Sarcoma of the Abdomen and Retroperitoneum
Complete en bloc resection at a Sarcoma Alliance recommended center
Sarcomas are rare cancers of connective tissue, and the ones that grow deep in the abdomen are among the most challenging to treat well. Outcomes depend heavily on the first operation being done completely and by a team that sees these tumors often. Dr. Papenfuss practices at the Aurora sarcoma program at St. Luke's Medical Center in Milwaukee, which is listed by the Sarcoma Alliance as a recommended sarcoma center, and presents every case at a weekly multi-institutional sarcoma conference.
What it is
Sarcomas arise from fat, muscle, blood vessels, nerves and other supporting tissue rather than from the lining of an organ. In the abdomen they most often grow in the retroperitoneum, the space behind the abdominal cavity around the kidneys, major vessels and spine. Common types there are liposarcoma (from fat) and leiomyosarcoma (from smooth muscle). Because the retroperitoneum has room, these tumors are often very large by the time they cause symptoms: a fullness, a visible bulge, or pressure on the bowel or kidney. GIST, the most common sarcoma of the digestive tract, has its own page.
How it is treated
Complete surgical resection is the cornerstone. For retroperitoneal sarcoma this often means removing the tumor en bloc with adjacent organs it abuts, such as a kidney, part of the colon, the spleen or a segment of bowel, to achieve clear margins. Attempting to shell the tumor out leaves cancer behind.
Radiation before surgery for some retroperitoneal sarcomas, particularly liposarcoma, decided case by case based on current trial data.
Chemotherapy for certain high-grade subtypes and for disease that has spread, chosen by sarcoma-specialized medical oncologists.
Biopsy before treatment is essential: subtype and grade drive every decision, and a core needle biopsy planned by the surgical team avoids spreading the tumor.
Surveillance after surgery for years, because recurrence is common and repeat resection is often possible.
Dr. Papenfuss's approach
Dr. Papenfuss is a high-volume abdominal sarcoma surgeon. St. Luke's is one of two Wisconsin centers on the Sarcoma Alliance's national list of recommended sarcoma centers, a designation that requires a dedicated multidisciplinary team, a regular sarcoma tumor board, sufficient patient volume and access to clinical trials. Every patient is discussed at a weekly multi-institutional sarcoma tumor board with sarcoma pathologists, radiologists, medical and radiation oncologists and orthopedic oncologists, so the plan reflects the current evidence for that specific subtype. Operations are planned with the organ-removing steps decided in advance, with vascular, urologic or other surgical specialists in the room when needed.
When to get a second opinion
For sarcoma the second opinion should come before surgery, not after. If you have a large abdominal or retroperitoneal mass, a biopsy that shows sarcoma, or were offered an operation at a center without a sarcoma program, ask for a review. Patients travel to us from across Wisconsin and the Upper Midwest. Call 414-649-3240 or request a consultation.
This page is general information, not medical advice for any individual patient.