Sarcoma Diagnosis

Dr. Kane

"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 Kane, III, MD, Chief of Sarcoma/Melanoma Surgical Oncology

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

Suspicious mass? Why a Roswell Park doctor should see it first

  • You might avoid surgery. Our advanced diagnostic techniques may determine whether your tumor is benign, in which case you may not need any surgery, not even for a biopsy.
  • Some treatments should begin before the tumor is removed. Preoperative therapies like chemotherapy and radiation therapy are often used to prevent tumors cells from spreading and to improve surgeons’ ability to remove it entirely, with clear margins. If your tumor is already removed before coming to Roswell Park, your treatment choices may be limited.
  • Sarcoma tumors are unique. Sarcoma tumors have a fragile outer capsule that contains the cancer cells into a mass. If the outer capsule is damaged during biopsy or an operation to remove it, cancer cells can “spill” from the tumor, allowing them to spread or regrow. In addition, microscopic cancer cells often infiltrate beyond what appears to be the edges of the tumor and these tumors often occur near critical blood vessels and organs. Sarcoma tumors should be biopsied and/or removed only by a highly skilled and experienced surgeon who specializes in this rare cancer.
  • Less-invasive biopsy. Core needle biopsy that’s guided by imaging such as ultrasound or computed tomography (CT) reduces the risk for cancer cells to spill from the tumor. This helps reduce the chance that the tumor will recur or that a patient would need more drastic surgery, such as amputation. Image-guided core biopsy takes only minutes with little or no discomfort.

Staging Sarcoma Treatment Options

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.

Second Opinion Game-Changer

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.