What Is Sarcomatoid Carcinoma

Introduction 

Definition of Sarcomatoid Carcinoma 

Sarcomatoid carcinoma is a lesser-known type of aggressive fast-growing cancer that’s a mix of sarcoma and carcinoma cancer types.¹ These tumours can be found over the body but are mostly found in the lungs. This type of cancer spreads fast and can be difficult to treat. 

Sarcomas are rare cancers that develop in the bones and soft tissues, while carcinomas are a type of cancer that forms in the epithelial tissue, which lines most of the organs in the skin and body. 

This article will provide an explanation on sarcomatoid carcinoma including symptoms, diagnosis and treatments. 

Types of sarcomatoid carcinoma 

Pulmonary Sarcomatoid Carcinoma (PSC) 

Pulmonary sarcomatoid carcinoma is a rare subtype of poorly differentiated non-small-cell lung carcinoma that accounts for 0.1-0.4% of lung cancers.² PSC carries a poor prognosis compared to other types of NSCLC even in the early stages of the disease. 

Renal Sarcomatoid Carcinoma 

Renal cell carcinoma (RCC) with sarcomatoid is a highly aggressive form of RCC. This type of cancer shows loss of epithelial components and has features such as spindle cells, high cellularity and cellular atypia.³ Sarcomatoid urothelial carcinoma is rare and accounts for 0.3% of all urothelial cancers.⁴ 

Skin Sarcomatoid Carcinoma 

https://www.mayoclinic.org/diseases-conditions/squamous-cell-carcinoma/symptoms-causes/syc-20352480 (SSCC) is a type of skin cancer, that is rare and aggressive, it spreads to other parts of the body, can cause complications and has a poor prognosis.⁵ 

Staging 

Sarcomatoid carcinoma staging is a crucial aspect of determining the extent of the cancer's spread and guiding treatment decisions. Staging will vary depending on the specific organ where sarcomatoid carcinoma is found. Below is an overview of the staging system commonly used for lung sarcomatoid carcinoma: 

• Stage 0 (T0, N0, M0): At this stage, the cancer has not invaded nearby tissues or spread to lymph nodes or distant organs. 
• Stage I (T1, N0, M0): The cancer is small and confined to the lung a. It has not spread to lymph nodes or distant organs. 
• Stage II (T2, N0, M0): In this stage, the tumour is larger or has started to invade nearby structures within the lung, but it has not reached the lymph nodes or distant organs. 
• Stage III (T1-2, N1, M0 or T3, N0-1, M0): The cancer has possibly grown significantly and may have spread to nearby lymph nodes. At this stage, the tumour may be larger or may have spread to lymph nodes but has not reached distant organs. 
• Stage IV (T4, N0-1, M0 or Any T, Any N, M1): In stage IV, the cancer has typically reached an advanced stage. It may have invaded nearby structures, spread to lymph nodes, and may have metastasized to distant organs. This stage is often associated with a poorer prognosis. 

Causes and risk factors 

Genetic predisposition 

Like some other cancers, if there is a family history of SC, then you are more at risk of being diagnosed. This is not a certainty, but compared to others, it is more likely. This may be due to errors in specific genes such as the RAS gene, that may cause the cells to grow rapidly and can be inherited.⁶ 

Smoking and carcinogens 

Most patients who have been diagnosed with PSC are either current smokers or used to smoke.

Age and gender 

 In PSC, advanced age is a high-risk factor, people with advanced age showed a worse survival rate. Patients are most commonly older people assigned male at birth (AMAB).⁷ 

Symptoms and clinical presentation 

Common symptoms 

Pulmonary sarcomatoid carcinoma: 

Common symptoms are a persistent cough, shortness of breath, and chest pain. 

Sarcomatoid renal cell carcinoma: 

Common symptoms are – pain in the back, blood in the urine, and bone pain. 

Sarcomatoid squamous cell carcinoma:  

Common symptoms are – bumps/nodules in the skin, sores, and red scaly patches. 

Diagnostic methods 

It is difficult to diagnose SC, therefore it will be diagnosed using a combination of methods such as imaging tests like X-rays, CT scans, and MRI scans to help identify potential tumours, while a biopsy, which involves taking a small tissue sample for examination, is typically needed to confirm the diagnosis.⁸

Imaging 

The healthcare provider may use a CT scan to identify the location of the tumour or a CT/PET scan for a more detailed view of the inside of the body. 

Histopathology 

This involves removing a sample of the tumour during a biopsy so that it can be studied under a microscope. By evaluating what the cells look like, you can determine what type of tumour it is. 

Immunohistochemistry 

This tests for substances, called antigens, associated with specific cell types. Certain types of antigens can signal that a cell is abnormal or malignant (cancerous). 

Topics to discuss with a doctor after diagnosis of Sarcomatoid Carcinoma? 

• What is Sarcomatoid Carcinoma? 
• What is my diagnosis? 
• What are the treatment options? 
• What can I expect once treatment is complete? 
• What are the long-term effects of this cancer and the treatment? 

Treatment approaches 

Sarcomatoid carcinoma is not curable, but treatments can be used to reduce the symptoms. 

Surgery 

The most effective surgery for sarcomatoid carcinoma is to remove the entire tumour.  However, this type of cancer is likely to spread across the body so surgery may be less effective. 

Radiation therapy 

Radiation therapy may be used to kill cancer cells by focusing high beam X–rays to the parts of the body that the cancer has spread to. 

Chemotherapy 

Chemotherapy will often be used after surgery, to remove any remaining cancer cells. Some examples of chemotherapy in metastatic sarcomatoid carcinoma are doxorubicin and ifosfamide.⁹ 

Targeted therapy 

Targeted therapy is a type of cancer treatment that uses drugs or other substances to precisely identify and attack cancer cells. This can be used in combination with other treatments. 

Immunotherapy 

Immunotherapy uses your own immune system to fight cancer. This therapy helps the immune system recognise and attack cancer cells. This type of therapy may be good for sarcomatoid carcinoma because it is associated with the overexpression of a protein called programmed cell death ligand 1. Some research found that immunotherapy was a promising treatment for sarcomatoid urothelial carcinoma.¹⁰ 

Clinical trials 

Some patients may consider being part of a clinical trial for the treatment of sarcomatoid carcinoma. This is a study that examines the safety and effectiveness of new treatments.  

Supportive care 

Palliative care 

Palliative care is a special type of medical care for people living with a serious illness such as cancer. Patients in palliative care may receive medical care for their symptoms or may also be receiving treatment to cure their cancer, this type of care can be given at any stage of the cancer – from diagnosis to the end of life. 

Psychological and emotional support 

A diagnosis of any cancer, including sarcomatoid carcinoma can be challenging, and patients may feel many different emotions such as being confused, anxious and upset. Therefore, it is important for patients of cancer to find support from family and friends with whom they feel comfortable enough to talk about their feelings or to join support groups to talk with people who may understand their situation. There is also professional psychological support available for cancer patients to receive counselling and reduce feelings of anxiousness. It may also be good to engage in activities that patients enjoy doing. 

Prevention and lifestyle factors 

Smoking cessation 

People who smoke are more at risk for lung cancer, in addition to other cancer types. However, research suggests that people who quit smoking cut their risk of lung cancer by 30-50% compared to people who keep smoking.¹¹ 

Environmental awareness 

Environmental exposure to air pollution, radiation and chemical carcinogens contributes to the risk of cancer.¹² It is important to limit and protect yourself against such exposures to reduce the risk of getting cancer. 

Early detection and screening 

In the diagnosis of cancer, early detection focuses on detecting symptomatic patients of cancer as early as possible, this can help to prevent the cancer from spreading across the body. Screening involves testing healthy individuals to test for early signs of cancer. 

Frequently asked questions  

How can I prevent SC? 

Although there is no specific prevention of cancer, to prevent SC it is important to maintain a healthy lifestyle by consuming healthy foods and staying active through exercise.  It is also important to avoid smoking. 

What is the survival rate of SC? 

The median survival rate is about 10 months, while the five-year survival rate for sarcomatoid carcinoma is approximately 15%. 

What can I expect if I have SC? 

If you have been diagnosed with SC, you can expect problems with swallowing and breathing. Therefore, treatment should be started as soon as possible, and this will depend on the severity of the cancer. Treatment will mostly involve the removal of the thyroid. 

When should I see a doctor? 

If you notice any changes in your health and feel any concerns. It is important to see your GP so that the cancer can be diagnosed sooner so that there is a better chance of getting treatment and preventing the spread of the cancer. 

Summary

Sarcomatoid Carcinoma is a rare but aggressive type of cancer, that is a combination of sarcoma and carcinoma cancers which may be localised to one part of the body or spread to other organs in the body. 

The symptoms may vary depending on the type of SC such as pulmonary or lung SC will lead to symptoms of coughing but sarcomatoid renal cell carcinoma will lead to pain in the back so if a person finds any changes in their health, they should talk to a doctor to find a diagnose at an early stage of the cancer so that treatment can begin sooner.