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Sarcoma Diagnosis and Staging

Sarcoma: Diagnosis

It is always important to be aware of changes in the body and if there is reason for any concern to consult a doctor. Sarcomas may have symptoms that are easy to detect, especially if it appears in the arms or legs as a lump or mass. When sarcomas grow in the abdomen or retroperitoneum, they may cause other symptoms such as a decrease in appetite, early satiety, increased abdominal girth and rarely bleeding in the stomach or bowels.

A thorough physical examination complemented by specific imaging of the tumor with either protocol-specific MRI (magnetic resonance imaging) scan for extremity lesions or high-quality CT (computed tomography) scan of the abdomen and pelvis for abdominal and retroperitoneal tumors. Additional imaging of the chest with plain X-rays or CT scan is also performed to complete staging.

The following symptoms don't confirm sarcoma is present, but are important to discuss with a doctor if they are present:

  • a new lump or a lump that is growing anywhere on your body
  • abdominal pain that is getting worse
  • blood in your stool or vomit
  • black, tarry stools (when bleeding happens in the stomach or bowels, the blood isn't always red, and it may make the stool look very black and tarry)

Sarcoma: Biopsy

If a physical examination or other test indicates a sarcoma is present. A biopsy is the primary test to perform in order to potentially further determine what type of sarcoma it is and determine its grade. A biopsy involves taking a piece of tissue from the tumor that is then examined by a pathologist under a microscope. Types of biopsies include:

  • Tru-cut or Core Needle Biopsy: this procedure is usually done in the doctor's office. The doctor will numb the area and use a special needle to take a sample of tissue to send to the pathologist.
  • Image Guided Core Needle Biopsy: using image guidance with a CT scan or ultrasound machine, a needle is inserted into the tumor and a small amount of tissue is removed for study.
  • Incisional/Excisional Biopsy: this procedure is often done in the operating room. The patient will usually be given medicine to relax or go to sleep and the area will be numbed. A small incision will be made and a tissue sample taken.

Sarcoma: Grading

The grade of a sarcoma is based on the way the cancer looks under the microscope. This is done by a pathologist, a doctor who specializes in diagnosing cancer by looking at the cancer microscopically. At Winship, we have a dedicated group of Sarcoma Pathologists that are nationally-recognized and consulted by other institutions to provide assistance in diagnosis these tumors

The grading system for sarcomas is divided into two categories - low grade and high grade. Low and high grade tumors are then  each divided into two more grades for a total of four. More about the official staging system can be found on the American Cancer Society website, "How are sarcomas staged?"