Sarcoma Diagnosis

From M. D. Anderson Sarcoma: What Can You Expect, part 2
Date: February 11, 2008
Duration: 04:51

Because sarcomas can develop in connective tissue any place in the body, they often present a variety of symptoms and therefore many times are difficult to diagnose. But because the patient’s eventual prognosis depends upon early and proper treatment, it’s critical to have a correct diagnosis.

Dr. Bruner:
It’s very important to have an exact diagnosis of the type of tumor, because cancer cases these days are treated with drugs that are specific for different genetic variance of cancer. Some times, we can make a diagnosis using our routine procedures, but sometimes we need to do a lot of special testing in order to work out the molecular genetics of the cancer in order to use the best drug for that particular cancer and treat it most effectively.

Patients who are suspected of having sarcoma have better chances of being correctly diagnosed, if they go to a center that has treated large numbers of patients with the disease. At M. D. Anderson, our physicians see more sarcoma patients in one day than most other physicians see in a lifetime.

Dr. Deavers:
Most cancers can be routinely diagnosed by a majority of pathologists. However, there are some cancers that are a little bit more complex and may need the expertise of a specialist. Some cancers can mimic benign tumors. Some cancers may be difficult to classify. Other cancers may not even have originated at the sites where they first appear.

Several methods are used to arrive at a diagnosis. First, your physician will examine you carefully and will probably order blood tests to assess your general physical condition.
A variety of diagnostic imaging studies may include a combination of x-rays, ultrasounds, ct scans, pet scans and MRIs.

X-rays are the simplest imaging studies and can give some basic information. But for most cancer diagnoses, more sophisticated imaging will be needed … such as: ultrasound, which uses sound waves to identify a mass; Computed tomography…or CT scanning…which takes pictures like an x-ray from different angles and provides cross-sectional views of the inside of your body. CT scans are better for imaging bones and lungs; Magnetic Resonance Imaging…or MRI…which uses radiofrequency waves to produce images similar to those of a CT scan. MRIs are better at imaging soft tissues – nerves, blood vessels and muscles; and pet scanning…imaging that shows metabolic activity of the tumor.

Dr. Hicks:
There’s really been an explosion of imaging technology over the last few years and a lot of the different imaging modalities have undergone advancement.

Dr. Macapinlac:
It allows us to see deep within the body and to see the body in a three-dimensional mode.
That means we can have slices of the body and go through them with very great accuracy and see the structures…

Even though these imaging techniques can give a lot of information, the only way to be certain that the tumor is cancer is with a biopsy. A biopsy involves taking a tissue sample from the suspicious area, so it can be examined under a microscope and analyzed by a pathologist who is an expert in differentiating cancer cells from other kinds of cells. If you’ve had a biopsy at an outside institution, the biopsy tissue must be reviewed by an M. D. Anderson pathologist who specializes in sarcoma. If the tissue is not sufficient for a correct diagnosis, your biopsy will be repeated at M. D. Anderson.

The tissues obtained through a biopsy are sliced, stained and mounted on slides to be viewed under a microscope. Normal cells typically have the same size, shape and color, and grow in an orderly pattern. Cancer cells, on the other hand, look different. Some are large; some are small. Some are more deeply or darkly colored by the stains used to highlight features of the cells.

Different kinds of biopsy procedures are used, depending on the location of the possible cancer. For example, Fine Needle Aspirations and Core Biopsies, which are done in an outpatient clinic, remove tissue samples with a needle. In an Excisional Biopsy, the surgeon makes a cut through the skin to remove the entire mass. In an Incisional Biopsy, a small part of the tumor is removed.