreads to how it is treated, underscoring the need for specialists familiar with its unique biology.
The Two Main Types: Soft Tissue and Bone Sarcoma
Sarcoma is primarily categorised into two groups:
1. Soft Tissue Sarcoma: This is the more common group, with tumours developing in muscles, fat, blood vessels, nerves, and fibrous tissues. There are more than 50 subtypes, including Gastrointestinal Stromal Tumour (GIST), Leiomyosarcoma, and Synovial Sarcoma.
2. Bone Sarcoma (Osteosarcoma): These tumours originate in the bone. The most common types are Osteosarcoma, which often affects teenagers during growth spurts, Ewing Sarcoma, and Chondrosarcoma.
How Common is Sarcoma Cancer?
Sarcoma's rarity is its defining feature. In the United States, approximately 17,000 new cases of soft tissue sarcoma and 3,000 new cases of bone sarcoma are diagnosed each year. To put that in perspective, over 290,000 new cases of breast cancer are diagnosed annually. This scarcity means the average primary care doctor might see only a handful of cases in their entire career, which contributes to the challenge of early detection. However, its impact is profound, particularly in paediatrics, where it is the third most common cancer type in children after leukaemias and brain tumours.
Recognising the Signs: Sarcoma Symptoms
Early symptoms are often subtle and easily mistaken for common injuries or benign conditions.
Symptoms of Soft Tissue Sarcomas
The symptoms include:
- The most common sign is a lump or swelling. Key characteristics of a concerning lump include:
- It is deep-seated within the muscle or tissue, not just under the skin.
- It is painless in its early stages (though it can cause pain as it grows and presses on nerves or muscles).
- It is growing larger over time (weeks or months).
- It is larger than 5 centimetres (about the size of a golf ball).
Symptoms of Bone Sarcomas
These often cause:
- Persistent bone pain that may worsen at night or with activity.
- Swelling and tenderness near a joint or in a limb.
- Unexplained broken bones (pathologic fracture) because the tumour has weakened the bone.
When to See a Doctor: The "Watch and Wait" Trap?
A common mistake is to adopt a "watch and wait" approach with a new lump. While most lumps are benign (like lipomas or cysts), any deep-seated, growing, or painless lump larger than 2 inches warrants medical evaluation. If you have a persistent lump or unexplained bone pain, consult a doctor online with Apollo24|7 for a preliminary evaluation. They can advise if an in-person visit and imaging are necessary. Early intervention is crucial.
How is Sarcoma Diagnosed?
Diagnosis requires a multi-step process, and accuracy is paramount as it directly impacts treatment.
The Crucial Role of Imaging (MRI, CT, PET scans)
If sarcoma is suspected, the first step is usually an MRI for soft tissue tumours or an X-ray, followed by an MRI for bone tumours. These images help determine the tumour's size, depth, and relationship to nearby nerves and blood vessels. A CT scan of the chest and a PET scan are often used to check for metastasis (spread) to the lungs or other organs.
The Biopsy: The Only Way to Confirm
A biopsy, where a small sample of tissue is extracted from the tumour, is the only definitive way to diagnose sarcoma. It must be performed by a surgeon or radiologist experienced in sarcoma to avoid compromising future surgery. The tissue sample is analysed by a pathologist to identify the specific subtype and grade (how aggressive the cells look).
Sarcoma Treatment Options
Treatment is highly personalised and almost always involves a combination of therapies delivered by a multidisciplinary team.
Surgery: The Primary Treatment Modality
The goal of surgery is to remove the entire tumour with a wide margin of healthy tissue around it to minimise the risk of recurrence. Today, limb-salvage surgery is the standard, successfully avoiding amputation in over 90% of cases.
Radiation Therapy and Chemotherapy
- Radiation Therapy: Often used before surgery to shrink the tumour or after surgery to kill any remaining cancer cells.
- Chemotherapy: Used more commonly for bone sarcomas or certain high-grade soft tissue sarcomas, either before surgery (neoadjuvant) or after (adjuvant) to target any microscopic spread.
Targeted Therapy and Immunotherapy: The New Frontier
For specific sarcoma subtypes, treatments that target specific genetic mutations within the cancer cells (targeted therapy) or boost the body's immune system to fight cancer (immunotherapy) are showing promising results and are areas of active research.
The Critical Importance of a Specialised Care Team
Due to its complexity and rarity, sarcoma care should be managed at a specialised cancer centre with a multidisciplinary team. This team includes surgical oncologists, medical oncologists, radiation oncologists, pathologists, and radiologists who all specialise in sarcoma. Their collective expertise ensures an accurate diagnosis and a cohesive, effective treatment plan. Getting a second opinion from a sarcoma speciality centre is highly recommended and is considered standard practice.
Conclusion
Sarcoma may be a rare cancer, but its impact on patients and families is immense. The journey often begins with a symptom that's easy to ignore, which is why raising awareness is so powerful. Knowing the signs—a deep-seated lump or persistent bone pain—can empower you to seek timely medical advice and advocate for yourself or a loved one. While the path from diagnosis to treatment is complex, advances in limb-saving surgery, targeted therapies, and the dedicated work of specialised multidisciplinary teams have significantly improved outcomes. Remember, if you have any concerning symptoms, don't hesitate to seek professional evaluation.
Consult a General Practitioner for Personalised Advice
Consult a General Practitioner for Personalised Advice
Dr Suseela
General Physician
5 Years • MBBS
Bengaluru
Apollo Medical Center, Marathahalli, Bengaluru
Dr. Kulshaan Singh
General Practitioner
7 Years • MBBS
Hyderabad
Apollo 247 Virtual Clinic, Hyderabad
Dr. Jetti Bala Venkata Subrahmanyam
General Practitioner
2 Years • MBBS
Hyderabad
Apollo 247 Virtual Clinic, Hyderabad
Dr. G Daya Sagar
General Practitioner
3 Years • MBBS
Hyderabad
Apollo 24|7 Virtual Clinic - Telangana, Hyderabad
Dr. Mainak Baksi
General Practitioner
13 Years • MBBS , MD (MPH)
Howrah
Mainak Baksi Clinic, Howrah
(50+ Patients)
Consult a General Practitioner for Personalised Advice
Dr Suseela
General Physician
5 Years • MBBS
Bengaluru
Apollo Medical Center, Marathahalli, Bengaluru
Dr. Kulshaan Singh
General Practitioner
7 Years • MBBS
Hyderabad
Apollo 247 Virtual Clinic, Hyderabad
Dr. Jetti Bala Venkata Subrahmanyam
General Practitioner
2 Years • MBBS
Hyderabad
Apollo 247 Virtual Clinic, Hyderabad
Dr. G Daya Sagar
General Practitioner
3 Years • MBBS
Hyderabad
Apollo 24|7 Virtual Clinic - Telangana, Hyderabad
Dr. Mainak Baksi
General Practitioner
13 Years • MBBS , MD (MPH)
Howrah
Mainak Baksi Clinic, Howrah
(50+ Patients)
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Frequently Asked Questions
Is sarcoma a deadly cancer?
Survival rates vary greatly depending on the specific subtype, stage at diagnosis, location, and how well it responds to treatment. Many sarcomas are highly treatable, especially when caught early and managed by a specialist team.
What is the main cause of sarcoma?
For most sarcoma cases, there is no known direct cause. Some risk factors include previous radiation therapy, certain genetic syndromes (like Li-Fraumeni syndrome), and exposure to certain chemicals, but most patients have no identifiable risk factors.
Can sarcomas be benign?
Yes, there are many benign (non-cancerous) tumours of connective tissue, such as lipomas (fat) or fibromas (fibrous tissue). However, any growing or symptomatic mass should be checked to rule out malignancy.
How fast does sarcoma spread?
The growth rate depends on the tumour's 'grade.' Low-grade sarcomas grow slowly and are less likely to metastasise quickly. High-grade sarcomas are aggressive and can spread to the lungs or other bones more rapidly.
Where does sarcoma spread to first?
The most common site for sarcoma metastasis is the lungs. For some types, it can also spread to other bones or distant soft tissue sites.