Watch: the CureRays® explainer series
Prefer to read? The full guide below is complete on its own, with tables you can revisit any time.
What is angiosarcoma?
Angiosarcoma is a rare and aggressive cancer that develops from the cells lining blood vessels and lymph vessels — the channels that carry blood and lymph fluid through the body. Because these vessels run everywhere, angiosarcoma can arise almost anywhere, but it most often appears in the skin, particularly on the scalp and face of older adults, where it can look like a bruise that does not heal, a raised purple area, or swelling. It can also develop in the breast, liver, spleen, heart, or deep soft tissues. Two important situations deserve special mention: angiosarcoma can arise years after radiation therapy was given to an area for another cancer (for example, in the breast or chest wall after breast cancer treatment), and it can develop in an arm or leg affected by long-standing lymphedema — chronic swelling, often after lymph node surgery. Angiosarcoma tends to grow quickly, can spread to other parts of the body, and may involve a wide area of tissue with edges that are hard to define, which makes it challenging to treat. Because it is rare and complex, care is best delivered by a specialized sarcoma team. Treatment usually combines surgery to remove the tumor, radiation, and chemotherapy, tailored to where the cancer is and how far it has spread.
The main types
Doctors group angiosarcoma by where it starts and how it behaves:
| Type | What it means, simply |
|---|---|
| Cutaneous angiosarcoma (skin) | The most common form, often on the scalp and face of older adults; it can spread across the skin with hard-to-see edges, making complete removal difficult and radiation an important part of treatment. |
| Radiation-associated angiosarcoma | Develops years after radiation therapy for another cancer, classically in the breast or chest wall; requires careful planning because the area has been irradiated before. |
| Lymphedema-associated angiosarcoma (Stewart-Treves) | Arises in a limb with long-standing chronic swelling, often after lymph node removal; uncommon but important to recognize. |
| Visceral and soft-tissue angiosarcoma | Occurs in organs such as the breast, liver, spleen, or heart, or in deep soft tissue; tends to be aggressive and is treated with a combination of surgery, chemotherapy, and radiation. |
Staging, in plain terms
Angiosarcoma is staged using the system for soft-tissue sarcomas, which combines the standard TNM measures with the tumor's grade. T describes the size and extent of the tumor; N indicates whether nearby lymph nodes are involved; and M indicates whether the cancer has spread to distant parts of the body, such as the lungs. Crucially, sarcomas also factor in grade — how abnormal and fast-growing the cells look under the microscope — and angiosarcoma is generally high grade, meaning aggressive. Doctors determine the stage with a biopsy and imaging such as CT or MRI of the tumor and scans to check for spread. One practical challenge specific to angiosarcoma, especially the skin form, is that the tumor can extend microscopically well beyond what is visible, so the true extent is often larger than it appears — an important consideration when planning surgery and radiation. The stage and grade together guide how intensive treatment should be and whether the goal is to remove and control the cancer locally or to treat disease that has already spread.
| Soft-tissue sarcoma TNM with tumor grade (size, depth, spread to nodes or distant sites, and how aggressive the cells look) | What it generally means |
|---|---|
| Localized, smaller tumor | Cancer confined to where it started and limited in size; treated with surgery to remove it, usually followed by radiation, with the goal of controlling it and preventing return. |
| Localized, larger or deeper tumor | A bigger or deeper tumor still confined to the area; treated with a combination of surgery, radiation, and often chemotherapy, given the higher risk of spread. |
| Regional spread to lymph nodes | Cancer that has reached nearby lymph nodes; treated with combined therapy addressing both the original site and the involved nodes. |
| Distant spread (metastatic) | Cancer that has spread to distant organs such as the lungs; treated mainly with systemic therapy (chemotherapy and targeted/antiangiogenic drugs), with radiation and surgery used to control specific sites and relieve symptoms. |
The standard of care
Angiosarcoma is almost always treated by a team that may include a surgeon, a medical oncologist, and a radiation oncologist, combining therapies for the best result. The usual building blocks are:
Surgery
When possible, the tumor is removed with a margin of healthy tissue. Achieving clear edges can be difficult — especially in skin angiosarcoma that spreads microscopically — which is why surgery is usually combined with radiation.
Radiation therapy
Often given after surgery to treat the wider area at risk and lower the chance of return; it can also be the main treatment when the tumor cannot be removed, and it covers a generous field because angiosarcoma extends beyond what is visible.
Chemotherapy
Drugs such as taxanes and anthracyclines are active against angiosarcoma and are used for larger tumors, before or after local treatment, and for disease that has spread.
Targeted and antiangiogenic therapy
Because angiosarcoma arises from blood-vessel cells, drugs that block blood-vessel growth are being used and studied, offering additional options for advanced disease.
Specialized multidisciplinary care
Because angiosarcoma is rare, aggressive, and complex, treatment is best coordinated by an experienced sarcoma team, often with access to clinical trials.
How radiation treatment works
Radiation therapy uses focused high-energy beams to damage the DNA inside cancer cells so they can no longer grow and divide. In angiosarcoma, radiation plays a major role because of one defining feature of this cancer: it often spreads microscopically far beyond what can be seen or felt, with edges that are difficult to define. This is especially true of angiosarcoma of the skin, such as on the scalp. As a result, even when a surgeon removes the visible tumor, cancer cells can remain in the surrounding tissue, leading to a high chance of the cancer coming back locally. Radiation addresses this by treating not just the tumor site but a generous surrounding area, catching hidden disease the eye and the scalpel can miss. It is most often given after surgery to lower the risk of return, but it can also be the primary treatment when a tumor cannot be removed or when a patient cannot undergo surgery, sometimes combined with chemotherapy to improve control. Because angiosarcoma frequently occurs in challenging locations — the curved surface of the scalp, the breast or chest wall (including areas that were irradiated years earlier for another cancer), or a swollen limb — careful planning matters. Modern techniques such as intensity-modulated radiation shape the dose around these complex areas, while electron beams can treat skin disease at a controlled depth, sparing deeper healthy tissue. Treating an area that has had previous radiation requires special expertise to balance effectiveness against the limits of tissue that has already received a dose. The radiation oncologist designs each plan to cover the wide area angiosarcoma puts at risk while protecting surrounding healthy tissue as much as possible.
The main ways radiation is delivered for angiosarcoma:
Wide-field external-beam radiation
Because angiosarcoma — particularly of the skin — spreads microscopically beyond its visible edges, radiation often covers a generous area around the tumor to catch hidden disease, delivered with shaped beams to control the cancer while limiting harm to healthy tissue.
Radiation after surgery (adjuvant)
Following removal, radiation treats the surgical bed and surrounding at-risk tissue to reduce the high chance of local recurrence that angiosarcoma carries.
Definitive radiation when surgery isn't possible
For tumors that cannot be removed or in patients who cannot have surgery, higher-dose radiation, sometimes combined with chemotherapy, is used to control the cancer.
Intensity-modulated and electron-beam techniques
Intensity-modulated radiation shapes the dose around complex areas like the scalp, while electron beams can treat skin disease at a controlled depth — both help cover broad at-risk areas while sparing deeper healthy tissue.
Latest studies shaping care
Care keeps improving — often toward getting the same excellent results with less burden on patients. A few developments:
Combined surgery and radiation improves local control: Studies show that pairing surgery with radiation, often over a wide field, improves control of angiosarcoma at its original site compared with surgery alone, addressing the cancer's tendency to spread microscopically.[1]
Angiosarcoma local-control series
Taxane chemotherapy active in angiosarcoma: Taxane-based chemotherapy has shown meaningful activity against angiosarcoma, including the scalp and face form, and is used for larger tumors and disease that has spread, sometimes alongside local treatment.[2]
Angiosarcoma chemotherapy studies
Antiangiogenic and immune therapies under study: Because angiosarcoma arises from blood-vessel-lining cells, drugs that block blood-vessel growth and emerging immunotherapies are being investigated, offering new directions for advanced disease.[3]
Angiosarcoma targeted-therapy trials
Common questions
Why does radiation cover such a large area? Angiosarcoma, especially in the skin, often extends microscopically well beyond what can be seen or felt, with edges that are hard to define. Treating only the visible tumor would leave hidden cancer behind, so radiation deliberately covers a generous surrounding area to catch those cells and reduce the high chance of the cancer returning locally.
Can angiosarcoma be caused by previous cancer treatment? In some cases, yes. A form of angiosarcoma can develop years after radiation was given to an area for another cancer, such as the breast or chest wall after breast cancer treatment. This is uncommon, but it is one reason any new bruise-like or non-healing change in a previously treated area should be checked promptly.
Why is care at a specialized center important? Angiosarcoma is rare, aggressive, and complex, with treatment that usually combines surgery, radiation, and chemotherapy in carefully coordinated sequence. An experienced sarcoma team is best equipped to plan this combination, handle challenging locations or previously irradiated tissue, and offer access to clinical trials.
References
Numbered sources for the studies cited above. Links open the primary publication on PubMed or the publisher’s site.