Sarcoma Diagnosis

As an NCI-designated Comprehensive Cancer Center, Winship Cancer Institute of Emory University not only sees a high volume of sarcoma patients every year, but also uses the latest diagnostic methods to help get them on their way to the appropriate treatment plan. Our multidisciplinary team of sarcoma experts consists of sarcoma pathologists, surgical oncologists, orthopedic oncologists, thoracic surgeons, sarcoma medical and radiation oncologists, musculoskeletal radiologists and supportive oncology specialists.

There are more than 150 different types of sarcoma. ​​Being able to appropriately identify and name the specific sarcoma that a patient has is the crucial first step in the management of sarcoma and allows Winship’s team to come up with an individualized treatment plan.

Malignant bone tumors. A bone sarcoma diagnosis is rare. Bone sarcomas total around 3,900 diagnoses per year in the U.S. and typically occur in children and teens. Bone sarcoma examples include:

• Osteosarcoma
• Ewing's sarcoma
• Chondrosarcoma

Soft tissue malignant tumors. Fewer than 5% of all soft tissue tumors are malignant and thus called soft tissue sarcomas. There are approximately 10,500 cases of soft tissue sarcoma per year in the U.S. They develop in the connective tissue of the body such as muscle, adipose tissue, nerves or blood vessels. Examples of the most common soft tissue sarcomas include:

• Undifferentiated pleomorphic sarcoma
• Leiomyosarcoma
• Liposarcoma
• Gastrointestinal stromal tumor (GIST)
• Malignant peripheral nerve sheath tumor
• Rhabdomyosarcoma
• Synovial sarcoma
• Myxofibrosarcoma
• Solitary fibrous tumors

Both soft tissue and bone sarcomas can present in multiple ways — from a slowly growing painless mass to one that is rapidly enlarging. Therefore, signs and symptoms can range from mild to severe, depending on location, the size of the tumor and the stage. Examples include:

• A new lump or bump present underneath the skin
• A lump or bump that appears to grow in size (any mass that is larger than 3 centimeters should be evaluated by a doctor)
• Increasing abdominal girth
• Pain in and around a bone for no apparent reason
• Swelling around a bone or joint
• Inability to move or lift a limb

The first step in making a sarcoma diagnosis is a thorough physical examination, followed by imaging. At Winship, our sarcoma experts use a variety of imaging techniques to pinpoint the exact location, size and stage of the tumor. Your Winship care team may use one or more tests and procedures to determine the stage of your cancer:

• X-Ray. During an X-ray, a doctor can see whether there are any deformities or abnormal growths within the bones. This is especially helpful for chest imaging.
• Computed tomography (CT) scan. A CT scan of the abdomen and pelvis can be very helpful for abdominal or retroperitoneal tumors.
• Magnetic resonance imaging (MRI). MRI uses magnets and radio waves to detect any abnormalities in the body. MRI can be especially helpful for tumors located in the trunk or extremities.
• Bone scan. Bone scans are a type of nuclear medicine test where a tracer — or small amount of radioactive substance — is injected into the body and absorbed by mutating cells. The tracer can then be viewed under imaging.
• Positron emission tomography (PET) scan. This type of imaging test injects a patient with a form of radioactive sugar that is absorbed by cancer cells. A special camera is then used to detect the sarcoma. PET scans are often combined with CT scans.

To complete the staging process, more than one set of scans may be performed. Once the team has as clear a picture of the extent of the sarcoma, a tissue sample, or biopsy, is taken to test for cancerous cells. A critical component in accurately diagnosing a sarcoma is having an expert sarcoma pathologist review the biopsy tissue. Winship has world-renowned sarcoma pathologists who analyze sarcoma biopsies on a daily basis.