Sinking in Sarcoma

Much of my life of late has been consumed by sarcoma.

Thankfully, not because I have one, but because I am doing a presentation at my home program’s resident rounds about them.  And I did one on my last surgery rotation about them.

In fact, it seems sarcoma predominates my current status.  I even saw a kid in emerg last week with a giant belly mass for which sarcoma was on the differential (I assumed more because all I have been doing is reading about sarcoma).  But, I was following up on the case and it turns out I was right… Sadly.  Although there are other things that could have been worse.

Last night, Patrick started decorating for Christmas.

I worked on my sarcoma presentation.

This was the view from my corner of the dining room table (and you know I must be serious when I am actually sitting at a table to do work).

Our blended winter family was spying on me as I worked.  The littlest one was hiding behind my laptop screen.

Our blended winter family was spying on me as I worked. The littlest one was hiding behind my laptop screen.

Tomorrow, the presentation will be over and I can finally use some of my extra time to do something not sarcoma (like catch up on the peds reading I am getting behind on… Or, Christmas shop).  I love presentations though.  And the nerd in me loves preparing them too.  I am clearly not right in the head.

Sarcomas are interesting.  I am focusing on extremity soft tissue sarcomas, so tumors made up of cells that were once muscles, fat, the lining of our joints and such.  There are over 50 subtypes, yet, they are only 1% of adult cancers.

The main treatment of a sarcoma is surgery.  But, good quality surgery specifically.  A good resection can be the difference between life or, well, a short life.

The other big sarcoma treatment is radiation.  Because there are so few sarcomas, there are limited really good quality trials on it and because there are few trials, the treatment, although signs point to it changing, has been fairly consistently surgery followed by radiation.  More and more evidence and practice based observations suggest it might be better to irradiate up front, possibly with chemo.  But, there is little to actually scientifically test it on.  So, it is a debate.  A big one in the field.

This debate came up during my surgical rotation when I presented on the debate itself.  Despite all kinds of retrospective studies suggesting radiation up front could be better, there is only one trial that looked at it and it ended early.   Surgeons are hesitant to send patients for radiation first.  Radiation oncologists would love to radiate first.

But, if patients don’t come until the chunk is out, there is really nothing you can do.  Well, except educate.

That is where good interdisciplinary teams come in.

In fact, I read a study about how the whole decision thing is very profession dependent, despite all of the people being aware of the same literature and guidelines.  Because there is so much ambiguity in guidelines.

Things are changing.  We don’t work as much in isolation.  But, we are still set in our ways.  And we love evidence.  Which is tough when evidence is forever limited by rarity.

I think that is why I like sarcoma.

It is different.  It is a bit controversial.  And it is diverse.

Kind of like people.

It taught me a good lesson in variability in practice, the need for good research and also the importance of the patient (until the last 20-30 years, amputation was the way to go with these… Thank goodness someone had the bright idea to try to improve things).

The whole presentation thing also reminded me that as much as I love this stuff, I still want to do the whole festive thing and pretend to be normal once in a while (aka not secretly fascinated by sarcomas).  And that eventually many things look more fun after hours of work, including the heap of dishes in the sink.

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