Sarcoma Diagnosis and Staging

Getting an accurate sarcoma diagnosis and understanding the stage of sarcoma is the first step in determining the best treatment for you. Because sarcoma may look like other conditions, evaluation by a specialized team of experts that see cases regularly is important. Columbia's sarcoma care program brings together some of the most experienced pathologists, surgeons, oncologists, and radiologists in the world to determine your original diagnosis and develop a cutting-edge treatment plan based on your unique case.

How is sarcoma diagnosed?

Because sarcoma symptoms aren’t always obvious, and there is no standard screening, it is difficult to find sarcoma early. Sarcomas can also develop gradually and be mistaken for other conditions. A sarcoma diagnosis usually includes the following:

Physical exam 

Your doctor will take your medical and family history, ask about symptoms (what you’ve noticed and for how long), and examine the area of concern. They will also look for tenderness, the firmness and size of any lumps, and how the lump moves against nearby tissues. 

Imaging tests 

These noninvasive tests can show your care team things about a suspicious lump or help guide other diagnostic tests. Imaging often includes chest x-rays, CT scans, MRIs, ultrasound, or PET scans to show if and where the cancer has spread. 

Biopsy

If your doctor suspects sarcoma, they will order a biopsy to confirm the diagnosis. A biopsy takes a small tissue sample of the tumor to be looked at under a microscope, and sometimes other lab tests may be done on the sample as well. Biopsies are very important for sarcoma since there are so many different types. Knowing the specific sarcoma type or subtype is critical in finding the best treatment.  

A biopsy can be done in several different ways. Needle biopsies (fine-needle aspiration or core needle) are the most common type. They take a sample of the suspicious area through the skin or, in some cases, using an endoscopic ultrasound through the esophagus. Less often, a surgical biopsy is needed. 

Pathologists examine the tissue and fluid to look for changes in cells and classify the tumor’s subtype. They also look for markers in the tumor that can help your care team determine your personalized course of treatment. Pathologists at Columbia are highly trained in diagnosing sarcomas and have advanced experience specializing in sarcoma.

Staging

Staging describes how far the cancer has grown or spread. It helps your doctor estimate how much the sarcoma has progressed and determine what kind of treatment is required.

Grading the tumor

Sarcomas are graded on a scale of 1–6 based on how the cells look, how quickly they seem to be growing, and how much of the tumor is made up of dead or dying tissue. Lower-grade tumors tend to grow more slowly, take longer to spread, and are easier to treat while higher-grade tumors behave more aggressively. Doctors must perform a biopsy to determine the grade of your tumor. Once the sarcoma has been graded, the grade is taken into consideration for staging.

Staging the tumor

The staging system for soft-tissue sarcoma is defined as follows: 

• Stage IA: The tumor is smaller than 5 cm (2 inches) across and has not spread to lymph nodes or more distant sites. The cancer is grade 1, or the grade cannot be determined. 
• Stage IB: The tumor is larger than 5 cm (2 inches) across and has not spread to lymph nodes or more distant sites. The cancer is grade 1, or the grade cannot be determined. 
• Stage IIA: The tumor is smaller than 5 cm (2 inches) across. It has not spread to lymph nodes or more distant sites. The cancer is grade 2 or 3. 
• Stage IIB: The tumor is larger than 5 cm (2 inches) across and has not spread to lymph nodes or more distant sites. The cancer is grade 2. 
• Stage III: The tumor is larger than 5 cm (2 inches) across and has not spread to lymph nodes or more distant sites. The cancer is grade 3OR: The tumor of any size and any grade has spread to nearby lymph nodes but not to distant sites. 
• Stage IV: The cancer, of any size and any grade, has spread to lymph nodes near the tumor or to distant sites. 

The staging for osteosarcoma is based on how large the tumor is, whether it has spread to other parts of the body, and how abnormal the cancer cells look under the microscope (the grade). There are a few different types of staging systems used.

Musculoskeletal Tumor Society (MSTS) staging system 

The MSTS system is based on three main factors: 

• The grade of the tumor 
• The extent of the primary tumor 
• If the tumor has metastasized  

These three factors are combined to give an overall stage between I and III.  

TNM staging system 

Sometimes, your doctor will use the American Joint Committee on Cancer (AJCC) TNM system to stage your osteosarcoma. It describes the cancer based on three main factors:  

• T (Tumor): Size of the tumor and whether it has grown into nearby organs or tissues. 
• N (Nodes): Whether the cancer has spread to nearby lymph nodes. 
• M (Metastasis): Whether the cancer has spread to distant parts of the body. 

Your care team at Columbia will work together across pathology, medicine, and surgery, using information from your physical exam, imaging, and biopsy results to determine your tumor’s stage and implement a personalized treatment plan aimed at giving you the best possible outcome.  

We move quickly to begin treatment, guided by your diagnosis and your personal health goals.