There is no definite cause for sarcoma that can be named. Genetics plays a rather minor role. Radiation therapy in conjunction with another disease can, in rare cases, contribute to the development of sarcoma. Environmental toxins and chemicals such as wood preservatives, herbicides, dioxin or arsenic as well as chronic inflammation also seem to promote the formation of soft tissue sarcomas. 

Performing surgery to treat a sarcoma requires a high level of experience. During an operation, the tumor must be removed completely in healthy tissue while preserving the extremity and the function must be affected as little as possible. The surgeon has to master all possibilities of tumor resection and also of reconstruction of a bone defect after bone tumor resection. Appropriate special tumor implants must be available. In addition, an individual treatment plan based on the patient's exact histology must be drawn up in a specialized center, which also takes into account possible additional forms of therapy such as chemotherapy or radiotherapy.

Men are more likely to be affected than women. Soft tissue sarcomas are rare with an incidence of 2-3 new cases per 100,000 inhabitants per year and account for 1-2% of all malignant tumors in adults. In Germany, about 3000 new cases per year are expected. In children, soft tissue sarcomas have a significantly higher proportion of malignant tumors (about 5%). Soft tissue sarcomas can occur at any age, but are more common between the ages of 45 and 55 or under the age of 15.  

There are no characteristic symptoms for sarcomas. This is why sarcomas are often detected late. Most sarcomas initially cause a painless swelling or lump. As they grow, a feeling of tightness may develop in the affected area. If the sarcoma pushes out nerves or grows into nerve tissue, pain occurs. Bone sarcomas may cause joint pain, joint stiffness, or a broken bone from the tumor.

In case of a suspected sarcoma it is especially important to find competent specialists who have a lot of experience with the diagnosis and treatment of this particular type of tumor. 

Magnetic resonance imaging (MRI), X-ray, Computed tomography (CT), Bone scintigraphy and Positron emission tomography PET. After imaging, a biopsy is required for histological confirmation. If possible, this biopsy should be performed at the center where the tumor is then operated on. If the biopsy is performed in the wrong way, it can significantly worsen the patient's prognosis.

It is always best for patients to consult a large center that has the greatest possible experience. Sometimes more can be done for sufferers here or experienced experts confirm the therapy and this gives greater certainty that the right thing is being done. It is also recommended to get a second opinion. Heidelberg University Hospital offers medical second opinions and video consultations for this purpose. At the National Center for Tumor Diseases, bone and soft tissue sarcomas are diagnosed and treated on an interdisciplinary basis. The Heidelberg Sarcoma Center is characterized by the excellent interdisciplinary cooperation of the different specialties. In the weekly sarcoma boards, approximately 600 patient cases are discussed and treatments are determined each year. Orthopedic surgeons, visceral surgeons, plastic surgeons, medical oncologists, radiation therapists, radiologists, pathologists, and representatives of other departments participate in this sarcoma board to determine the appropriate treatment strategy for each individual case of disease. Most sarcomas occur in the extremities and spine and can only be treated sufficiently by surgical removal by the orthopedic surgeons at Heidelberg University Hospital.

After a successful operation, an individual rehabilitation plan is developed to restore the function of the operated limb or back as much as possible. Physiotherapy treatment is already provided during the inpatient stay for the operation in order to mobilize the patient again as quickly as possible. In addition, an individual post-surgical care plan (for a period of five (5) to ten (10) years) is provided. Initially, follow-up appointments may take place every three months, but the examination intervals may be extended in the future. The follow-up appointments can be performed on an outpatient basis, or in a specialist's office or in specialized clinics. Particular attention is paid to whether new tumor cells are formed and then treat them quickly.

The Sarcoma Center in Heidelberg with its highly qualified specialists uses modern implants made of titanium. In spinal orthopedics, implants made of carbon are also used so that subsequent diagnostics in MRI and CT can continue to be max. efficient and meaningful. This can also or a possible postoperative radiation therapy with heavy ions be made possible. In addition, silver-coated implants to prevent infection or patient-specific implants (3D manufactured from titanium with a special surface to optimize bony ingrowth) are used for extremities and pelvis.  For the reconstruction of large bone defects, especially in the joint area, the most modern tumor endoprostheses with silver coating or custom-made metal implants are used. If possible, reconstruction is carried out biologically using the patient's own graft bone or foreign bone.

For most malignant bone tumors and for many highly malignant soft tissue tumors, individually adjusted chemotherapy is performed in addition to surgery either before or after surgery. Radiation therapy may be required for some bone tumors. Highly malignant soft tissue tumors are usually additionally irradiated either before or after surgery. If possible, in the form of proton irradiation or heavy ion irradiation. In some cases, ion beams are the best possible radiation therapy, as they are particularly effective, can be controlled with high precision, and cause hardly any side effects. Proton therapy and heavy ion therapy hit the tumor much more precisely and deliver their therapeutic energy accurately in the tumor - surrounding healthy tissue is spared and there are fewer side effects. Gene typing is performed for all sarcomas at the Heidelberg Sarcoma Center to enable individualized therapy. In the future, highly precise forms of treatment with chemotherapy or immunotherapy can be individually adapted to each tumor.

Sarcoma recurrences can occur as with all tumor diseases. These can occur locally as a local recurrence or in the form of metastases, usually in the lungs. In order to detect recurrence or metastasis at an early stage, regular follow-up is performed by means of examination and MRI of the operated area and a CT scan of the lung. If possible, surgical removal of these local recurrences or metastases is performed, as this is associated with a better prognosis. Systemic therapy will often be required (chemotherapy or targeted therapy, participation in a clinical trial if necessary).