Metastatic (stage 4) sarcoma

Metastatic sarcoma is sarcoma that has spread from where it started to another part of the body. For many cancers, metastatic cancer also is called stage 4 cancer.

Metastasis is the medical term for disease that spreads to an area away from where it started. When cancer spreads, healthcare professionals say it metastasizes or is metastatic.

Sarcoma is a rare type of cancer that starts in the bones or the soft tissues. When sarcoma spreads, the cancer is still named for where it started, not for where it spread.

How long it takes sarcoma to spread varies greatly by subtype, grade and other tumor characteristics. Some sarcomas can spread years after they initially develop.

Metastatic sarcoma is a serious condition, but what it means for you depends on the type of sarcoma and other factors. Treatment for stage 4 sarcoma may include chemotherapy, surgery, targeted therapy, immunotherapy or radiation.

When sarcoma is advanced and has spread to other organs, it typically can't be cured. But treatment can help control the cancer and lessen symptoms. Treatments may extend your life and help you to live as well as possible, for as long as possible.

Sometimes metastatic sarcoma doesn't cause symptoms. Some people may have no symptoms for months or years. When symptoms happen, they can vary based on the type of tumor and the size of the tumors.

Symptoms of metastatic sarcoma also may differ depending on where the cancer spreads. Symptoms may include:

• Shortness of breath, cough or chest pain if the cancer has spread to the lungs.
• Bone pain or a broken bone if the cancer has spread to a bone after starting in another place.
• Headache, seizures, changes in vision or dizziness if the cancer has spread to the brain.
• Yellowing of the skin or whites of the eyes, called jaundice, or swelling in the stomach area if the cancer has spread to the liver.

Symptoms also may come from where the sarcoma first started. For example, pain and swelling are common symptoms of osteosarcoma. Osteosarcoma is a kind of cancer that begins in the cells that form bones.

When to seek care

If you have symptoms that last a long time or make you feel worried, schedule an appointment with a doctor or other healthcare professional. If you've been treated for cancer in the past, tell your healthcare team about your medical history and any symptoms that concern you.

New symptoms or symptoms that get worse can mean that cancer has spread. Pain that doesn't have a clear cause could be a sign of something serious. Let your healthcare team know right away if your symptoms change.

It's not clear what causes metastatic sarcoma. This advanced form of sarcoma happens when cancer cells break away from where they first formed and spread to another part of the body.

Where sarcoma spreads can depend on the type of sarcoma. Soft tissue sarcoma can spread to distant sites such as the lungs, liver or brain. Some soft tissue sarcoma types are more likely than others to spread to nearby lymph nodes.

Ewing sarcoma, which begins in the bones and the soft tissue around the bones, most often spreads to the lungs, other bones or bone marrow. Osteosarcoma, which starts in the bone-forming cells, most often spreads to the lungs and can spread to other bones.

The risk that a sarcoma will spread depends on the type of sarcoma and certain features of the tumor. These factors differ by sarcoma type.

For soft tissue sarcoma, common risk factors for cancer spreading to distant parts of the body include:

• Higher tumor grade. High-grade sarcomas are more likely to spread, especially during the first few years after diagnosis. Tumor grade describes what the cancer cells look like under the microscope and how aggressively the tumor is likely to behave.
• Larger tumor size. Larger soft tissue sarcomas are more likely to spread than smaller tumors.
• Tumor depth. Soft tissue sarcomas that are deeper in the body have a higher risk of distant spread.
• Sarcoma type. Some types of soft tissue sarcoma are more likely to spread than others.
• Cancer that has come back after treatment. Soft tissue sarcoma that returns after treatment has a higher risk of spreading to distant parts of the body.

For bone sarcomas, the factors that affect the risk of cancer spreading also vary. Your care team considers your type of sarcoma and features of your tumor when discussing the risk that the cancer will spread.

Your diagnosis likely will start with a physical exam and discussion of your medical history. To diagnose metastatic sarcoma, your healthcare professional may suggest imaging and other tests. The tests you need depend on the type of sarcoma and where it started.

Imaging tests

Imaging tests make pictures of the inside of the body. The pictures can help your healthcare team understand the size of your sarcoma and where it is. Imaging tests may include:

• Computerized tomography (CT) scan. A CT scan can look for cancer that has spread to the lungs or other parts of the body.
• Magnetic resonance imaging (MRI). MRI can show the size and location of the original tumor and how it is affecting nearby tissues.
• Positron emission tomography (PET) scan. A PET scan can help find active cancer throughout the body.
• Bone scan. A bone scan can examine the whole skeleton for cancer that has spread to the bones.

Some sarcoma types may need additional imaging because they are more likely to spread to certain parts of the body. For example, brain imaging may be used for soft tissue sarcomas that are more likely to spread to the brain.

Your care team can use the results of imaging tests to determine how far the sarcoma has spread. This information helps guide treatment decisions.

Biopsy

To confirm the diagnosis, your healthcare professional might suggest a biopsy. A biopsy is a procedure to remove a sample of tissue for testing in a lab. How a healthcare professional collects the biopsy sample depends on where the affected tissue is.

A biopsy for metastatic sarcoma may involve placing a needle through the skin to get the sample. Or it may involve surgery.

Treatment for metastatic sarcoma depends on many factors. The type of sarcoma, where it started, where it has spread, treatments you've already had and your overall health all play a role in your treatment.

Treatment for stage 4 sarcoma may include chemotherapy, surgery, targeted therapy, immunotherapy or radiation.

Your care team may use chemotherapy, targeted therapy or other medicines to control cancer throughout the body. Radiation, bone-strengthening medicines or surgery can help treat issues in specific bones. For most people with metastatic cancer, treatment focuses on controlling the cancer, relieving pain and maintaining quality of life.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Chemotherapy may be more effective in treating some types of sarcoma than others. Which medicines are used depends on the type of sarcoma. For stage 4 cancers, chemotherapy might help relieve pain and slow the growth of the cancer.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Immunotherapy

Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. This treatment might help control some sarcoma types that have spread to other parts of the body..

Surgery

Surgery may be an option when metastatic tumors can be completely removed. For example, surgery may be considered when there are a limited number of metastases, such as tumors that have spread only to the lungs. But surgery may not be an option for some metastatic sarcomas.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.

Radiation therapy may be used to control metastatic tumors or relieve symptoms, depending on the type of sarcoma and where it has spread. For some sarcomas, radiation therapy may be used along with chemotherapy and surgery to treat the original tumor and areas where the cancer has spread.

Palliative care

Palliative care focuses on relieving symptoms and improving quality of life at any stage of cancer. For bone metastasis, treatments such as surgery, radiation therapy or medicines also may be used to relieve symptoms even when eliminating the cancer isn't possible. Palliative care can be provided alongside treatments intended to control the cancer.

Coping with metastatic sarcoma involves more than coping with symptoms or side effects. It also involves coming to terms with the news that your cancer has spread.

Treatments for metastatic sarcoma can slow the growth of the cancer and may extend your life. But cancer that spreads typically can't be cured. Your healthcare team will work to ease your pain and keep you comfortable so that you can focus on what's important to you.

People find their own ways to cope with a cancer diagnosis. Until you find what works best for you, here are some things you can try.

Find out enough about metastatic sarcoma to help you decide about your care

Ask your healthcare team about the details of your cancer and your treatment choices. Ask about where you can get more information. Good places to start are the U.S. National Cancer Institute and the American Cancer Society.

Find someone to talk with

A close friend or family member who is a good listener might be a good person to talk with about your fears or worries. Sometimes friends and family members may have trouble coping with your diagnosis, so you might choose to talk with a professional. Talking with a counselor, medical social worker, or a pastoral or religious counselor can be helpful. These experts are trained to help guide you during this challenging time.

Connect with other cancer survivors

You may find comfort in talking with other people who have cancer. Contact your local chapter of the American Cancer Society to find cancer support groups in your area. You may find it helpful to hear how other people and their families cope with cancer.

Work toward accepting your diagnosis

It can be hard to accept that your cancer may not have a cure. For some people, having a strong faith or a sense of something greater than themselves makes this process easier.

Others want to talk with someone who knows about life-threatening illnesses. This could be a medical social worker, a psychologist or a chaplain.

Make end-of-life choices

Some people find comfort in planning ahead for difficult times. This can include organizing legal or financial details so your family is not burdened with these decisions. You also may choose to review your end-of-life care wishes with your healthcare professional. Write down your wishes and share them with your friends and family.

Think about hospice care

If cancer therapies no longer work, or if you no longer want them, you might find comfort in hospice care. Hospice care provides medical, emotional and spiritual support. Hospice care focuses on keeping you comfortable and easing your physical and emotional pain.

Hospice programs are usually for people who are expected to live about six months. Some hospices are buildings where you stay. Others have special beds within a hospital, and some offer care at home. Hospice staff work together with your cancer care team to make sure your needs are met. Choosing hospice doesn't mean giving up — it's another way to help manage difficult health issues.

Start by making an appointment with a doctor or other healthcare professional if you have symptoms that worry you.

Sometimes it can be difficult to remember all the information you're given during an appointment. Bring a family member or friend with you, if possible, to help you. Someone who goes with you may remember something that you missed or forgot.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a certain test. Make a list of:

• Your symptoms, including symptoms that don't seem linked to the reason for your appointment, and when they began.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines vitamins or other supplements you take, including the doses.
• Questions to ask your healthcare team.

For metastatic sarcoma, some basic questions to ask include:

• What's likely causing my symptoms?
• Are there other possible causes for my symptoms?
• What tests do I need?
• What treatments are there? Which do you suggest?
• What's my prognosis?
• Are there experimental treatments or clinical trials I can try?
• I have other health conditions. How will those affect my treatment?
• Are there brochures or other printed material that I can have? What websites do you suggest?
• Will I need a follow-up visit?

Be sure to ask all the questions you have. If you don't understand an answer, ask your care team to explain it again. You can take notes or ask if you can record the appointment so you can review the information later. Your care team is here to help you.

Cancer survival rates or survival statistics tell you the percentage of people who survive a certain type of cancer for a specific amount of time.

Survival rates for metastatic sarcoma vary widely. The likely outcome of your condition, called the prognosis or outlook, depends on the type of sarcoma, where the cancer has spread and other factors. Survival rate statistics describe groups of people and can't predict exactly what will happen to you.

Cancer statistics often use a five-year relative survival rate. This rate compares survival among people with the cancer and survival among people in the general population.

For soft tissue sarcoma that is distant, meaning it has spread to a distant part of the body, the five-year relative survival rate is 17%.

Survival rates differ among types of bone sarcoma. For distant Ewing sarcoma, the five-year relative survival rate is 41%. For distant chondrosarcoma, the five-year relative survival rate is 28%. Chondrosarcoma is a type of sarcoma that usually begins in the bones of the pelvis, hip and shoulder. For distant chordoma, the five-year relative survival rate is 54%. Chordoma is a type of cancer that starts in the bones of the spine or the skull.

Survival statistics are based on people treated in previous years, and treatments can improve over time. Survival statistics also are based on how far the cancer had spread when it was first diagnosed. They don't necessarily apply if a sarcoma spreads or comes back later.

Your care team knows the details of your cancer and treatment. Care team members can give you a personalized outlook and help you make sense of what it means for you. Your care team may share a range of survival to help you and your family plan for the future. Some people want to know as much as possible about prognosis, while others choose to focus on treatment and day-to-day life. It's up to you to decide how much information is helpful.