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Synovial Sarcoma

  • Over time, your child’s joints naturally grow and change. However, throughout this process, problems can sometimes occur. A synovial sarcoma is one such abnormality and is a serious condition that affects the soft tissues of the body. The rare, malignant (cancerous) tumor most often occurs near the knee, but can also occur near other joints, mainly in the arms and legs.

    A diagnosis of cancer can be overwhelming and your list of questions may seem endless. An important first step in understanding what lies ahead is familiarizing yourself with the basics about the condition.

    The cause of synovial sarcoma is unknown, but it has been linked to genetics.
    It’s rare, and it most often occurs in adolescents and young adults and affects more boys than girls.
    The tumor can spread to others areas of the body, especially the lymph nodes.
    Synovial sarcoma is a serious condition requiring a combination of surgery, radiation therapy and/or chemotherapy.
    In general, small tumors and those that can be removed surgically are much easier to treat. Larger tumors, tumors that can’t be removed surgically and those that have spread to other parts of the body are more difficult to cure.

    The detailed information on the following pages will help you gain a better understanding of synovial sarcoma and a clearer picture of what to expect.

    How Dana-Farber/Boston Children’s Cancer and Blood Disorders Center approaches synovial sarcoma?


    The diagnosis of a life-threatening condition, like cancer, affects your entire family. We’re here to help you every step of the way. At Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, we offer the ideal setting, utilizing world-recognized cancer expertise at Dana-Farber and internationally renowned pediatric expertise at Children’s within the research and educational setting of Harvard Medical School. We are a top cancer center and top children’s hospital. Our team’s comprehensive experience and knowledge is unparalleled and gives young patients the best chance at survival.

    Experts in our Bone & Soft Tissue Tumor Program are devoted to caring for children and teenagers with synovial sarcoma and other bone and soft tissue disorders.

    Our multidisciplinary approach to care ensures in-depth discussion of each case and personalized treatment plans for every patient. We integrate expertise from the following specialists:

    • pediatric oncologists, surgical oncologists and radiation oncologists
    • pediatric experts from every medical subspecialty, such as orthopedics, pathology, physical therapy and radiology, among others.
    • highly skilled and experienced pediatric oncology nurses
    • Child Life specialists, psychologists, social workers and resource specialists who provide supportive care before, during and after treatment?
    • We are a world leader in opening new avenues of "translational research," bringing laboratory advances to the bedside and doctor's office as quickly as possible. All of our senior medical staff members of the Bone and Soft Tissue Tumors Program participate in clinical research activities.

    Reviewed by Megan Anderson, MD
    © Boston Children’s Hospital; posted in 2011


  • What is synovial sarcoma?
    Synovial sarcoma is a malignant (cancerous) tumor of the soft tissues, usually around joints. The most common location is near the knee, but it can also occur near other joints, mainly in the arms and legs. It can spread (metastasize) to other areas of the body, particularly to the lungs, but also, less commonly, to nearby lymph nodes.

    Is synovial sarcoma common?
    Synovial sarcoma is a rare tumor that tends to occur in adolescents and young adults and affects more boys than girls. As a group, soft tissue sarcomas account for less than 1 percent of all new cancer cases each year. In the United States, only about 900 children and adolescents are diagnosed with soft tissue sarcomas each year.

    Is it curable?
    Synovial sarcoma can be treated using a combination of surgery, radiation therapy and/or chemotherapy. Tumors that can be removed with surgery are generally easier to treat. Larger tumors, those that have spread to other parts of the body, or those that cannot be removed surgically are more difficult to cure.

    Causes

    What causes synovial sarcoma?
    The exact cause of synovial sarcoma is not entirely understood, however, research has indicated that specific genetic defects may play a role.

    Signs and symptoms

    What are the symptoms of synovial sarcoma?
    Sometimes the symptoms of synovial sarcoma can resemble those of arthritis, bursitis or synovitis. While symptoms may vary from child-to-child, the most common include:

    • swelling
    • a mass that may or may not be accompanied by pain
    • limping or difficulty using legs, arms, hands or feet

    Questions to ask your doctor

    You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your doctor’s recommendations.? ?If your child is has been diagnosed with a synovial sarcoma, you probably have a lot on your mind. So it’s often helpful to write questions down. Some of the questions you may want to ask include:

    • What does a diagnosis of a synovial sarcoma mean for my child?
    • How will you manage my child’s symptoms?
    • What kind of surgery will my child have?
    • How long will recovery take?
    • Will my child need chemotherapy or radiation?
    • What are the possible short and long-term complications of treatment?
    • What is the long-term outlook for my child?
    • How likely is it that the synovial sarcoma will come back?
    • What services are available to help my child and my family cope?


    FAQ

    Q: How serious is it?
    A: Synovial sarcoma is a malignant (cancerous) tumor that can spread to other parts of the body. It is a serious condition that requires a combination of surgery, radiation therapy and/or chemotherapy.

    Q: Will my child be OK?
    A: The prognosis for children with synovial sarcoma depends on several factors including the size and location of the tumor, whether it can be removed surgically, whether the tumor has spread and your child’s response to treatment. In general, small tumors and those that can be removed surgically are much easier to treat. Larger tumors, tumors that cannot be removed surgically and those that have spread to other parts of the body are more difficult to cure.

    Q: Will my child need chemotherapy or radiation?
    A: Yes, in addition to surgery, your child’s physician may also recommend chemotherapy and/or radiation.

    Q: Where will my child be treated?
    A: Children with synovial sarcoma are treated through our joint  Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, one of the world’s best pediatric cancer centers, known for quickly translating scientific discoveries into new treatments.

    Children treated through the Bone & Soft Tissue Tumors Program receive inpatient (overnight) at Boston Children’s Hospital and outpatient (day) care at Dana-Farber Cancer Institute.
    If your child needs surgery, he will see doctors in our Department of Orthopedics on the second floor of the Fegan building.


  • The first step in treating your child is forming an accurate and complete diagnosis.

    How does a doctor know that it’s synovial sarcoma?
    Your child’s physician may use one of more of the following tests to determine the exact type of tumor your child has and whether the tumor has spread. These may include a:

    • physical exam, including checking the area where the tumor is located and other possible areas of involvement
    • x-rays to produce images of internal tissues, bones, and organs
    • magnetic resonance imaging (MRI) to produce detailed images of the area where the tumor is located
    • computerized tomography scan (also called a CT or CAT scan) to capture a detailed view of the body, in some cases
    • biopsy or tissue sample from the tumor to provide definitive information about the type of tumor; this is collected during an image-guided needle biopsy.
    • bone scan to detect bone involvement
    • complete blood count (CBC), which measures size, number and maturity of different blood cells in a specific volume of blood.
    • Other blood tests including blood chemistries

    After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child’s condition. Then we will meet with you and your family to discuss the results and outline the best treatment options.


    Coping and support


    In addition to providing medical care, we strive to also meet all of your family’s emotional and quality-of-life needs. We know that unfamiliar places, especially hospitals, often create anxiety and fear for a child. We also know this isn’t an easy time or task for parents, who have their own fears and concerns about the situation. Our family support services will help address many of your needs and concerns. Read about our resources and support services.




     

  • We know how stressful a diagnosis of cancer can be, both for your child and for your whole family. That's why our physicians are focused on family-centered care: From your first visit, you'll work with a team of professionals who are committed to supporting all of your family's physical and psychosocial needs. We'll work with you to create a care plan that's best for your child.

    Treatment options will vary greatly, depending on your child's situation. Your child's doctor and other members of your care team will discuss the options with you in-depth.

    Traditional treatments for synovial sarcoma
    Prompt medical attention and aggressive therapy are important. Treatments for synovial sarcoma may involve a combination of therapies including surgery, radiation and/or chemotherapy. The most common procedures include:

    Surgery
    Depending on the size and location of the tumor, your child may either need:

    Limb-salvage surgery helps preserve the limb by removing the tumor and wide margins of healthy tissue surrounding the tumor.
    Amputation may be necessary if the tumor cannot be removed (for example, if it involves the nerves and blood vessels).

    Radiation therapy
    Our doctors use precisely targeted and dosed radiation to kill cancer cells left behind after your child's surgery. Radiation can also be given before surgery in order to shrink the tumor.

    Chemotherapy
    Chemotherapy is a drug that interferes with the cancer cell's ability to grow or reproduce.

    Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.
    Often, a combination of chemotherapy drugs is used.
    Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.

    While chemotherapy can be quite effective in treating certain cancers, the agents don't differentiate normal healthy cells from cancer cells. Because of this, there can be many adverse side effects during treatment. Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.

    Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:

    • as a pill to swallow
    • as an injection into the muscle or fat tissue
    • intravenously (IV), directly to the bloodstream
    • intrathecally, directly into the spinal column with a needle

    Supportive care

    The term “supportive care” refers to any type of treatment to prevent and treat infections, side effects of treatments and complications, and to keep your child comfortable during treatment. It is an important part of our care for all children receiving cancer treatment.

    Will my child be OK?
    The outlook for children with synovial sarcoma depends on several factors including:

    • the size and location of the tumor
    • whether it can be removed surgically
    • whether the tumor has spread
    • your child's response to treatment

    In general, small tumors and those that can be removed surgically are much easier to treat. Larger tumors, tumors that cannot be removed surgically and those that have spread to other parts of the body are more difficult to cure. Outcomes can vary significantly depending on these factors.

    What is the recommended long-term care for children treated for synovial sarcoma?
    Children treated for synovial sarcoma should visit a survivorship clinic every year to:

    • manage disease complications
    • screen for early recurrence of cancer
    • manage late effects of treatment

    ?A typical follow-up visit may include some or all of the following:

    • a physical exam
    • laboratory testing
    • imaging scans


    Through the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber Cancer Institute, childhood cancer survivors receive a comprehensive follow-up evaluation from their cancer care team.

    Our childhood cancer survivorship clinic is held weekly.
    In addition to meeting with your pediatric oncologists, your child may see one of our endocrinologists, cardiologists, neurologists, neuro-psychologists or alternative/complementary therapy specialists.
    We also offer the following services:

    • patient and family education
    • psychosocial assessment
    • genetic counseling
    • reproductive and fertility evaluation and counseling
    • opportunities to speak with other childhood cancer survivors

    Coping and support

    In addition to providing medical care, we strive to also meet all of your family's emotional and quality-of-life needs. We know that unfamiliar places, especially hospitals, often create anxiety and fear for a child. We also know this isn't an easy time or task for parents, who have their own fears and concerns about the situation. Our family support services will help address many of your needs and concerns. Read about our resources and support services.

  • At Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, our care is informed by our research. We have a long history of research and innovation in treating childhood cancers.

    Boston Children's Hospital and Dana-Farber are conducting numerous research studies that will help clinicians better understand and treat soft tissue sarcomas, including studying:

    angiogenesis inhibitors—substances that may be able to prevent the growth of tumors
    biological therapies—substances that may be able to involve the body’s own immune system to fight cancer or lessen harmful side effects of some treatments
    neoadjuvant chemotherapy and radiotherapy, which may reduce the incidence of metastatic disease

    We are a world leader in opening new avenues of "translational research," bringing laboratory advances to the bedside and doctor's office as quickly as possible. All of our senior medical staff members of the Bone and Soft Tissue Tumors Program participate in clinical research activities. Our program director, Carlos Rodriguez-Galindo, MD, is also the co-director of our new Clinical and Translational Investigation Program, which aims to dramatically improve translational research in pediatric hematology and oncology.

    In addition to a variety of clinical trials, we also conduct extensive laboratory research to identify new treatments and improve therapies for bone and soft tissue tumors.

    Read all about our innovative approach at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center

    For more information about current research on bone tumors, visit our Bone & Soft Tissue Tumor Program page.


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