Tests for soft tissue sarcoma

You usually have a number of tests to check for soft tissue sarcoma. Soft tissue sarcomas are cancers that start in the connective and supporting tissues of the body. These include the:

• fat

• muscle

• blood vessels

• deep skin tissues

• nerves

• tendons and ligaments

• tissues around the joints

The bones are also a supporting tissue. Cancers that start in the bones are called bone sarcomas or primary bone cancers. These are often treated differently from soft tissue sarcomas. 

Tests your GP might do

Most people with symptoms that could be due to cancer start by contacting their GP surgery. Your first appointment may be a telephone appointment. Your GP surgery then might arrange for you to go in and see a doctor or other healthcare professional.

Your GP can do some tests to help them decide if you need to see a specialist. This usually includes:

• a physical examination

• an ultrasound scan

• blood tests

Your GP may also arrange for you to have other tests such as an MRI or CT scan. This depends on your symptoms and test results. You have an MRI or CT scan at your local hospital.

Physical examination

Your doctor usually asks you to lie or sit down. They will look and feel your skin to check for any abnormalities or areas that are swollen.

They may also listen to your chest and tummy (abdomen ) to find out if they sound normal.

You can ask for someone else to be in the room with you if you want, to act as a chaperone. A chaperone is a trained health professional such as a nurse. A friend or relative can also stay with you for support and comfort. They can be with you during the examination.

Ultrasound scan

Ultrasound scans use high frequency sound waves to create a picture of a part of the body. The ultrasound scan has a probe that gives off sound waves. The sound waves bounce off the organs inside your body, and the probe picks them up. The probe links to a computer that turns the sound waves into a picture on the screen.

You usually have an ultrasound scan at your local hospital imaging department. The ultrasound can show blood flow and changes in the soft tissues.

Blood tests

Blood tests can check your general health including:

• how well your liver and kidneys are working
• the number of blood cells in your blood such as white blood cells,  platelets and red blood cells.  You may hear this being called a full blood count
• if you have any signs of infection

Tests your specialist might do

Depending on your symptoms and the results of your tests, your GP might refer you to a specialist doctor. This is usually a cancer doctor who specialises in sarcoma.

Not all hospitals have sarcoma specialists. So you might have to travel to another hospital to be seen by a sarcoma specialist.

Your specialist usually does more tests. These might include:

• MRI scan

• taking a sample of tissue called a biopsy

• CT scan

• x-ray

MRI scan

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to take pictures of the inside of your body.

MRI scans can help doctors take a closer look at any changes found on an ultrasound scan.

Biopsy

A biopsy is when a surgeon takes a sample of tissue from the abnormal area. They send it to a laboratory where a specialist doctor called a pathologist looks at the sample under a microscope. It is the only way to find out for sure if you have soft tissue sarcoma.

You usually have a core needle biopsy. Some people may need to have a surgical biopsy instead, but this is less common.

Core needle biopsy

You have a local anaesthetic injection to numb the area. Then your doctor uses a needle with a special cutting tool on the end to take the tissue sample. You usually have more than one biopsy taken.

Your doctor might use an ultrasound or CT scan to help them guide the needle into place.

Surgical biopsy

You may have a surgical biopsy if:

• the results of the core needle biopsy are unclear

• the abnormal area is deep in your body

You have a surgical biopsy under local or general anaesthetic. A general anaesthetic means that you are asleep and won’t feel anything.

Your surgeon uses a scalpel to open the area and take a tissue sample. If the abnormal area is small enough, they may remove it completely. This is called an excision biopsy. It depends on:

• where the abnormal area is
• how big it is as to where they take the sample from
• how much tissue they remove

After the biopsy

Your surgeon sends the samples to a laboratory where a pathologist looks for cancer cells. You usually get the results within 2 to 3 weeks. The doctor who arranged the biopsy will give them to you.

CT scan

A CT (or CAT) scan stands for computer (axial) tomography. It is a test that uses x-rays and a computer to create detailed pictures of the inside of your body. The computer puts them together to make a 3 dimensional (3D) image.

You might have a CT scan of your chest, abdomen and pelvis . This can help to show where the cancer is and whether it has spread.

X-ray

An x-ray is a test that uses small amounts of radiation to take pictures of the inside of your body. They can show changes caused by the cancer or other medical conditions.

You may have an x-ray of your chest in the imaging department of the hospital.

Tests in your soft tissue sarcoma cells

If you have soft tissue sarcoma, your doctor might do some tests on the sarcoma cells.

There are many different types of soft tissue sarcoma and it can be difficult for pathologists to tell one from another.

Some gene changes are linked with specific types of soft tissue sarcoma. So your doctor may check the cancer for gene changes (mutations). These are called cytogenetic tests. This can help your doctor find out what type of sarcoma you have and decide on the best treatment for you.

Some of cytogenetic tests they might do include checking for changes in the:

• NF1 gene which is linked with malignant peripheral nerve sheath tumour (MPNST) in people with familial neurofibromatosis

• TP53 tumour suppressor gene which increases the risk of sarcoma and other cancers in people with Li-Fraumeni syndrome

• RB gene which increases the risk of sarcoma in people who have familial retinoblastoma

Treatment

The tests you have help your doctor find out if you have soft tissue sarcoma and how far it has grown. This is the stage of the cancer.

This is important because doctors recommend your treatment according to the stage of the cancer.

Coping

Coping with a diagnosis of soft tissue sarcoma can be difficult. There is help and support available for you and your family.