New lump
A nodule at or near the surgical site that was not previously there.
Soft tissue sarcoma
CONDITION / TUMOURS
Sarcoma recurrence.
Sarcoma recurrence is the return of the tumor after treatment: at the surgery site or in other organs, often in the lungs. About 80% of recurrences are detected within the first 3 years, so regular follow-up is required after treatment.
CONCEPTUAL VISUALIZATION- What it is
- The return of sarcoma after treatment — at the surgery site (local recurrence) or in other organs (metastases).
- when
- About 80% of recurrences are detected within the first 3 years, but later recurrences can also occur.
- How common
- In the registry of 668 patients from two centers (2018–2025), only metastases were present in 23.8%, only local recurrence in 13.5%, and both in 10.5%.
- Who notices
- In a study of 500 patients, almost 90% of local recurrences were detected by the patients themselves.
01 / WHAT IS ITWhat is
What is
recurrence of sarcoma.
Even after optimal treatment, sarcoma can return. Recurrence can be local — when the tumor grows again at the surgery site — or distant, when metastases appear. Soft tissue sarcomas often metastasize to the lungs.
About 80% of recurrences are detected within the first 3 years after treatment. But late recurrences also occur: in a population registry among 377 patients who survived 3 years without recurrence, it later appeared in 15%. Therefore, monitoring continues for a long time.
Recurrence is a complex situation, but not hopeless: a local recurrence can be surgically removed again or treated with radiation, and some lung metastases can be removed. What is suitable depends on the size and location of the tumor, previous treatment, and the presence of metastases.
For the first occurrence of sarcoma, examination, and initial surgery — see the page "Soft Tissue Sarcoma".
This is general information. The doctor will tell you what will suit you after the examination and examinations.
02 / SIGNSHow to notice
How to notice
recurrence of sarcoma.
A local recurrence often can be felt. Report any changes to your team without waiting for a scheduled check-up.
Mass is growing
It increases over time. In one study of 253 patients, the faster the recurrence grew, the worse the prognosis.
pain
A lump that is growing may start to hurt.
A cough that does not go away
It may be a sign of a tumor near the lungs.
Changes on imaging
Some recurrences and metastases are found on routine MRI, CT, or X-ray even before symptoms appear.
03 / REASONSIt depends on what
It depends on what
risk of recurrence.
The risk of recurrence remains even after optimal treatment. But certain circumstances increase it.
Margins of the removed tissue
If tumor cells were found at the edge of the incision or the reserve of healthy tissue was small, the risk of late local recurrence was higher.
Excision without examination
After "shelling out" without a tissue margin, in most cases, the tumor remains in the wound, and with it, the chances of recurrence are higher (odds ratio 3.56).
How sarcoma is treated for the first timeDegree of malignancy
High-grade tumors more often metastasized, including late metastases.
Early recurrence
If the tumor returned early, this indicates a more aggressive tumor. The outcomes of treating late recurrences were better.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Suspicion of recurrence is a reason to contact your team immediately, without waiting for the next check-up, but it usually does not require urgent care. Dialing 103 may be needed due to complications after repeat surgery.
103 immediately if:
- bleeding from the wound does not stop, even if it is pressed;
- blood gushes, bright red, it is difficult to stop;
- suddenly having difficulty breathing;
- chest pain or pain in the upper back;
- the heart beats very often;
- the person fainted.
To the doctor:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: After surgery, pain or swelling in the surgical area increases; the calf or leg hurts and swells. On the same day: The wound has become red, pus is coming out; you feel unwell or have a fever; a cough with blood appears. Without waiting for a scheduled check-up: A new lump appears at or near the surgical site; the lump is growing or has started to hurt; the cough does not go away.
05 / DIAGNOSTICSAs confirmed
As confirmed
Recurrence.
- Review
The doctor examines and palpates the surgical area and compares new images with previous ones.
- MRI of the surgical area
The method of choice to monitor the area where the tumor was.
- CT scan or chest X-ray
To check the lungs. In a randomized study of 500 patients, the 3-year survival was the same with X-ray and CT monitoring — 67% and 66%.
- Biopsy
After surgery and radiation, changes in the tissues can resemble a tumor, so a suspicion on the images is confirmed by tissue examination.
06 / TREATMENTHow we treat
How we treat
recurrence of sarcoma.
Treating a local recurrence is difficult, and there is no single protocol. The plan depends on where the tumor returned, its size, whether this area was previously irradiated, and whether there are metastases. It is formulated by a team of specialists.
01
Local recurrence
The goal is to remove the tumor again and preserve the limb.
- Repeat operation
- The main methods are repeat removal and radiation; the limb is preserved if possible, but in some cases amputation is needed.
- Clear margins
- In a cohort of 253 patients after repeat excision of a recurrence, only tumor cells at the margin were independently associated with subsequent recurrence.
- Forecast
- It is very variable. In the same cohort, 5 years after repeat excision, 29% died from sarcoma; outcomes were worse when the recurrence grew rapidly, had a high grade, multiple foci, or dirty margins.
- Amputation
- Overall, for sarcoma it is rarely offered, mostly only when the tumor has returned after limb-sparing surgery. In the same cohort, amputations were more frequent when the recurrence grew quickly: 19% versus 7%.
02
Radiation and medication
They are prescribed by an oncologist and a radiation therapist.
- Repeat radiation
- If this area has already been irradiated, there are fewer options for repeat treatment, and the risk of complications is higher.
- Brachytherapy
- Irradiation via catheters in the tumor bed. In a systematic review of 7 retrospective studies, the tumor was successfully controlled for 5 years in 18–87% of patients, with severe complications occurring in 0–49%. This is an option for selected patients.
- Medicines
- If the recurrence grew quickly, the authors of a cohort of 253 patients recommend considering medication before or after surgery. In the case of metastases, chemotherapy can slow tumor growth and relieve symptoms; the decision is made by an oncologist.
03
Metastases in the lungs
Sometimes — lung surgery.
- Removal of metastases
- In a systematic review of 8 studies (1004 patients), after removing metastases from the lungs, 20% to 58% survived 5 years. Outcomes were better when there was a single metastasis, the disease had not returned for a longer time, and it was completely removed.
04
Supervision
To detect recurrence in time.
- How common
- Guidelines recommend check-ups and examinations every 3–6 months. The schedule is chosen according to risk: for low-risk cases, frequent visits in the first two years may not affect the outcome.
- What is examined
- MRI — for the surgical area, CT — for the lungs; intervals depend on the grade and type of tumor. At a minimum — regular check-ups and chest X-rays.
- For how long
- Late recurrences can occur, so for high-grade tumors, especially if it was not possible to take a wide margin of tissue during the first surgery, long-term monitoring is justified.
- Self-examination
- Almost 90% of local recurrences in the study were detected by the patients themselves. Know how your scar feels to the touch, and tell your doctor about any changes without waiting for a scheduled visit.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Recurrence of sarcoma at the Doctor Valikhnovskyi Institute of Surgery is treated under the department of "Soft Tissue Oncosurgery." The clinic is responsible for the surgical part: repeated tumor removal, if possible preserving the limb, and tissue reconstruction. Radiation and medications are prescribed and managed by the oncologist and radiation therapist, removal of lung metastases is handled by the thoracic surgeon; the treatment plan is developed together at a medical board.
CLINIC SERVICE
Oncosurgery of soft tissues
Sarcomas and other soft tissue tumors — with preservation of the limb and restoration of tissues in the same operation.
View service
What we do for this condition
- MRI and biopsy — first, the recurrence is confirmed and the exact location of the tumor is determined.
- Consilium — the surgeon, oncologist, and radiation therapist decide whether preoperative treatment is necessary.
- 3D modeling — if necessary, MRI and CT data are combined into a three-dimensional model to visualize the vessels, nerves, and bones near the tumor.
- Repeated removal in a single block — the tumor is removed along with a layer of healthy tissue, without opening it; the edges are evaluated by a pathomorphologist.
- Limb preservation — if possible, the tumor is removed while preserving the arm or leg and its function.
- Vascular prosthetics and nerve repair — if the tumor has grown into an artery, vein, or nerve.
- Flaps in the same surgery — after previous surgeries and radiation, the surgeon can close the wound with a flap — tissue with good blood supply.
- Rehabilitation — after muscle removal and nerve repair — exercises to restore strength and movement.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Materials onlineSend discharge summaries and histology from the first surgery, radiation data, recent MRI and CT scans.
- ConsultationExamination and comparison of images; if necessary — biopsy.
- Consilium and planTogether with the oncologist and radiation therapist: whether it is possible to remove the recurrence, whether radiation or medication is needed, and how to close the wound.
- SurgeryRepeated removal and tissue reconstruction — if possible in one operation.
- SupervisionRegular MRI and CT according to the oncologist's schedule; report new changes immediately, without waiting for the visit.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Does recurrence mean the treatment was wrong?
Not necessarily. Even after optimal treatment, sarcoma can return — that’s why regular follow-up is needed afterwards.
When does sarcoma usually come back?
About 80% of recurrences are detected within the first 3 years. Late recurrences also happen, so monitoring continues longer.
Is it possible to operate again?
Repeated removal is one of the main methods to treat local recurrence, and the limb is preserved if possible. Whether surgery is suitable for you is decided at a multidisciplinary board after MRI and biopsy.
Will the limb have to be amputated?
In general, amputation is rarely suggested for sarcoma, and mainly only when the tumor has returned after a limb-sparing surgery. Therefore, in case of recurrence it might be discussed, but the goal is to preserve the limb if possible. The decision is made at a multidisciplinary meeting.
Is it possible to undergo radiation therapy again?
Sometimes yes, for example, with brachytherapy, but after previous radiation the risk of complications is higher. The decision is made by a radiation oncologist.
What should I do if I feel a lump between check-ups?
Do not wait for the next visit, but contact your team immediately. Almost 90% of local recurrences in the study were noticed by the patients themselves.
How often should MRI and CT be done?
Guidelines recommend check-ups and examinations every 3–6 months; the exact schedule depends on the grade and type of tumor. It is determined by an oncologist.
Are lung metastases treated?
Yes, in some patients they are removed. In a systematic review after such surgery, 5-year survival ranged from 20% to 58% — better outcomes occur when there is a single metastasis and it is completely removed.
Sources
18 sources · British and European guidelines, systematic reviews, randomized trial, cohorts, and NHSshowCollapse
- UK guidelines for the management of soft tissue sarcomasBritish Journal of Cancer, 2025doi:10.1038/s41416-024-02674-y ↗
- Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2024: imaging immediately after neoadjuvant therapy in soft tissue sarcoma, soft tissue tumor surveillance, and the role of interventional radiologyEuropean Radiology, 2025doi:10.1007/s00330-024-11242-0 ↗
- Imaging recommendations for soft-tissue sarcomas: model guidelines from diagnosis to post-treatment follow-upClinical Radiology, 2024doi:10.1016/j.crad.2024.08.023 ↗
- Follow-up of the soft tissue sarcoma patientJournal of Surgical Oncology, 2015doi:10.1002/jso.23814 ↗
- Late Local Recurrence and Metastasis in Soft Tissue Sarcoma of the Extremities and Trunk Wall: Better Outcome After Treatment of Late Events Compared with EarlyAnnals of Surgical Oncology, 2021doi:10.1245/s10434-021-09942-8 ↗
- Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority TrialClinical Orthopaedics and Related Research, 2014doi:10.1007/s11999-013-3385-9 ↗
- Timing and Frequency of Surveillance After Resection of Extremity and Trunk Soft Tissue Sarcoma: Identifying Opportunities for ImprovementAnnals of Surgical Oncology, 2026doi:10.1245/s10434-026-19337-2 ↗
- Local recurrence management of extremity soft tissue sarcomaEFORT Open Reviews, 2023doi:10.1530/EOR-23-0095 ↗
- Growth Rate and Outcomes in Locally Recurrent Extremity and Truncal Soft Tissue SarcomaJAMA Network Open, 2024doi:10.1001/jamanetworkopen.2024.31530 ↗
- Local Recurrence and Metastasis Define Distinct Recurrence Phenotypes in Soft Tissue SarcomaCancers, 2026doi:10.3390/cancers18132100 ↗
- Re-excision after unplanned excision of soft tissue sarcoma: A systematic review and metanalysis. The rationale of systematic re-excisionJournal of Orthopaedics, 2021doi:10.1016/j.jor.2021.05.022 ↗
- Pulmonary metastasectomy in soft tissue sarcomas: a systematic reviewJournal of Thoracic Disease, 2021doi:10.21037/jtd-2019-pm-13 ↗
- Reirradiation using brachytherapy for locally recurrent soft tissue sarcoma: A systematic reviewBrachytherapy, 2026doi:10.1016/j.brachy.2026.07.171 ↗
- Symptoms of soft tissue sarcomaNHS, 2024nhs.uk/conditions/soft-tissue-sarcoma/symptoms ↗
- Treatment for soft tissue sarcomaNHS, 2024nhs.uk/conditions/soft-tissue-sarcoma/treatment ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
- DVT (deep vein thrombosis)NHS, 2026nhs.uk/conditions/deep-vein-thrombosis-dvt ↗
The figures on the page are from these sources.
Suspect
recurrence?
Send recent MRI or CT scans and discharge summaries from the first treatment. The doctor will say whether the tumor can be removed again and what to discuss with the oncologist.