Soft Tissue Sarcoma Diagnosis & Detection

How Are Soft Tissue Sarcomas Diagnosed?

During your first visit to a Cancer Treatment Centers of America (CTCA) hospital, you’ll undergo a comprehensive exam to evaluate the soft tissue sarcoma and determine if it has spread to any other part of your body. If you have been recently diagnosed, we will review your pathology to confirm you have received the correct soft tissue sarcoma diagnosis and staging information, and develop treatment recommendations that are appropriate for you and your personal needs.

Since there are more than 50 different types of soft tissue sarcomas, an accurate diagnosis is extremely important in order to properly assess all of your treatment options. We will also review your medical records and health history to fully understand any additional medical needs that may exist.

Throughout your treatment, we will use soft tissue sarcoma detection tests to monitor its response to treatment. If the cancer is resisting treatment, we will modify your plan or recommend using a different therapy.

Diagnostic Tools and Tests for Soft Tissue Sarcomas 

Soft tissue sarcomas can be difficult to identify, since these tumors are often painless and can be located in parts of the body that may be difficult to examine. Therefore, at CTCA we use advanced imaging technology to properly locate, identify and stage your disease.

These imaging tools and laboratory tests will also be used throughout your treatment to monitor your response to therapy and allow us to modify your soft tissue sarcoma treatment plan, if necessary.

Biopsy

Once you have confirmed a suspicious lump or mass, your doctor will order a biopsy to determine the nature of the tumor. A biopsy allows the laboratory to retrieve a sample of cells, which a pathologist will then examine under a microscope to determine if they are cancerous.

At this point, your doctor can determine what type of soft tissue sarcoma you have, and he or she can then start the process of staging your disease. In some cases, imaging tests are also required to complete the staging process, and to determine the best treatment plan for you. 

The two most common techniques used for performing a soft tissue sarcoma biopsy are: needle biopsy and open surgical biopsy. In rare cases, a sentinel lymph node biopsy may also be necessary.

• Needle Biopsy – For this procedure, your doctor will numb the area of the planned biopsy with a local anesthetic before inserting a needle into the tumor to retrieve a sample of cells. A CT or ultrasound scan may be used to help guide the biopsy needle, especially if the lump is not near the surface of your body. Since there are so many types of sarcomas, a large “core” needle is used whenever possible, as this allows for a larger tissue sample. A needle biopsy may be especially useful for tumors that are hard to reach, such as a retroperitoneal sarcoma (a sarcoma located deep within the abdomen or pelvis) or a sarcoma deep within the thigh.
• Surgical Biopsy – Because of the nature of managing sarcomas, an open surgical biopsy is only performed by an experienced surgical oncologist who has worked with sarcomas before. This procedure is usually performed under general anesthesia, because the surgeon will remove a relatively large sample of the tumor. With soft tissue sarcomas, the surgeon must be careful not to disrupt the tumor, as it could cause the cancer cells to spread. A surgical biopsy for soft tissue sarcoma takes careful planning, and there are two important steps that your surgeon will take:
• Create a longitudinal (“lengthwise”) incision for extremity tumors.
• Place the incision in such a fashion that after the biopsy, the surgical oncologist will be able to completely remove the entire tumor, as well as the previous surgical biopsy scar. 
• Sentinel Lymph Node Biopsy – Certain types of soft tissue sarcomas will spread to the lymph nodes, such as angiosarcoma, epithelioid sarcomas and synovial sarcomas. Cases that spread to the lymph nodes only account for about 2 to 3 percent of all soft tissue sarcomas. During a sentinel lymph node biopsy, a radioactive substance and/or a colored dye is injected near the tumor site. Then, the first lymph nodes that pick up the dye (the sentinel lymph nodes) are removed and reviewed by a pathologist to check for the presence of cancer cells.

Imaging Tests

Several types of advanced imaging tests for soft tissue sarcoma may also be used when staging and diagnosing the disease. These tests are especially helpful if the sarcoma is under the body’s surface.

Imaging tests can assist in locating suspicious areas and determining the size and location of possible tumors. These tests can also asses the tumor’s relationship to important surrounding structures and help determine if the cancer has spread to other areas of the body. In addition to aiding your team in diagnosing soft tissue sarcoma, these tests may also be used to monitor your response to treatment:

• Computed Tomography (CT) Scan – A CT scan is a special type of X-ray test that generates three-dimensional, cross-sectional images throughout the body. Unlike a normal X-ray, CT scans can create detailed images of the internal organs, like the liver and lungs. CT scans are useful when making the initial soft tissue sarcoma diagnosis, and to see if the cancer has spread to other areas of the body. CT scans can also be used to guide a biopsy needle.
• Magnetic Resonance Imaging (MRI) – Doctors often use MRI scans to precisely evaluate soft tissue sarcoma cells within the body. MRI uses a powerful magnet to generate images, so there is no radiation exposure. An MRI can be very effective for outlining a tumor in the soft tissues, and can also help to determine if cancer cells have spread.
• Positron Emission Tomography (PET) Scan – This imaging technique is used to look at metabolic activity within different organs of the body. A radioactive tracer material, usually a form of glucose, is injected intravenously and a special camera is used to take a picture of radioactive areas within the body. Because cancer cells are growing rapidly, and are often more metabolically active compared to normal cells, they absorb more of the radioactive glucose. PET scans are very sensitive, but they do not show much detail, so they will often be performed in combination with a CT scan (called PET/CT). The PET/CT scan allows doctors to identify abnormal activity and know precisely where this activity is taking place.
• Ultrasound – This imaging test for soft tissue sarcoma involves using high-frequency sound waves to produce images of organs and tissues within the body. Ultrasound can be used to provide information about a tumor or surroundings tissues and organs, and to precisely locate the position of a tumor in order to guide a needle biopsy.
• Chest X-Ray – The lungs are a common location for soft tissue sarcomas to metastasize (spread). Therefore, an X-ray of the chest may be taken to see if the cancer has spread to the lungs.

Laparoscopy

For tumors located within the abdomen, a laparoscopic procedure is sometimes used to diagnose or stage the extent of disease. During laparoscopy, your surgical oncologist will make one or more small incisions in the abdomen, and insert a video camera and other special surgical instruments. Laparoscopic ultrasound and laparoscopic biopsies may also be performed by your surgeon.

Next Topic: Staging Soft Tissue Sarcoma