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
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