Diagnosis
How is the type determined?
First, your doctor will ask you many questions concerning your complaints, and you will be examined. This way your doctor can have an idea concerning aggressivity, location and possible causes of the tumor.
Afterwards, a number of scans will be performed to determine the type and extent of the tumor. Sarcoma growth will not be hampered, and may extend locally in other tissues or show distant spread (metastasising).
Which imaging is possible?
If you have a bone sarcoma, plain radiographs (X-rays) will be taken. A CT orMRI scan will be taken in order to determine the extent of the local ingrowth.
Radiograph
A radiograph is a kind of imaging using Röntgen rays (X-rays) to visualise the inside of the body, especially your bones. This examination is usually painless.
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If you need an injection with contrast fluid, you will feel a needle puncture e.g. in a joint. Depending on the body part that needs to be examined, you will be asked to remove part of your clothing, jewels or other metallic objects. Then, you will be brought towards the table in order to make the images. You will be asked to assume certain positions: it is important to follow the instructions and to keep still during the acquisition of the image. If certain positions are impossible or too painful for you to attain, please notify the radiology nurse. After the imaging you can dress and leave. You will receive a letter containing a code or a report of the examination: keep this letter and take it with you to your treating physician.
CT-scan
A CT scan is a kind of imaging using Röntgen rays (X-rays) to visualise the inside of the body. This examination is usually painless. If you need an injection with contrast fluid, you will feel the needle puncture e.g. in your hand or in a joint.
Read more
Depending on the body part that needs to be examined, you will be asked to remove part of your clothing, jewels or other metallic objects. Then, you will be brought towards the table in order to make the images. You will be asked to assume certain positions: it is important to follow the instructions and to keep still during the acquisition of the image. If certain positions are impossible or too painful for you to attain, please notify the radiology nurse. After the imaging you can dress and leave. You will receive a letter containing a code or a report of the examination: keep this letter and take it with you to your treating physician.
MRI
A MRI scan is a kind of imaging using magnetic waves to visualise the inside of the body. This examination is usually painless. If you need an injection with contrast fluid, you will feel the needle puncture e.g. in your hand or in a joint.
Read more
Depending on the body part that needs to be examined, you will be asked to remove part of your clothing, jewels or other metallic objects. Then, you will be brought towards the table in order to make the images. You will be asked to assume certain positions: it is important to follow the instructions and to keep still during the acquisition of the image. If certain positions are impossible or too painful for you to attain, please notify the radiology nurse. After the imaging you can dress and leave. You will receive a letter containing a code or a report of the examination: keep this letter and take it with you to your treating physician.
Bone scan
A bone scan is an examination using radioactive isotopes.
First, a weak radioactive fluid (isotope) is administered through a vein injection. This fluid is attracted to zones with a higher activity, such as tumors or bone metastases, and will pool there. The first phase can take a few hours of waiting. Afterwards, you will be guided towards the table of the scanning machine, and your whole body will be examined. The zones containing the pooled isotopes will emit radioactive waves, which are captured by the camera. This way, the bone parts that are possibly affected by the tumor are visualised.
During the third and last phase the computer fuses the data into one image.
The advantage of a bone scan is the possibility to visualise the whole body in one image.
The scan itself takes about 50 minutes, not counting the preparatory phase.
It is important to obtain these images before putting a knife or needle in the tumor in order not to distort the images. If not, the characterisation of the sarcoma becomes harder. Furthermore the doctors will use the images to determine the correct way to approach the tumor, and which zone is the best one. This will be discussed at a multidisciplinary meeting. Sarcoma can metastasise to other body parts (other bones, lungs, abdomen) and therefore these regions will also be examined using scans.
More information is available at the specialized centers below:
How is the type determined?
First, your doctor will ask you many questions concerning your complaints, and the affected body part will be examined. Afterwards, your doctor will ask a radiograph and an MRI to evaluate the local extent of the disease. As osteosarcoma may spread to your lungs or other bones, your doctor will order a CT scan of your lungs and a bone scan.
A biopsy is always necessary to confirm the suspected diagnosis.
First, your doctor will ask you many questions concerning your complaints, and the affected body part will be examined. Afterwards, your doctor will ask a radiograph and an MRI to evaluate the local extent of the disease. As osteosarcoma may spread to your lungs or other bones, your doctor will order a CT scan of your lungs and a bone scan.
A biopsy is always necessary to confirm the suspected diagnosis. In order to evaluate whether tumor cells are present in you bone marrow, a bone marrow aspiration may be performed during your biopsy.
In many patients finding a chondrosarcoma is incidental during medical imaging (X-ray or bone scan) after for instance a trauma. Sometimes patients may have pain because the affected bone becomes fragile.
Usually an MRI is planned in order to distinguish between a benign (enchondroma) or a malignant (chondrosarcoma) cartilage tumor, and to evaluate the tumor volume. In case of doubt, your doctor will advise a biopsy.
Chondrosarcomas are classified according to their malignant properties:
- Grade 1 or low grade
- Grade 2 or intermediate grade
- Grade 3 or high grade
A low grade malignant tumor usually does not metastasise, but it has a higher propensity to return if it is not completely removed. The higher the grade, the higher the risk for developing distant metastases, and the more aggressive the treatment needs to be.
First, your doctor will ask you many questions concerning your complaints, and the affected body part will be examined. Afterwards, your doctor will ask an ultrasound as a first evaluation, and also an MRI to evaluate the local extent of the disease. As osteosarcoma may spread to your lungs or sometimes to you lymph nodes, your doctor will order a CT scan of your lungsand abdomen. Sometimes an additional PET-CT scan may be necessary, this is another kind of isotope scan.
A biopsy is always necessary to confirm the suspected diagnosis.
How is a biopsy performed?
In order to determine which sarcoma type your have, some tissue has to be examined by the pathologist. In order to obtain a tissue sample, a biopsy is planned. A biopsy can be performed open (a small surgery) or closed (using a thick needle).
Does a biopsy encompass risks?
A biopsy always encompasses a calculated risk. People may say that once a tumor has ‘seen the air’, the patient is lost. This is not true. By taking a biopsy the tumor will not spread toward other organs. However, malignant tumor cells may be left behind in the biopsy tract.
A biopsy has to be performed correctly to avoid problems later. The biopsy tract has to be removed along with the tumor at the moment of final sarcoma resection. This is the reason why the doctor performing the biopsy has to keep the final resection surgery in mind.
Infection of the biopsy wound has to be avoided at all costs. An infection may prohibit the start of possible chemotherapy or may even compromise the final surgery.
As a sarcoma contains many blood vessels, a hemorrhage may occur during biopsy, or the wound may bleed afterwards. Your doctor will devote maximum effort to avoid a hematoma, for example by placing a drain (a small tube) to evacuate the blood. Usually a temporary compression bandage will be applied.
What happens after biopsy?
The tissue sample is taken to the lab immediately. The microscopic investigation is very thorough, and it may take up to 10 days to receive a definitive result. This waiting period is very stressful for you and your loved ones, because you do not know what will happen. Doctors will do everything to keep this period as short as possible, but the pathologist needs time to run all necessary tests to reach a definitive diagnosis.
The results will be discussed again during a multidisciplinary meeting, and a treatment plan will be defined. Your treating physician will discuss the results and the treatment plan with you and your loved ones. This plan is a proposal: it is imperative that you being the patient have a say concerning the treatment. Do not hesitate to ask for more information, or a second consultation to enable you to process all the information before deciding.