Angiosarcoma is a unique type of cancer, as it appears in the inner lining of blood vessels and can occur in any region throughout the body. However, angiosarcomas are most commonly found on the skin, as well as in the breast and liver tissues. In rare cases, this type of cancer can occur in the heart and lungs. Subcutaneous angiosarcoma arises beneath the surface of the skin.
Deep tissue tumors account for almost 25% of angiosarcomas, whereas this cancer accounts for about 8% of breast tissue cancers. As with several other types of cancer, surgery is the main treatment, along with chemotherapy or radiotherapy.
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Neoadjuvant therapy
The process of undergoing chemotherapy or radiation therapy, or both, prior to a surgical operation of the tumor is referred to as neoadjuvant therapy.
Radiation therapy refers to a type of cancer treatment that uses high-energy beams like X-rays, protons, or similar types of radiation to destroy all traces of cancer cells. Generally, the doses of radiation vary from 45 Gy to 65 Gy.
Chemotherapy, on the other hand, refers to a type of cancer treatment in which chemical agents and drugs are used to destroy cancer cells. If angiosarcoma spreads all over the body, chemotherapy may be optional. If surgery cannot be undergone, then chemotherapy may be combined with radiotherapy in some situations.
Chemotherapy and radiotherapy are considered the most important treatments for angiosarcomas, as they can be carried out both before and after the surgery. The doses used in radiation and chemotherapies, which are given in the neoadjuvant setting, are often less than those which are given after the surgery. In local tumor appearing regions, radiation is used; whereas chemotherapy is often utilized for treating the complete spread of the disease.
The medicine called doxorubicin is optional for chemotherapy; however, a mixture of mesna, doxorubicin, and ifosfamide (MAI) is used by some medical treatment centers. Liposomal doxorubicin is also utilized. For head, neck, and scalp angiosarcomas, paclitaxel and docetaxel are effectively used.
Surgery
Like all other soft tissue cancers, surgery is often considered the primary treatment method for angiosarcomas. The main intention of surgery is to remove the whole cancerous mass from the affected area. Using surgical methods, the primary cancer cells can be controlled, even if the cancer is invasive.
The best surgical results can be given by preoperative mapping. Here, biopsies are performed to identify the chances that the surgeon will be able to successfully remove all of the cancer cells.
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In extreme cases of this type of cancer, both limb-sparing and amputations are often the surgical procedures that remain available to these patients. Most researchers indicate that there is no difference between amputation versus limb-savage with patients’ endurance.
At present, limb-sparing is able to remove at least 90% of sarcomas, which represents cases where the maximum number of cancer cells have been removed. If only specialists or the surgeon feels confident that the sarcoma can be removed completely, then the patients can be treated with limb-sparing surgery.
For breast angiosarcomas, surgery may be implemented as a lumpectomy or mastectomy, depending on the presence of cancer and its size and occupied region. For cancers located in the breast, a mastectomy is often considered the ideal treatment method.
The surgical removal of a heart angiosarcoma involves a cardiovascular surgeon removing the tumor as well as a section of normal tissue around it (margin). In most cases, removal of the entire tumor may not be possible.
Adjuvant therapy
The treatments that are performed after the surgical method are together termed as adjuvant therapy, where every sign of viewable cancer cells is removed. Sometimes, radiation therapy and chemotherapy is performed after the surgery as it is used to destroy all the remaining cancer cells, although the patients may have taken these treatments previously. The same medicine may be used before and after the surgery.
Medications
Antineoplastic agents such as doxorubicin, ifosfamide, and gemcitabine are used to inhibit further growth of the tumors, as well as the reproduction of these cancerous cells.
Doxorubicin destroys cells that undergo rapid production of DNA and can be used for the treatment of many different types of cancers. Typically, doxorubicin is administered intravenously.
Ifosfamide(fex) is an alkylating agent that helps in inhibiting the synthesis of the protein and DNA.
Gemcitabine (Gemzar) functions by inhibiting ribonucleotide reductase and fighting with deoxycytidine triphosphate to fit itself into the DNA.
After the completion of treatment, for several years, patients will require regular checkups. During these visits, it is imperative that patients discuss any of their symptoms with their treating healthcare provider in order to prevent both secondary occurrences and recurrence of the angiosarcoma.
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