Sarcoma is relatively uncommon and can originate in virtually any part of the body’s connective tissues.  Consequently, there is great variability in the characteristics of the initial presentation of the disease.  Additionally, sarcoma affects a wide range of patient populations – from newborns and young children to middle aged and older adults.  As a result, the diagnostic experience of many sarcoma patients is disappointingly slow.  General practitioners seldom see a sarcoma case, so it is generally not suspected right away.  In many cases diagnosis may not occur until after a referral to a specialist, there is an emergency, or until surgery for another suspected condition.

 

Your physician will do an examination and other tests to find out whether the tumor is in fact a sarcoma or perhaps a different condition.  A definitive diagnosis can only be made by doing a biopsy.  Many of the following tests may be done prior to a biopsy.

 

To begin an evaluation, a physician may take a complete medical history. When doing this, the physician will ask questions about the suspicious symptoms, when they began and how they have changed over time.  Family history may also be discussed to help track diseases or medical conditions in your family tree.  A complete physical examination will also be performed, which will include analyzing and feeling the area where there is pain and swelling.

 

A very important step in diagnosing sarcoma is the examination of a sample of the tumor tissue under a microscope.  Procedures used for the removal of the tissue from a suspicious mass are called biopsies.  Different methods of biopsy can be used depending on the location of the tumor in your body and size of the affected area.  The method of biopsy will be selected based on the goal of obtaining adequate tissue samples without causing unnecessary discomfort to the patient. It may be beneficial for a biopsy to be done by an experienced orthopedic oncologist (surgeon who specializes in sarcoma), or radiologist with expertise in soft tisse or bone sarcomas.  All biopsy specimens are examined under a microscope by a pathologist, a doctor with special training in microscopic examination.  It is also important the pathologist completing the assessment of the biopsy has expertise in dealing with sarcomas.  The physician will look at the size and shape of the cells and how the cells are arranged.

In certain cases, in addition to pathology, special laboratory genetic tests involving the biopsy specimen are needed to accurately diagnose the type of sarcoma.

 

 

And finally, imaging or visual testing is also important in aiding physicians in diagnosing many medical conditions.

 

X-rays allow physicians to get a one dimensional image of internal body structures using a low dose of radiation to take  pictures of the body.  Additionally, X-ray imaging of the chest may be done to determine if any cancer has spread to the lungs.

 

A CT (sometimes referred to as CAT) scan, or Computed Tomogram, is an x-ray procedure that produces detailed cross-sectional images of the body.  Instead of taking one picture to produce a one dimensional image, as does a usual x-ray, a CT scanner takes many pictures as it rotates around you.  A computer then combines these pictures into an image of a slice of your body, and then produces multiple slices of the body part that is being studied.  Often, after the first set of pictures is taken, another set may be taken after you receive an intravenous injection of a “dye,” or contrast agent, that helps better outline internal structures.

 

Positron emission tomography (PET) is a type of imaging test that uses glucose (a form of sugar) that contains a radio-active atom.  The substance is injected into a vein, and a special camera is used that can detect the radioactivity in the body.  Cancer cells of the body absorb large amounts of the radioactive sugar because of their high rate of metabolism. These scans may be done prior to and throughout treatment to evaluate your response to it.

 

An MRI (Magnetic Resonance Imaging) is a scan that uses radio waves and strong magnets.  The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases.  A computer will translate the pattern of radio waves given off by the tissues into very detailed cross-sectional images of parts of the body.

 

Also, ultrasounds, an imaging method that involves using sound waves and their echoes to produce a picture of internal organs or masses, are used throughout evaluation for a sarcoma.  A small microphone-like instrument called a transducer emits the sound waves.  These high frequency waves are then transmitted into the area of the body being studied and echoed back and picked up by the transducer.  The patterns of echoes are then converted by a computer into an image that is displayed on a computer screen.  To have an ultrasound examination, you simply lie on a table and a technician will first lubricate your skin with gel or oil then move the transducer over the part of your body being examined.

 

Once a diagnosis has been made, the best course of treatment should be discussed with and decided on by physicians specializing in sarcoma.

**Usually, if you suspect something is wrong, you will begin by seeing your general practitioner or family doctor.  After your examination, if suspicion for a sarcoma is present, it is important your physician refer you to a team of specialists who have extensive experience in the diagnosis and treatment of sarcomas for further evaluation.