Knowing you have a sarcoma—and which kind—helps you get the right care promptly. Delayed care or an inaccurate diagnosis or treatment can make future treatment more complicated, so it’s important that you visit a program specializing in sarcoma care. At Penn Medicine, we treat more than 200 sarcoma cases every year. Our expert sarcoma team will provide a timely and accurate diagnosis and make sure you have the information you need in order to determine what to do next.
Once you or your doctor reach out to us, we will get you an appointment as soon as possible, usually within a few days. Whether your appointment is a first evaluation or a second opinion, you can expect an accurate diagnosis and a personalized treatment plan, if needed, within a week of your first appointment or biopsy in most cases.
When to Get Evaluated for Masses of the Bone or Soft Tissue
Most lumps and bumps in soft tissues and lesions in the bone are not malignant (cancerous). However, it’s still important to watch for warning signs that could require an evaluation of a lump or bump.
For potential bone sarcomas, watch for consistent bone pain that gets worse over time. Some sarcomas start in the bone and break into the surrounding soft tissues to form a lump. The lump may grow over time.
For potential soft tissue sarcomas, keep in mind that these tumors don’t usually cause pain or discomfort. Instead, look for lumps and bumps that do not go away, sit deeper inside tissue, grow over time, feel firm, and cannot be easily moved by pressing on them.
If it turns out you have a benign (noncancerous) tumor rather than a sarcoma, we will still ensure you receive the care you need for that diagnosis. Our team has expertise in many simple and complex benign bone and soft tissue tumors.
How Are Sarcomas Diagnosed?
Sarcoma diagnosis depends on careful and thorough evaluation by an experienced medical team who understands the complexities of sarcomas.
For a successful and accurate diagnosis, doctors must distinguish sarcomas from benign tumors and other masses, as well as from other cancers. They must also establish the exact type of sarcoma present—there are more than 60 different sarcoma types and subtypes. This is achieved by performing important health evaluations including:
- Personal and family medical history assessment
- Symptoms evaluation
- Complete physical exam
- Initial imaging scans
If you have a confirmed sarcoma diagnosis, we will also need to see if the cancer has metastasized (spread) by performing additional scans. If you’ve had a biopsy elsewhere, our team will ensure we receive it from the other hospital or clinic so that we can review the actual tissue.
Imaging for Sarcomas
Imaging is required to thoroughly evaluate bone lesions or soft tissue lumps and bumps for a potential sarcoma diagnosis. Results are evaluated by our experienced radiologists, who specialize in musculoskeletal imaging of bones, joints, and soft tissues.
The scans used depend on the type of sarcoma suspected. They include:
- Ultrasound: For soft tissues, ultrasound imaging can show the size, shape, and location of the suspected mass. It can also help tell if it’s a fluid-filled cyst or tumor. Ultrasound is not used for diagnosing bone sarcomas.
- X-rays: Though not effective for diagnosing soft tissue tumors, X-ray images can show our team if cancer started in a bone or spread there from elsewhere. X-rays can sometimes also help doctors tell the type of bone sarcoma present.
- Computed tomography (CT): By taking X-rays from many angles, our team can create a 3D image of the suspected tumor while measuring its size. CT scans can also determine if cancer has spread to other areas such as the lungs.
- Magnetic Resonance Imaging (MRI): Using magnetic fields instead of radiation, these scans help our team confirm a sarcoma diagnosis. They provide detailed information about the tumor and the tissues around it. They also help with treatment planning, including determining whether sarcoma surgery can remove the tumor.
Sometimes imaging is all we need to determine an accurate diagnosis, but in many cases, you may need further testing.
Bone or Soft Tissue Biopsies
Unless imaging tests definitely rule out sarcoma, a biopsy should be performed before any treatment in order to confirm if the bone lesion or soft tissue lump or bump is a sarcoma, and which kind. We can also get a better sense of how quickly the cancer may grow and spread.
If we have your imaging studies in the Penn Medicine system, we can often offer a biopsy the same day as your consultation—an option not often available elsewhere. We then return at least preliminary results within a day or two.
Once we take a sample, one of our musculoskeletal pathologists studies the tissue under a microscope. Our pathologists see a high number of sarcomas each year, so they know exactly what to look for. Other sarcoma programs often come to our pathologists for guidance in reviewing their own tissue samples.
Sarcoma Staging
In addition to confirming a diagnosis, imaging and biopsy results help us stage sarcomas, to gauge how aggressive the tumor seems, how much it’s grown, and how likely it is to spread. Accurate staging helps us make recommendations for next steps, which can help you make informed decisions about your sarcoma treatment.
When staging a sarcoma, we consider the tumor’s size, grade (comparing tumor tissue to normal tissue), and whether it has spread to other areas of the body.
Staging Bone Sarcomas
To stage bone sarcomas, we may recommend additional, specialized imaging. Bone sarcoma staging includes four main stages, with additional sub-stages:
- Stage IA: The tumor is smaller (8 centimeters or less) and the cancer has not spread. The tissue should look fairly close to healthy tissue, meaning grade 1, or low grade.
- Stage IB: As with stage IA, cancer has not spread and tumor tissue appears fairly normal when it can be graded. However, the tumor is larger (greater than 8 centimeters) or there is more than one tumor present.
- Stage IIA: Cancer still has not spread, but the tumor is a higher grade (grade 2 or 3). At this stage, it’s still 8 centimeters or smaller.
- Stage IIB: Like stage IIA, tumors are either grade 2 or 3 and the cancer has not spread. The tumor is bigger than 8 centimeters.
- Stage III: While the cancer has not spread, the bone has developed more than one high-grade tumor.
- Stage IVA: Cancer has spread to the lungs.
- Stage IVB: Cancer has spread to other locations, such as lymph nodes or other bones or organs.
Staging Soft Tissue Sarcomas
Soft tissue sarcomas in the legs and retroperitoneum (back part of the belly) are divided into four main stages and several sub-stages:
- Stage IA: The tumor is still small (5 centimeters or less) and the cancer has not spread. The tumor’s tissue looks fairly close to healthy tissue, and is grade 1 or low grade.
- Stage IB: The tumor is larger than 5 centimeters but the cancer has not spread and tumor tissue appears fairly normal.
- Stage II: Cancer still has not spread. However, tumor tissue is high grade, and looks different than healthy tissue. It may differ by a modest amount (grade 2) or by a lot (grade 3). Stage II tumors are 5 centimeters or less.
- Stage IIIA: Like stage II, the tumor is either grade 2 or 3 and cancer has not spread. The tumor is larger–between 5 and 10 centimeters.
- Stage IIIB: The tumor has grown beyond 10 centimeters and is either grade 2 or 3, and the cancer has not spread.
- Stage IV: The cancer has spread, to nearby lymph nodes or places farther away in the body.
When evaluating treatment options, we also consider the tumor’s depth because deeper tumors often require more extensive treatment than shallower tumors.
Make an Appointment
Please call 800-789-7366 or make an appointment.
The Penn Sarcoma Program offers same-day appointments to patients who have their imaging available. To learn more, call 215-349-8200.