Breast sarcomas are a very rare form of breast cancer. Less than one percent of all breast cancers that are diagnosed are sarcomas. Unlike most breast cancers which begin in the milk ducts, breast sarcomas begin in the connective tissue that supports the ducts and lobules of the breast.
Because breast sarcoma cells are more like the connective tissue in the breast than the ductal breast tissue, they act differently than more common kinds of breast cancer. They are often high grade, which means that the cells are dividing rapidly or are very abnormal-looking. Breast sarcomas also tend to be larger at diagnosis than other types of breast tumors.
Some kinds of inherited genetic disorders are known to increase one’s risk of developing a primary breast sarcoma. Just as with other forms of breast cancer, however, the reason for the development of a primary breast sarcoma is often unknown. Secondary tumors can develop after radiation therapy, chronic lymphedema, certain chemicals, some forms of chemotherapy, and immune system diseases.
The first sign of breast sarcoma is usually a painless lump. As the lump gets bigger, it might press against nerves or muscles and make you uncomfortable or give you trouble breathing, or both. There are no tests that can find these tumors before they cause symptoms that you notice.
If your doctor suspects that you may have breast sarcoma, a biopsy will be done. There are three types of biopsy that may be used:
Samples will be taken from the primary tumor, lymph nodes, and other suspicious areas. A dermatopathologist views the tissue under a microscope to look for cancer cells and to determine the grade of the tumor. The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the cells are dividing. High-grade tumors usually grow and spread more quickly than low-grade tumors.
Dermatopathologists at DF/BWCC are among the best and most experienced in the world with special expertise in providing an accurate diagnosis for complex cases. In many instances when asked to review a case to provide a second opinion, the diagnosis and treatment plan is changed.
You may also have imaging tests such as:
After a breast sarcoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. This process is called staging.
Staging and treatment of breast sarcomas differ from other types of breast cancer. Lymph node status is not as important in staging breast sarcomas as in other kinds of breast cancer. When sarcomas spread, they typically do not travel through the lymphatic system. Even in the case of large breast sarcomas, the lymph nodes are usually negative for cancer, and axillary node dissection (removal of the underarm lymph nodes) is usually not required.
Surgical treatment aims to prevent the cancer from coming back in the breast. Surgery might be a wide excision, in which the tumor and extra tissue are removed, or mastectomy, in which the whole breast is removed.
Radiation therapy may also be given.
Systemic therapy is used to prevent the cancer from coming back or from spreading to another part of the body. Systemic therapy for a sarcoma may be recommended if the tumor is very large or is known to have spread outside of the breast. Because sarcoma tumor cells are not ductal breast cells, they do not typically have hormone or HER2 receptors, so endocrine and HER2 - targeted therapies are generally not used.
Your oncology team will recommend a treatment plan based on what is known about breast sarcomas in general and tailored specifically to your disease.
You will receive a thorough diagnostic evaluation to determine your course of treatment. Careful monitoring and the involvement of an experienced surgical oncologist are important to the successful outcome for patients with breast sarcoma.
If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.
The day of surgery, you will be cared for in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with breast sarcoma. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.
The Center for Sarcoma and Bone Oncology at Dana-Farber/Brigham and Women’s Cancer Center provides advanced and innovative multidisciplinary care for patients with sarcoma. Our treatment team includes surgical oncologists, medical and radiation oncologists, plastic surgeons, nutritionists, pathologists and anesthesiologists. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.
Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.
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