Before any treatment can be planned, the team needs to know exactly what the tumour is, exactly where it is, and whether it has spread. That takes a series of tests, usually over a few weeks. Waiting for results is often the hardest part of the whole journey — it helps to know what each test is for.
The tests you may have
Clinical examination. The specialist will look at and feel the lump or the affected area, and ask about your history — how long it has been there, whether it is growing, whether it hurts.
X-ray. A quick, simple picture, most useful for tumours in bone.
MRI scan. Magnetic resonance imaging uses a strong magnet and radio waves — no X-rays — to map the tumour and everything around it, including muscle, nerve and blood vessels. It is the scan surgeons rely on most when planning an operation. It does not hurt, but it means lying still inside a tunnel for a while, so let the staff know beforehand if confined spaces trouble you.
CT scan. A CT combines X-rays with computer processing to produce thin cross-sectional slices through the body. A scan of the chest is usually included, because if a sarcoma is going to spread, the lungs are where it most often shows up first.
PET scan. A PET scan measures activity rather than shape. A trace of a short-lived radioactive sugar is injected, and because many tumours consume sugar faster than surrounding tissue, active areas light up on the images in a way an ordinary scan would not show.
Biopsy. Using a needle and local anaesthetic, a small sample of the lump is taken for the laboratory, with a CT scanner or ultrasound steering the needle to precisely the right spot.
Why the biopsy matters so much
The biopsy is the test that gives the tumour its name. An expert pathologist examines the cells under the microscope, often with special testing. This usually takes several days, sometimes longer — a frustrating wait, but a precise answer matters more than a fast one.
Sampling a suspected sarcoma is not a routine biopsy. It should be carried out only at a specialist unit, by an interventional radiologist who performs these regularly — because the exact path the needle takes has to be chosen so it can later be removed with the tumour. A sample taken along the wrong track can jeopardise the definitive operation, which is why the biopsy is planned by the very team that will operate. Being referred to RPA before a biopsy is therefore a good sign, not a hold-up.
Staging — putting the results together
Together, these tests tell the team where the tumour is, whether it is growing, and whether it has spread. This is called staging. The stage, along with the tumour’s type and grade from the biopsy, is what the multidisciplinary team uses to work out the best treatment plan for you — which is the subject of the next step.
You can bring a family member or friend with you to any of your appointments. Four ears are better than two, and there is a lot to take in.