Sarcoma

Diagnosing

Standard screening tests for sarcoma don’t exist. Instead, your doctor will likely make the diagnosis through a combination of a clinical examination, imaging tests and, most importantly, confirmation by a biopsy. Your doctor will recommend the specific tests required to make a correct diagnosis based on your age and medical condition, inherited disorders, type of cancer suspected, severity of symptoms and previous test results.

Imaging tests

Some imaging tests are done to look for the cause of symptoms and to find a sarcoma tumor. Other tests are done after a sarcoma is diagnosed to look for cancer spread (metastasis).

An X-ray of the area with the lump may be ordered. If cancer is suspected, other imaging tests will be ordered. A chest X-ray may be done after an initial diagnosis to see if sarcoma has spread to the lungs.

Ultrasound is the use of sound waves to create a picture of internal organs and can sometimes determine if a lump is a cyst with fluid, which is likely to be benign (noncancerous) and not a sarcoma. An ultrasound can also be used to help guide a biopsy needle precisely into a tumor inside the body.

Computed tomography (CT) is often performed if the doctor suspects sarcoma in the chest or abdomen. CT is an X-ray procedure that produces detailed, cross-sectional images of your body and is used to see if the sarcoma has spread into the lungs, liver or other organs. Sometimes a special dye (contrast medium) is injected into a vein in the arm or is taken as a pill to provide better detail on the image. CT (like an ultrasound) also can help guide a biopsy needle precisely into a tumor.

Magnetic resonance imaging (MRI) is routinely done if a doctor suspects sarcoma. MRI can show a tumor’s location, size and sometimes even the type of tissue (like fat or muscle), which is helpful information for planning a biopsy. Radio waves and strong magnets instead of X-rays are often better than CT for evaluation of sarcomas in the arms or legs. MRI is also used to examine the brain and spinal cord.

Positron emission tomography (PET) may be ordered if your doctor suspects the cancer has spread. PET is not often used for sarcoma, but it can be helpful in certain cases.

Integrated PET/CT collects images from both scans at the same time and combines the images. This combination of images provides more information about a tumor’s structure and how much energy it uses compared with normal tissues. This information can be helpful in deciding if abnormalities seen on the CT scan are cancer or benign tumors.

Biopsy

A biopsy is the most important procedure to confirm the diagnosis. With biopsy, a small amount of tissue from the tumor is removed for examination under a microscope by a pathologist (a doctor trained to examine tissues and interpret the results) to see if it is cancer.

Several types of biopsies are used to diagnose sarcoma. Doctors experienced with these tumors will choose one or more types of biopsy, based on the size and location of the tumor. Samples are taken from the primary tumor, lymph nodes or any other suspicious areas.

For a needle biopsy, a doctor removes a small sample of tissue from the tumor with a needle-like instrument, performing either a core-needle biopsy or a smaller, fine-needle biopsy. If the tumor is too deep to feel, the doctor can use CT or ultrasound to help guide the needle accurately into the tumor.

Surgical biopsies include an incisional biopsy, which almost always involves removing enough tissue to diagnose the exact type and grade of sarcoma, and an excisional biopsy, in which the surgeon removes the entire tumor.

Molecular laboratory testing

Your doctor or the pathologist looking at the sarcoma may suggest molecular laboratory tests on a tumor sample to identify specific genes, proteins and other factors unique to the tumor. Sometimes these special tests are needed to accurately determine whether a sarcoma is present and, if so, what type. Your doctor may use the test results to recommend the best treatment because each type of sarcoma may respond differently to different treatments.

 

 

Bone Sarcoma Tests

If bone sarcoma is suspected, your doctor also may recommend the following tests:

Blood tests may help find bone cancer because people with osteosarcoma or Ewing sarcoma may have higher alkaline phosphatase and lactate dehydrogenase levels in the blood. High levels, however, do not always mean cancer. Alkaline phosphatase is normally high when cells that form bone tissue are very active, such as when children are growing or a broken bone is healing.

Bone scans use a radioactive tracer to look at the inside of the bones. The tracer is injected into a vein and collects in areas of the bone. Healthy bone is detected by a special camera and appears gray. Areas of injury, such as those caused by cancerous cells, appear dark.

 

Additional Resources

 

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