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NCCN Guidelines for Patients


Soft Tissue Sarcoma, Version 1.2014


Getting an imaging scan is often easy. Before the

scan, you may need to stop taking some medicines,

stop eating and drinking for a few hours, and remove

metal objects from your body. During the scan, you will

need to lie face up on a table that moves through the

machine. As the machine takes pictures, you may hear

buzzing, clicking, or whirring sounds. You will be alone,

but a technician will operate the machine in a nearby

room. He or she will be able to see, hear, and speak

with you at all times. You will likely be able to resume

your activities right away unless you took a sedative.


A biopsy is the removal of tissue or fluid samples

to test for disease. A biopsy is recommended after

adequate imaging of the tumor. After the biopsy,

a pathologist will examine the samples with a

microscope to confirm if there’s cancer.

A biopsy can be done with a needle. There are two

types of needle biopsies. A core-needle biopsy is the

more common and favored method. It obtains a larger

sample for testing. A fine-needle aspiration removes a

smaller piece of tissue and doesn’t require any cutting

into the skin (incision).

Besides needle biopsies, an incisional biopsy can

be used. An incisional biopsy requires anesthesia to

numb the area and a cut into the skin. It is a minor

surgery that removes some but not the entire tumor.

If after the first biopsy, it is unclear if the tumor is

cancer, a second biopsy should be done. The second

biopsy should be done using imaging to guide the

needle into the tumor. If the tumor is cancer, more

testing should be done to learn more about the

cancer. Your doctors will want to know the cancer

grade, which is discussed on page 17. Testing for

abnormal genes within the cancer cells may also be

done. It is important that the testing be done by a

pathologist who has experience with sarcoma.

Imaging of chest

Chest imaging is recommended before treatment of

sarcomas that are discussed in this chapter. Imaging

of your chest will allow your doctors to assess if the

cancer has spread to your lungs. You may receive a

plain radiograph or CT of the chest. Chest CTs are

often used when images from a plain x-ray would be

unclear due to lung scarring or other health conditions.


PET scans are a type of imaging test. To create the

images, a sugar radiotracer is used. If the radiotracer

is FDG (






lucose), you must fast for 4

hours before it is injected into your body. Between 40

to 60 minutes after injection, the radiotracer will emit a

small amount of energy. This energy can be detected

by the imaging machine.

In the PET images, cancer appears brighter (“hotter”).

This is because cancer cells use sugar more quickly

than normal cells. Hot spots suggest that cancer is


PET may be useful if the tumor is larger than 3 cm, is

firm, and is deep within your body. PET may help your

doctors decide the prognosis and grade of the cancer.

It may also help them assess if a tumor is shrinking

during chemotherapy.

CT of abdomen and pelvis

Some sarcomas are more likely to spread to other sites

than other sarcomas. These include myxoid and round

cell liposarcoma, epithelioid sarcoma, angiosarcoma,

and leiomyosarcoma. If you have these sarcomas, you

may receive a CT scan of your abdomen and pelvis to

assess if the cancer has spread. CT of these areas is

also done if this is where the sarcoma started. In this

case, CT may show if tumor has come back or spread

to the organs in the abdomen.

MRI of total spine

Myxoid and round cell liposarcomas are likely to


Sarcomas in limbs, outer trunk, head, or neck Treatment planning