Angiosarcoma is a unique type of cancer. It appears in the inner lining of blood vessels and can occur in any region throughout the body; however, it is most commonly found on skin and in the breast, liver, and tissues. In rare cases, it occurs in the heart and lungs. Subcutaneous angiosarcoma arises beneath the surface of the skin.

Deep tissue has almost 25% of angiosarcomas, while in breast tissue it is about 8%. As with every other cancer, surgery is the main treatment along with chemotherapy or radiotherapy.

Neo-Adjuvant Therapy

The process of giving chemotherapy or radiation therapy, or both, prior to surgical operations of the tumor is referred to as neo-adjuvant therapy.

Chemotherapy and radiotherapy are considered as the most important treatments for angiosarcomas as they can be carried out before and after the surgery. The doses used in radiation and chemo therapies, which are given in the neo-adjuvant setting, are often less compared with the doses given after the surgery. In local tumor appearing regions, radiation is used; on the other hand, chemotherapy is utilized for treating the complete spread of the disease.

• Radiation therapy: This refers to a type of cancer treatment that especially uses high-energy beams like X-rays, protons, or similar types of radiation to destroy all trace of cancer cells. If surgery has not been undergone, then radiation therapy may be optional. Generally, doses of radiation vary from 45Gy to 65Gy.

• Chemotherapy: This 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, then chemotherapy may be optional. If surgery cannot be undergone, then chemotherapy may be combined with radiotherapy in some situations. The prognosis is generally improved by using chemotherapy treatment for a newly diagnosed patient affected with osteosarcoma.

The medicine called doxorubicin is optional for chemotherapy, but 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 angiosarcoma, paclitaxel and docetaxel are effectively used. In recent times, paclitaxel is known as an individual agent that can be used for chemotherapy.

Surgery

In angiosarcoma, surgery is considered as the primary treatment method. It is essential for all soft tissue cancer treatments. 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 there is a wide spread of the disease.

The best surgical results can be given by preoperative mapping. Here, biopsies are performed to know the chances for removal of cancer cells completely.

In extreme cases of this type of cancer, limb-sparing as well as amputation are the two types of surgical procedures followed. Most researchers state that there is no difference between amputation versus limb-savage with patients’ endurance.

• Limb-sparing: At present, using limb-sparing at least 90% of sarcomas are removed. This represents the fact that the maximum number of cancer cells is 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.

• Amputation: This type is used for treating soft tissue cancer initially.

Breast angiosarcoma: In this, the surgery may be implemented as a lumpectomy or mastectomy based on the presence of cancer and their size and region. For cancers located in the breast, mastectomy is often considered as the treatment method. 
Heart angiosarcoma: In this type of angiosarcoma, a cardiovascular surgeon removes the tumor as well as a section of normal tissue around it (margin); but 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.

Medication

Antineoplastic agents such as Doxorubicin, Ifosfamide, and Gemcitabine are used to inhibit growth as well as reproduction of cells.

Doxorubicin: this destroys cells that undergo rapid production of DNA and can be used for the treatment of any kinds of cancers. It is mostly administered through IV.

Ifosfamide(fex): this is an alkylating agent that helps in the inhibition of the synthesis of the protein and DNA.

Gemcitabine (Gemzar): Ribonucleotide reductase is inhibited and it fights with deoxycytidine triphosphate to fit itself into the DNA.

After the completion of treatment, for several years, one needs to have regular checkups. Discussion of symptoms is vital to prevent secondary occurrences as well as recurrence.