Patients with sarcoma present in many ways, but the most common symptoms are pain and swelling in an arm, leg, or other body part. Usually these symptoms result in evaluation by their primary care physician, who obtains an X-ray, ultrasound, CT scan, or MRI, revealing a suspicious mass. Immediate referral to Children's Hospital is strongly recommended. Our team will coordinate diagnostic testing and a biopsy performed by our highly specialized surgical team. We then work closely with our pediatric pathologists and radiologists to confirm the identity of the tumor and the extent of disease.
The following tests and procedures may be used to find and diagnose various types of sarcoma:
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
X-ray: An X-ray of the organs and bones inside the body.
CT scan (CAT scan): A procedure making a series of detailed pictures of areas inside the body, such as the abdomen or pelvis, taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
MRI (magnetic resonance imaging): A procedure using a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
Lumbar puncture: A procedure used to collect cerebrospinal fluid (CSF) from the spinal column to check for cancer cells. This is done by placing a needle between two bones in the spine and into the spinal column to remove a sample of CSF. This procedure is also called an LP or spinal tap.
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy is done after imaging tests are done.
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone. Samples are removed from both hipbones. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
Once a diagnosis of sarcoma has been made, our team will work closely with the patient and their family to develop a personalized, multidisciplinary treatment plan specifically tailored to the patient. Depending on the type of sarcoma, treatment includes a combination of surgery, radiation therapy, and chemotherapy.
Our surgeons are leaders in surgical techniques that completely remove tumors and preserve as much body function as possible. Our pediatric radiation oncologists use sophisticated technology targeting tumors to minimize damage to healthy tissue. We have pediatric pharmacists and nutritionists on staff to assist in the care of each patient to ensure they remain strong and healthy before, during, and after treatment. Working with child life specialists and other specially trained staff members, your child will receive care that will help him or her get back to a normal pattern of life as soon as possible.
The most common types of treatment for cancer are surgery, radiation therapy, and chemotherapy.
Surgery to completely remove tumors is done whenever possible. If the tumor is very large, radiation therapy, or chemotherapy may be given first, to make the tumor smaller and decrease the amount of tissue needing to be removed during surgery. A second surgery may be needed to remove any remaining cancer cells or check the area around where the tumor was removed for cancer cells and then remove them.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy or chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery — to lower the risk cancer will come back — is called adjuvant therapy.
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
To learn more about different types of treatment for childhood and adolescent cancer, visit the National Cancer Institute website.
The chance of recovery and treatment options depend on the following:
Where in the body the tumor started
The size of the tumor at the time of diagnosis
Whether the tumor has been completely removed by surgery
Whether the tumor has spread to nearby lymph nodes or distant parts of the body
The patient's age and general health
Whether the tumor has just been diagnosed or has recurred (come back)
For patients with recurrent cancer, prognosis and treatment depend on the following:
Where in the body the tumor recurred (came back)
How much time passed between the end of cancer treatment and when the cancer recurred
© 2014 Monroe Carell Jr. Children's Hospital at Vanderbilt