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Sarcoma develops from tissues like muscle or bone tissues. There are two primary types of sarcoma:

  • Soft tissue sarcoma which starts in the soft tissues such as fat, nerves, muscles, fibrous tissues, deep skin tissues or blood vessels.
  • Osteosarcoma, which develops from bone.

We are going to focus on soft tissue sarcoma in this section.

A sarcoma may appear as a painless lump under the skin, often on an arm or a leg. Sarcomas that begin in the abdomen may not cause symptoms until they become very large. As the sarcoma grows larger and presses on nearby organs, nerves, muscles, or blood vessels, symptoms may include pain or trouble breathing.

Visit the National Cancer Institute where you can find more information on bone and soft tissue sarcomas. And be sure to ask your cancer care team questions about your individual situation.

Diagnosis

If a soft tissue sarcoma is suspected, a biopsy will be done. The type of biopsy will be based on the size and location of the tumor. There are three types of biopsies commonly used. Your physician will choose the best one for you:

  • Incisional biopsy: The removal of part of a lump or a sample of tissue.
  • Core biopsy: The removal of tissue using a wide needle.
  • Excisional biopsy: The removal of an entire lump or area of tissue that doesn’t look normal.

The following tests may be done on the tissue that was removed:

  • Immunohistochemistry study: is used to tell the difference between different types of cancer.
  • Light and electron microscopy: Used to look for certain changes in the cells.
  • Cytogenetic analysis: Used to look for certain changes in the chromosomes.
  • FISH (fluorescence in situ hybridization): A laboratory test used to look at genes or chromosomes in cells and tissues.
  • Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of tumor markers on the cell surface.

Staging

Stage I

Divided into Stages IA and IB:

  • Stage IA - the tumor is low-grade (likely to grow and spread slowly) and 5 centimeters or smaller. It may be either superficial (in subcutaneous tissue with no spread into connective tissue or muscle below) or deep (in the muscle and may be in connective or subcutaneous tissue).
  • Stage IB - the tumor is low-grade (likely to grow and spread slowly) and larger than 5 centimeters. It may be either superficial or deep in the tissue.

Stage II

Divided into Stages IIA and IIB:

  • Stage IIA - the tumor is mid-grade (somewhat likely to grow and spread quickly) or high-grade (likely to grow and spread quickly) and 5 centimeters or smaller. It may be either superficial or deep in the tissue.
  • Stage IIB - the tumor is mid-grade (somewhat likely to grow and spread quickly) and larger than 5 centimeters. It may be either superficial or deep in the tissue.

Stage III

The tumor is either:

  • High-grade (likely to grow and spread quickly), larger than 5 centimeters, and either superficial or deep in the tissue; or
  • Any grade, any size, and has spread to nearby lymph nodes.

Stage IV

The tumor is any grade, any size, and may have spread to nearby lymph nodes. Cancer has spread to distant parts of the body, such as the lungs.

Treatment Options

For each stage of soft tissue sarcoma, there are different treatment options available. Some of the options that may be offered by your doctor are as follows:

Stage I Sarcoma:

  • Surgery (wide local excision or Mohs microsurgery).
  • Radiation therapy before and/or after surgery.

If cancer is found in the head, neck, abdomen, or chest, treatment may include the following:

  • Surgery.
  • Radiation therapy before or after surgery.
  • Fast neutron radiation therapy.

Stages II and III adult soft tissue sarcoma treatments include:

  • Surgery (wide local excision).
  • Surgery (wide local excision) with radiation therapy, for large tumors.
  • High-dose radiation therapy for tumors that cannot be removed by surgery.
  • Radiation therapy or chemotherapy before limb-sparing surgery. Radiation therapy may also be given after surgery.
  • A clinical trial of surgery followed by chemotherapy, for large tumors.

Stage IV adult soft tissue sarcoma that involves lymph nodes may include the following treatments:

  • Surgery (wide local excision) with or without lymphadenectomy. Radiation therapy may also be given after surgery.
  • Radiation therapy before and after surgery.
  • A clinical trial of surgery followed by chemotherapy.

Treatment of stage IV adult soft tissue sarcoma that involves internal organs of the body may include the following:

  • Surgery (wide local excision).
  • Surgery to remove as much of the tumor as possible, followed by radiation therapy.
  • High-dose radiation therapy, with or without chemotherapy, for tumors that cannot be removed by surgery.
  • Chemotherapy with 1 or more anticancer drugs, before surgery or as palliative therapy to relieve symptoms and improve the quality of life.
  • A clinical trial of chemotherapy with or without stem cell transplant.
  • A clinical trial of chemotherapy following surgery to remove cancer that has spread to the lungs.

Treatment for recurring sarcoma may be somewhat different and will be guided by your cancer treatment team of physicians and nurses.