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Sarcoma: Diagnosis

Most commonly, bone sarcoma patients present with a pain in the area of the lesion. In more advanced lesions, patients may notice swelling in the area or present with a fracture of the affected bone. A complete patient history is extremely important when diagnosing bone tumors.

Physical Examination
A physician will do a complete examination of the painful area to evaluate the surrounding skin, blood vessels, nerves or bone and any surrounding lymph nodes.

Radiological Imaging (X-rays and scans)

  • Plain X-ray Films:
    Standard x-rays are taken to evaluate the bone. They can show tumor location. Usually more detailed imaging such as a MRI or CT scan is needed to further evaluate. Chest x-rays are also useful to evaluate for metastatic tumors in the lung.
  • Magnetic Resonance Imaging (MRI):
    This is one of the most useful methods to image tumors in the extremities. It provides the physician with a detailed view of the tumor and its surroundings.
  • Computed Tomography (CT scan):
    This is another way to image a tumor. Especially useful in tumors which are in the abdomen and pelvis. CT scan of the chest is also frequently recommended to assess for metastases of sarcoma, or disease which might have traveled to the lungs.
  • Positron Emission Tomograhy (PET scan):
    This is a newer study done in Nuclear Medicine, which looks at the metabolic activity of cells in the body. Tumor cells often have very active metabolism and therefore can be seen on a PET scan. However, other conditions involving increased metabolism (including healing scars) sometimes show up on PET scans as well. PET scans are occasionally used for sarcoma patients, but usually are not as useful as CT and MRI scans.
  • Bone Scan:
    This study is done in nuclear medicine, which uses radioactive dye to highlight the bones. This scan is sometimes used to look for cancer in other parts of the bone that has metastasized.

NOTE: Each physician chooses which method of imaging they prefer to give them the best view of the primary tumor and any other tumors which may be present.

Biopsy
A biopsy is the only way to tell for sure if you have a malignant tumor and, if so, what kind of cancer it is. Because sarcomas are rare, a specialist in sarcoma pathology generally reviews the results of the biopsy before any treatment starts. Tumor location determines what type of biopsy will be used.

Generally two types of biopsies can be used:

  • Core needle biopsy:
    This procedure is less invasive than the other method described next. It can be done in the office by your surgeon using local anesthesia. The surgeon will numb the area around the tumor and extract a small amount of tissue from the tumor with a special biopsy needle for the pathologist to examine.
  • Incisional biopsy:
    A small incision (about an inch) is made, and tissue is removed for examination. This is a more invasive procedure and is most often done in the operating room under either local or general anesthesia. The advantage of this procedure is that is provides more tissue for the pathologist to review.

NOTE: Once the pathologist has tissue from a biopsy, the type of soft tissue sarcoma and how aggressive it is can be determined.


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