Sarcoma Diagnosis and Staging
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)
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.
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?"