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CANCER SERVICES

Diagnosis & Treatment

Sarcoma

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How are sarcomas diagnosed?

Diagnosis

There are over 80 subtypes of sarcoma, and receiving an accurate and detailed diagnosis is the first step in determining the best treatment for your specific case. As an integrated academic healthcare center, NewYork-Presbyterian offers expert diagnosis and treatment from leading sarcoma specialists.

Our doctors are highly specialized and work together as multidisciplinary care teams to diagnose and treat each sarcoma case. Interventional radiologists and surgeons collaborate to conduct meticulous biopsy planning, and specialized pathologists conduct expert pathology reviews to confirm diagnostic accuracy.

The process of sarcoma diagnosis often includes: 

  • Imaging: Imaging tests such as MRIs, ultrasounds, and CT scans are used to identify tumors, determine their location, and indicate if the cancer is spreading (metastasizing). 
  • Biopsy: A biopsy is usually performed after imaging tests to confirm the diagnosis and classify the tumor’s subtype. It involves collecting a small tissue sample of the tumor and examining it closely under a microscope.  
  • Staging/Grade: Information gathered from the imaging tests and biopsy are used to determine the specific type of sarcoma, as well as the stage and grade of the tumor, which further informs treatment. 
  • Treatment Planning: A tumor board, or group of multidisciplinary experts, meet to discuss your specific diagnosis and develop a treatment strategy. Your personal preferences and goals are central to this decision-making process through shared decision-making.

How are sarcomas treated?

Treatments

Your care team will consider several factors when developing a treatment plan, including:

  • Subtype: In addition to differentiating between soft tissue sarcoma and bone sarcoma, the specific subtype of your tumor provides information as to how the cancer may behave and what treatments may be most effective.
  • Location: The tumor’s location, as well as its proximity to vital structures, helps guide therapy and may influence the choice or timing (sequencing) of treatments.
  • Grade & Stage: The cancer’s stage and grade refer to the extent of spread and degree of aggressiveness, which helps predict how the tumor might respond to different treatments.
  • Resectability: This refers to the ability to surgically remove the entire tumor. Ideally, sarcoma surgery achieves “negative margins,” meaning no cancer cells were found at the outer edge of the removed tissue when examined under the microscope.
  • Patient Goals: We prioritize the removal of tumors while doing our best to preserve your quality of life, both short and long-term. Your doctor will discuss your personal preferences and treatment goals with you in great detail, and they will be central to your course of treatment.

Targeted therapy & immunotherapy

When being treated for sarcoma, some patients may receive systemic therapies such as chemotherapy, targeted therapy, and immunotherapy. These treatments are more likely when the cancer is at an advanced stage, when the tumor can’t be removed surgically, or when standard therapies are not working as effectively as intended. Targeted therapies and immunotherapies are often subtype-specific, rather than one-size-fits-all, and are often part of clinical trials.

Surgery

Limb-sparing surgery (or limb salvage surgery) is an option for the vast majority of extremity sarcoma patients. The goal of limb-sparing surgery is to remove the tumor while causing the least impact on function of the limb and without amputating the limb.

Once a tumor is removed, reconstructive surgery can help restore the functionality and appearance of the affected area. Our reconstructive surgeons work alongside surgical oncologists and orthopedic oncologists to restore form and function, using advanced techniques including tissue transfers (using tissue from another part of your body) or allografts (using tissue, most commonly bone, from human donors). Tissue substitutes (not from human donors) may also be used.

Other types of surgery for sarcoma include GIST surgery and retroperitoneal sarcoma surgery.

What to expect during recovery:

  • Hospital Stay: Length of hospital stay depends on the size and location of the tumor and the complexity of the procedure.
  • Physical Therapy: While no two patients are alike, the general goals of physical therapy are to help you move safely, restore your function, reduce pain, and prevent long-term disability. Gentle rehabilitation often begins shortly after surgery, sometimes the same day. While still in the hospital or immediately upon returning home, your physical therapist will help you safely transition into daily activities, such as climbing stairs. Once your incisions have sufficiently healed, you will begin an outpatient physical therapy program in order to rebuild strength and restore full range of motion.
  • Additional Treatments: In many cases, surgery is accompanied by other treatments such as radiation therapy or systemic therapy (e.g. chemotherapy, and targeted therapies). Some of these occur after surgery to eliminate remaining cancer cells and reduce recurrence, especially in advanced cases or when the entire tumor cannot be removed. These may also be given prior to surgery in circumstances when it can make surgery safer, more complete, or has been demonstrated to be beneficial in that specific type of sarcoma.
  • Long-Term Monitoring: Regular check-ups with your care team are a standard and important part of care after surgery. These visits may include imaging tests, physical exams, and lab tests.

Radiation therapy

Radiation therapy delivers targeted radiation beams directly to the tumor, while aiming to spare nearby healthy tissue. It may be used with chemotherapy and before or after surgery as a sarcoma treatment. Learn more about different types of radiation therapy below.

  • External radiation treatments: Intensity-modulated radiation therapy (IMRT) and other forms of external radiation can deliver highly-focused radiation beams shaped to the contours of your tumor, sparing nearby healthy tissues and reducing your risk of side effects.
  • Intraoperative Radiation Therapy (IORT): Large doses of radiation are administered after the tumor is removed
  • Internal radiation or brachytherapy: Small, radioactive pellets (or seeds) are placed in or near the tumor site using thin catheters (tubes). The pellets deliver high doses of radiation.

FAQs

FAQs

Sarcoma is often caught late and can be challenging to diagnose. However, many sarcomas are curable, especially when they are detected early and treated before they spread to other parts of the body. For localized sarcomas, treatment often combines surgery with therapies such as radiation. In cases of advanced, metastatic sarcoma, management, rather than a cure, is typically the goal.

The exact cause of most sarcomas is unknown. While it is usually not hereditary, certain inherited conditions have been shown to increase your likelihood of developing sarcoma. These include Li-Fraumeni syndrome, familial retinoblastoma, and neurofibromatosis type 1. If this is a concern, our genetic counselors can help assess your risk through molecular testing.

Except in rare cases when immediate treatment is required, seeking a second opinion is always appropriate. Who you seek a second opinion from matters, and you can always ask your doctor for recommendations. A second opinion can be an opportunity to confirm your diagnosis and learn more about your treatment options. For many, it allows them to feel more empowered and confident in their treatment decisions.

Some questions you can ask your provider include: 

  • What is the subtype, stage, and grade of my sarcoma?  
  • What are my treatment options? What do you recommend? 
  • What would the goal of treatment be?  
  • What are the risks and side effects? 
  • How much experience do you have treating this type of cancer?  
  • How long will treatment last? What will recovery be like? 
  • What is the likelihood of the cancer recurring? 
  • What will long-term monitoring look like? 
  • Am I eligible for any clinical trials? 

There are two primary types of sarcoma: soft tissue sarcomas, which originate in soft tissues such as muscles or blood vessels, and bone sarcoma. Between the two main types, there are over 80 subtypes, which differ depending on the type of cell they originated from. While still rare, soft tissue sarcoma is more common than bone sarcoma.

 

This content has been reviewed by the following medical editors.

Russell S. Berman, MD, FACS

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Trust NewYork-Presbyterian for Sarcoma Care

NewYork-Presbyterian has nationally-recognized doctors and oncologists with experience treating many forms of sarcoma. Our experts will expertly identify any symptoms or signs of sarcoma and provide you with a comprehensive diagnosis and personalized treatment plan. If you think you have symptoms of sarcoma, don't hesitate to contact us for an appointment.