If a soft tissue sarcoma is suspected, the most important initial investigation is always a complete history and physical:
Complete history and physical:
History
The history should include:
Specific information regarding primary tumor:
- Tumor mass:
- When was the mass first noticed?
- How quickly is the mass changing in size (e.g. rapidly or slowly)?
- Are there any overlying skin changes?
- Is there associated pain/tenderness/redness or warmth?
- If pain is present, does the pain radiate anywhere?
- Is there any functional abnormality of the affected limb?
- Is there any enlargement of regional lymph nodes?
- Is there any distal lymphedema/swelling of limb?
General health:
Is there any previous history of:
- Other illnesses such as TB?
- Previous radiation therapy?
- Are there any systemic symptoms?
- Appetite change, weight loss, appetite, fevers, night sweats?
- Review of symptoms:
- General questions about lung, cardiac, GI and GU symptoms
- Is there any pain elsewhere?
- Are there any pulmonary symptoms (such as shortness of breath, cough or chest pain)
Family history:
- Is there any relevant family history (previous history of cancers in relatives)
Physical examination
Specific to region of tumor:
- Size of tumor in cm
- Mobile or attached (fixed) to deep tissues
- Any breakthrough of skin (fungating tumor)
- Are any regional lymph nodes enlarged?
- Any distal edema involving limb where tumor is located?
- Any evidence of a deep vein thrombosis?
General examination:
- Vital observations
- Weight, height, blood pressure, pulse and temperature
- Examination of chest (respiratory and cardiovascular systems) and abdomen
Other Investigations
Blood work:
General including CBC, liver function tests and electrolytes, creatinine and BUN.
Blood coagulation studies prior to biopsy
Radiology
To assess extent of primary tumor (local disease)
- MR scan of affected limb
To exclude distant metastatic disease:
- CXR
- CT of chest to exclude pulmonary metastases
- For liposarcoma; CT of chest, abdomen and pelvis to exclude metastatic disease in these areas
- PET- CT scan: Very sensitive for tumors such as extra-osseous Ewing sarcoma
Biopsy
- Needs to be carefully planned by surgeon and treatment team
N.B.
PRIOR TO THERAPY in any young person there should be a discussion about any potential side effects of treatment on fertility.
