Sarcoma Diagnosis

As a rare cancer, general physicians don’t always suspect sarcoma immediately. Many sarcomas are mistakenly diagnosed as a hematoma, abscess, ganglion cyst, hernia or a benign lipoma (a noncancerous tumor made of fat cells). The national average for the length of time it takes to arrive at a sarcoma diagnosis is six months. Roswell Park’s sarcoma/soft tissue tumor team aims to shorten that time by evaluating patients with suspicious masses sooner, rather than later.

A soft tissue mass should be considered somewhat suspicious and warrants evaluation if it has one of the following characteristics:

  • Is larger than five centimeters (the size of a lime)
  • Goes deep to the connective tissue (fascia) of the body
  • Is getting bigger
  • Causes symptoms

Tests to diagnose sarcoma

  • Imaging scans usually recommended for suspected sarcoma include: X-ray, CT, magnetic resonance imaging (MRI) or positron emission tomography (PET). In general, CT is used for abdominal or trunk areas of the body; MRI for imaging the limbs and planning surgery. For some cases, especially if the mass is located near many important blood vessels, CT-angiography is advised.
  • Percutaneous Image-Guided Core needle biopsy: For this procedure, you’ll remain awake, but a light sedative will keep you comfortable and pain-free. You’ll need only a band-aid afterwards. The physician uses ultrasound (and sometimes CT imaging) to guide the placement of a hollow or core needle through the skin and into the tumor. In this way, the physician can take several samples from different areas of the tumor.

Sarcomas can have areas of tissue that are fatty, benign, or have already died off. Taking samples from higher-grade (more aggressive) areas of the tumor provide a more accurate diagnosis. If you’re coming to us for a second opinion, we may biopsy using this procedure.

Roswell Park is the only provider in the Western New York region that offers a full molecular pathology service to analyze your biopsy and other samples, fast-tracking diagnosis and avoiding delay in commencing treatment. This includes the following key pathology studies:

  • Immunohistochemistry study: By adding an antibody, dye, or radioisotope to the sample of cancer cells, the pathologist looks for certain antigens or proteins, that help identify one sarcoma type from another.
  • Light and electron microscopy: Cells are viewed using a high-powered microscope to look for changes in the cancer cells.
  • Cytogenic analysis: Cells are viewed to look at the actual chromosomes of the cancer cell.
  • FISH (fluorescence in situ hybridization): A process that allows the pathologist to look at the genes and chromosomes of the cell.
  • Flow cytometry: A test which measures the number of cells in a sample and can determine the percentage of cells that are live, or have a certain characteristic, size, shape or tumor marker.
  • DNA sequencing: Process that determines the order of components in a single DNA molecule.

At Roswell Park, our pathologists review the pathology slides and testing of every new patient. In about 11 to 18% of these secondary reviews, the diagnosis is changed, impacting your treatment options and your way forward.

Getting a second opinion Make an appointment

Ideally, we’d like to see the patient before any biopsy or removal of the suspected tumor. Image-guided biopsy techniques spare patients from unnecessary surgery, discomfort and risks, and we can start appropriate therapy more quickly. If the tumor is already removed, that patient has unfortunately been denied those choices.
John M. Kane III, MD, FACS
Professor of Oncology
Chief of Melanoma/Sarcoma