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Sarcoma
Video

Experience Counts: Why Experienced Providers are Needed in Epithelioid Sarcoma Treatment

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Question:

Why are experienced pathologists needed in the treatment of epithelioid sarcoma?

Seth Pollack, MD:

It’s really, really important to have your pathology reviewed at a major center by an experienced bone and top tissue pathologist, and all the major centers have them. We know that when pathologists that are not experienced with sarcoma review sarcoma cases, they frequently misclassify them. And this is especially important with epithelioid sarcoma. And one thing that can happen with epithelioid sarcoma is some pathologists will mistake it for what’s called a reactive process, meaning a bunch of inflammation that’s happening in the area because there are cells that are sometimes called benign granulomas or they’re like a confluence of cells, and it looks like a reactive process.

So if you’re having tumors, if things don’t make sense to you… Sometimes I’ll hear about patients, they’ll have a tumor, it’s growing. They had a biopsy, their doctor says, “Oh, don’t worry about it,” and they don’t worry about it. But then, a month or two goes by and that tumor is still growing and it’s causing them symptoms. Don’t take no for an answer. I mean, you should go and get yourself an evaluation at a place where they’re experienced in dealing with sarcomas because an experienced bone and soft tissue pathologist will know how to look at this and say, “Yes, this is really reactive,” or, “No, this is a type of cancer.”

A lot of the times people will classify epithelioid sarcoma as having two main types, and they’ll call them the proximal type or the distal type. And actually, the way these types are classified is really the way it looks to the pathologist under the microscope. So when we say proximal, usually, in medicine, that means close in, close to the trunk, and distal means way out, like in the extremities. So the classic presentation of distal epithelioid sarcoma would be in the hand or the arms or legs, whereas the proximal is really more in the trunk, and particularly in the pelvis. That’s a really tough place for epithelioid sarcoma to go.

Now, I mentioned that, really, the way we classify them is based on the pathology. So there are cases where it’s a really strange thing. You could say that you have a proximal epithelioid sarcoma, even though it’s anatomically distal, even though it’s in the hand because the pathologist thinks it looks more like the classic proximal epithelioid sarcoma.

Question:

While your experienced oncologists needed in the treatment of epithelioid sarcoma.

Seth Pollack, MD:

It can be very frustrating for epithelioid sarcoma patients that don’t have a doctor in their life that has ever treated an epithelioid sarcoma patients. And if that’s you or if that’s the person that you know and love with epithelioid sarcoma, I would say it can’t hurt to get another opinion from a major sarcoma center. And you don’t have to go to them for all of your visits. Usually, I have people all the time who come from a few hours away, so they wouldn’t want to come to me for treatment all the time, but they just come and we chat once a year or every six months, and I got their doctor on my cell phone, and we text and we just try and stay in the loop. So I think it’s important that people have somebody experienced with epithelioid sarcoma involved in their care, and I think they can do that without replacing their whole team.

 

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