Every Wednesday afternoon in a hospital conference room, Jorge Casas, MD, founder of Dallas Sarcoma Associates, meets with a team of specialists: an oncologist, radiation oncologist, pathologist, radiologist, interventional radiologist, orthopedic surgeon, plastic surgeon, thoracic surgeon, and sometimes a vascular surgeon and surgical oncologist.

To treat rare sarcoma diagnoses, these are the doctors required.

Sarcomas are tumors that start in the bones or connective soft tissues, such as muscles, tendons and nerves. While they account for just 1% of all adult cancer — usually occurring in patients in their 50s, 60s and 70s — they make up 21% of childhood cancers.

Most of the time when you’re dealing with cancer, it’s a carcinoma, which lines the cells that form organs, such as the breast or lungs. Sarcomas on the other hand are exceedingly rare. “There are just a handful of us throughout the world that treat these tumors,” says Dr. Casas. Today, to receive cancer care for a sarcoma diagnosis, patients have to travel to a specialized cancer center for treatment. “Here in Dallas, 70% of my patients come from outside the Dallas-Fort Worth area. Parents drive or fly long distances for treatment, but this is to ensure they receive the highest level of care.”

At this weekly sarcoma consensus conference, this team of doctors discuss one patient at a time, applying their knowledge and expertise to determine the next steps for treatment. “It really is a team sport,” says Dr. Casas. “We talk about diagnoses, present and review slides from biopsies, surgeries or imaging, and discuss how people are responding to chemotherapy and how to schedule surgeries.”

An orthopedic surgeon with a specialty in oncology, Dr. Casas is on the cutting edge of innovations that have made sarcoma surgeries faster, safer and more effective.

While rare, sarcomas affect more than 50,000 patients and their families at any one time. That’s why Dr. Casas feels passionately about the importance of research and innovations. “On the soft-tissue sarcomas we see in older adults, they are all over the map. With each sarcoma, it’s almost like a unique disease different from all the others.”

While continuous research and medical advancements are still required, Dr. Casas feels grateful for the surgical innovations that have decreased uncertainty and shortened operating times.

“Long surgeries are not good for patients. Earlier in my career, you would book a whole day to perform surgery on a pelvic tumor — it could take as long as 14 hours. Now, you can do it in four to five hours. That’s less time under anesthesia, and there’s less of a chance for infection, both of which are good for the patient.

For soft-tissue sarcomas, the MRI was one of the first groundbreaking developments due to the in-depth information it provided. “With an X-ray, you can see the bone, and with a CT scan, you can see into 3D architecture and solid organs, but the MRI shows much more.”

That information paved the way for complex reconstruction. “You can see ligaments, tissues, muscle and bone marrow, which is really helpful for sarcoma surgeons as it shows the extent of swelling that surrounds the tumor,” Dr. Casas explains. “You can see how much you may have to sacrifice to get them out.”

For bone tumors, doctors have access to software that’s able to merge images from a CT scan and an MRI. If a patient has sarcoma of the pelvis, for example, doctors can employ a 3D printer to make a plastic “cutting guide” that contours precisely to the patient’s bone. “When I plan these surgeries with the engineers, I can be precise about the margins and take into account neighboring structures like blood vessels and nerves.”

Once the cancer is removed, doctors fill the recession with a precise reconstruction. To make the reconstruction, they have a few options.

With the same technology used in hip replacements, one option for reconstruction is to 3D print an implant on metal. After surgeons wedge the metal implant into the bone, the bone grows into the metal. “The piece of metal is printed in such a way that it has a surface the bone can grow onto,” says Dr. Casas.

Alternatively, doctors might create an implant from an organ donor’s bone. “It’s made precisely to fit the shape of the defect left after the cancer is removed during surgery,” Dr. Casas says. “If you see the before and after reconstruction images, it’s a game-changer.”

Sarcoma diagnoses make up 21% of childhood cancer, and Dr. Casas’ heart goes out to the families whose children face sarcoma treatment. “When you have sarcoma, or a child with sarcoma, it can be a big deal,” he says.

Typically, bone pain is the leading indicator that children may need to see a doctor — especially night pain, says Dr. Casas. Other times, children fracture or break a bone, and the X-ray signals a bigger problem. As the father of two children, Dr. Casas understands how difficult it is for parents to know when they should be concerned. “I have two daughters; one does lacrosse and field hockey. The other is a competitive swimmer,” he says. Pain isn’t uncommon in growing and developing children — especially those who are so active.

With a full multi-disciplinary team of experts ready to evaluate, diagnose and provide treatment for sarcomas, families can feel certain their loved ones are receiving the unique care they need, when they need it.