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World class sarcoma care in the West Midlands

Treatments and Procedures

Depending on the most appropriate pathway for you, you will be treated at one or more of our hospital sites.

Diagnostic and resection services are provided across three hospital sites within the Trusts – Royal Orthopaedic Hospital, Queen Elizabeth Hospital and Birmingham Children’s Hospital, dependant on the most appropriate pathway for you. Chemotherapy and radiotherapy are delivered at Queen Elizabeth Hospital and Birmingham Children’s Hospital.

Surgery

Surgical process

  • Surgery will only occur once a thorough investigative process has been carried out. You will be kept thoroughly informed of the diagnostic processes, results and discussions at the Multi-Disciplinary Team (MDT) meetings. After receiving the results of any biopsies undergone you will then meet the surgeon in the clinic to discuss any planned surgery. This will involve a detailed discussion of the procedure, the risks of the surgery, along any other alternative options for treatment, and the likely time to recovery and discharge. There will be plenty of time to ask questions and voice any concerns. Your consent will be formally recorded on the consent form. You may not be given a date for surgery at this appointment but will be contacted by the secretarial team with more information at a later date.
  • Following this appointment, you will be asked to attend the Pre-Operative Assessment Clinic (POAC) which is usually, but not always, on the same day as your sarcoma clinic appointment. Here the anaesthetic team will take a thorough medical history and examination. They will organise any additional investigations required and liaise with your G.P. in order to optimise you prior to being admitted for surgery. They will discuss the different anaesthetic options with you and provide some written advice on which medications to take prior to arrival for surgery. The anaesthetic may comprise of either a general anaesthetic, a spinal or epidural (where anaesthetic is injected around the spine), a regional anaesthetic (a limb is numbed with local anaesthetic) or a combination of the above procedures. Modern anaesthetics are extremely safe.
  • Once provided with a date you will usually be admitted on the morning of the day of surgery although exceptionally some patients are admitted the day before. The ward nursing staff will complete further pre-operative safety checklists. The surgical team will see you in the morning to confirm your consent to undergo surgery and to answer any further questions that you may have. The anaesthetic team will also see you to further discuss the anaesthetic choice with you. You may not be the only patient on that theatre list and as such there is no guarantee your order on the list as patients are prioritised according to clinical need.
  • When your time for surgery arrives you will be taken down to theatre on your ward bed (or escorted round if on the Admissions & Day Case Unit). You will be greeted by the anaesthetist and team who will then commence the anaesthetic process.
  • Following surgery you will be taken to the recovery unit which is staffed by anaesthetists and highly trained specialist nurses. When you have fully recovered and are comfortable you will be taken back up to the ward.
  • You will either be seen by the surgical team on the same day post-operatively or the following day. Inpatient stays can range from day-case to over seven days depending on the type of procedure that you are undergoing. Rehabilitation with our specialist oncology physiotherapists will commence as soon as it is possible and safe to do so. Prior to discharge our team of occupational therapists will ensure that you are being discharged back to a safe environment and will order any additional equipment that you may require at home. The majority of patients are discharged directly home but occasionally some are required to have an interim stay in a rehabilitation hospital local to them prior to going home.

Types of surgery

The surgery that is performed varies widely according to the location of the tumour in the body, its proximity to different structures and the type of tumour. The main aim of surgery is to remove the tumour in its entirety with a cuff of normal tissue around it. This is called a Wide Local Excision (WLE). Performing surgery in this way attempts to ensure that all of the tumour is removed including the microscopic parts that cannot be seen with the naked eye.

Wherever possible we try to avoid amputations if at all possible but only if it does not compromise a patient’s oncological outcome in doing so. We endeavour to perform limb salvage surgery (LSS) in order to enable patients to have as a good a functional outcome as possible. This is done by reconstruction of the limbs and joints with endoprostheses (metal implants), allografts (donor bone) or autografts (patient’s one bone) and by incorporating additional treatments such as radiotherapy. 

There are option varies treatment strategies and the surgeon will discuss this in depth with you at the time you see them in clinic.

Radiotherapy

Details coming soon

Chemotherapy

Details coming soon