Imaging tests such as X-ray, MRI, ultrasound, CT, bone scans and Positron Emission Tomography (PET) scans are used to diagnose sarcoma. The test is dependent upon an individual’s situation. Some tests are better for diagnosing bone sarcomas and others are better at detecting soft tissue sarcomas.
However, the only reliable way to determine whether a tumor is benign or malignant is through a surgical biopsy. Therefore, all soft tissue and bone lumps that persist or grow should be biopsied. A biopsy is a procedure to remove a piece of suspicious tissue for lab testing.
During this procedure, a doctor makes an incision or uses a special needle to remove a sample of tumor tissue. A pathologist examines the tissue and lab tests can determine whether the cells are cancerous and what sarcoma subtype they represent. If cancer is present, the pathologist can usually determine the type of cancer and its grade. The grade of the tumor is determined by how abnormal the cancer cells appear when examined under a microscope. The grade predicts the probable growth rate of the tumor and its tendency to spread. Low-grade sarcomas, although cancerous, are unlikely to spread to other parts of the body (metastasize). High-grade sarcomas are more likely to spread metastasize.
How a biopsy sample is collected depends on your particular situation. It could be removed with a needle passed through the skin or cut away during an operation.
In general, treatment for sarcomas depends on the stage and subtype. The stage of the sarcoma is based on the size and grade of the tumor, and whether the cancer has spread to the lymph nodes or other parts of the body (metastasized). Traditional treatment options for sarcomas include surgery, radiation therapy, and chemotherapy. Developments in sarcoma treatment include the use of immunotherapies, targeted, and cellular therapies (a subtype of immunotherapy).
Surgery is the most common treatment for sarcomas. If possible, the doctor may remove the cancer and a safe margin of the healthy tissue around it. Depending on the size and location of the sarcoma, it may occasionally be necessary to remove all or part of an arm or leg (amputation). However, the need for amputation rarely arises; no more than 10 percent to 15 percent of individuals with sarcoma undergo amputation. In most cases, limb-sparing surgery is an option to avoid amputating the arm or leg. In limb-sparing surgery, as much of the tumor is removed as possible, and radiation therapy and/or chemotherapy are given either before the surgery to shrink the tumor or after surgery to kill the remaining cancer cells.
Radiation therapy (treatment with high-dose x-rays) may be used either before surgery to shrink tumors or after surgery to kill any cancer cells that may have been left behind.
Chemotherapy (treatment with anticancer drugs) may be used with radiation therapy either before or after surgery to try to shrink the tumor or kill any remaining cancer cells. If the cancer has spread to other areas of the body, chemotherapy may be used to shrink tumors and reduce the pain and discomfort they cause, but is unlikely to eradicate the disease. The use of chemotherapy to prevent the spread of sarcomas has not been proven to be effective. Patients with sarcomas usually receive chemotherapy intravenously (injected into a blood vessel).
Immunotherapy is a form of treatment that uses your immune system to fight the sarcoma. Your body’s immune system may not attack your cancer because the cancer cells hide from the immune system cells. The tumor puts the “brakes” on the immune system and the immunotherapy treatment releases the “brakes”.
Targeted therapy is a treatment that uses medicines that target specific mutations present in the tumor cells. Your doctor should test your tumor cells (genomic sequencing) to determine if they harbor targetable mutations.
Ablation therapy treatments destroy cancer cells by applying electricity to heat the cells, very cold liquid to freeze the cells or high-frequency ultrasound waves to damage the cells.
Clinical trials are being done to find new, more effective treatments for sarcomas, and better ways to use current treatments.
