Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Overview

Soft-tissue sarcoma can start anywhere in your body, but it is most often found in the legs or arms. Cancer develops when normal cells in the body start to change and grow uncontrollably. Over time, a mass called a tumor may develop.

After we learn everything we can about your soft-tissue sarcoma, we discuss the treatment options and develop a plan that is right for you. Treatment options for soft-tissue sarcoma include surgery, radiation therapy, and chemotherapy. Targeted therapy is also an option for a specific type of soft-tissue sarcoma.

Surgery

If there is no sign of spread, you will likely undergo surgery to remove the tumor. If the cancer has spread to other parts of your body, we may be able to remove those tumors as well by surgery. The purpose of surgery is to remove the tumor and a small amount of healthy tissue surrounding the tumor (margins). We do this to make sure no cancer cells are left behind that could cause a recurrence.

In some cases, chemotherapy, radiation, or both may be given before surgery to help shrink the tumor and make it easier to remove. Treatment may also be needed after surgery to kill any remaining cancer cells. The types of surgery used to treat soft-tissue sarcoma are:

  • Wide local excision. The entire tumor is removed along with 1 to 2 cm of normal tissue around the tumor.
  • Mohs microsurgery. This technique removes the tumor from your skin in thin layers. Mohs surgery may be used for small low-grade tumors located on a part of your body where appearance is important.
  • Limb-sparing surgery. Sarcomas in your legs or arms may be treated with surgery that removes the tumor without having to remove the limb. We take tissue from another part of your body to replace tissue removed during surgery to excise the cancer.
  • Amputation. Although rarely needed, removing the limb is sometimes the only way to remove all the cancer. Amputation may also be the best option in cases where important muscles, nerves, bone, and blood vessels would need to be removed with the cancer. This would result in chronic pain or a limb that does not function properly.
Side effects of surgery

Side effects of surgery vary greatly and depend on the location and extent of the surgery. We will talk with you about possible side effects of your specific surgery. Potential side effects of surgery include:

  • Pain around the surgical site
  • Phantom itching, tingling, or pain from a removed arm or leg
  • Infections
  • Temporary or permanent loss of function where the tumor was removed
  • Chronic swelling of an arm or leg
  • Decreased mobility

Radiation Therapy

Radiation therapy uses high-energy radiation to kill cancer cells or stop them from growing. It may be used before surgery to shrink a tumor or to kill any cancer cells left behind after surgery. It may also be used as the main treatment if surgery is not an option.

A commonly used type of radiation therapy, called external-beam radiation, delivers radiation from a machine outside the body. You will likely receive treatment 5 days a week for several weeks.

There are several methods for delivering external-beam radiation therapy to the tumor. These include:

  • Conventional fractionated radiation therapy. The total dose of radiation is spread out over several weeks.
  • Intensity-modulated radiation therapy (IMRT) or 3-dimensional conformal radiation therapy (3D-CRT). Special computers are used to directly target the tumor and minimize the damage to normal tissues.
  • Proton-beam radiation therapy. Instead of X-rays, the source of radiation is protons. Because protons release their energy after traveling a certain distance, more radiation can be delivered at the exact location of the tumor, sparing healthy tissues.

Another type of radiation used to treat soft-tissue sarcoma called brachytherapy delivers radiation from inside your body. Radioactive seeds are placed into or near the tumor to deliver a high dose of radiation.

Side effects of radiation therapy

Side effects vary depending on the type of radiation you receive, the dose, and which part of your body is treated. Most problems go away after treatment ends. Possible side effects of radiation therapy include:

  • Skin changes, such as redness
  • Fatigue
  • Swelling
  • Pain
  • Weakness

Chemotherapy

You may receive chemotherapy drugs to kill cancer cells. Chemotherapy drugs can be delivered through a vein or as a pill. Known as systemic chemotherapy, these drugs enter the bloodstream and attack cancer cells throughout the body. Chemotherapy may be used before or after surgery, or it may be the main treatment if surgery is not possible. The specifics of which drugs are used depend on subtype of soft-tissue sarcoma being treated. 

Side effects of chemotherapy

Chemotherapy can cause a variety of side effects, the severity of which depends on the type and dose of the drug as well as the length of time it is given. You may experience 1 or more of the following side effects of chemotherapy:

  • Hair loss
  • Nausea and vomiting
  • Loss of appetite
  • Mouth sores
  • Diarrhea
  • Fatigue
  • Low blood cell counts

Chemotherapy drugs can also cause infertility by permanently damaging the ovaries or testicles.

We have effective methods for preventing and managing chemotherapy side effects. For example, without enough healthy blood cells, you are at higher risk for infections, bleeding, and severe fatigue. We may give you medications to boost your blood counts, antibiotics to treat and prevent infections, and transfusions of red blood cells and platelets. Modern drugs for treating nausea are highly effective.

Targeted Therapy

Targeted therapy is a relatively new approach to treating cancer. It involves the use of drugs that target specific parts of the cancer cell that help it survive and grow.

For example, for a subtype of soft-tissue sarcoma called gastrointestinal stromal tumor (GIST), 2 drugs are available to target the cancer. The first drug stops the signal from an abnormal protein called KIT that tells GIST cells to grow and multiply uncontrollably. If you are unable to receive this drug because of side effects, or if the drug does not work or stops working after a period of time, other options are available.

Side effects of targeted therapy

Because targeted drugs take aim specifically at cancer cells, they cause less collateral damage to healthy cells. But targeted drugs used to treat GIST are not without side effects. Side effects vary depending on which targeted drug you receive, but might include:

  • Fluid buildup, which can cause swelling or bloating
  • Muscle cramps
  • Nausea
  • Diarrhea
  • Rash
  • Mouth sores
  • High blood pressure
  • Fatigue 

We will watch you closely for these and other side effects. Notify us as soon as you notice symptoms so we can help you manage them.

Follow-up Care

When you finish treatment for soft-tissue sarcoma, we will work with you to develop a plan for follow-up care. We will conduct regular checkups to monitor your recovery and to immediately catch any signs of the cancer coming back or getting worse.

Follow-up appointments are an important part of your cancer care. During these regular visits, we do physical exams and check for symptoms that may be caused by cancer.

Although many side effects of therapy go away once treatment ends, some problems can last weeks, months, or even longer. Follow-up appointments are an opportunity to tell us about any ongoing symptoms or side effects you experience so we can help you.

If you had an arm or leg removed, your follow-up care includes physical therapy to help you learn how to physically cope with the loss of limb. Rehabilitation can also help you deal with the emotional and social impact of losing an arm or leg.

Taking your medication

Targeted drug therapy can last for a year or longer, and it is very important to take your medication as prescribed. Talk to us before stopping use of any medication so that we can provide you with the resources and help you need to continue therapy and keep your cancer under control. Here are some tips for taking your pills:

  • Read the prescription bottle and make sure you understand how often you are supposed to take the medicine.
  • Use a pill box divided into sections for each day of the week. Some even come with alarms that let you know when it is time to take your medicine.
  • Take your medicine at the same time every day or along with a daily activity, such as eating breakfast.
  • Ask a family member or friend to help remind you to take your medicine.
  • Talk to us about what to do if you miss a dose.
  • Let us know if side effects or financial strains interfere with taking your medicine. We can help manage side effects of treatment and also provide information on programs to help you afford your medication.
  • If you plan to travel, make sure you carry your medicine in a carry-on bag. You should also take extra pills with you in case you are away from home longer than expected.
Clinical trials

We are always looking for new and better ways to treat soft-tissue sarcoma. Clinical trials are research studies that test new treatments or procedures that may prove better than standard treatments. We will talk with you about whether a clinical trial may be right for you.

Your Care with Me

If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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