If a soft tissue sarcoma is suspected, the most important initial investigation is always a complete history and physical:
Complete history and physical:
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?
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)
- Is there any relevant family history (previous history of cancers in relatives)
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?
- Vital observations
- Weight, height, blood pressure, pulse and temperature
- Examination of chest (respiratory and cardiovascular systems) and abdomen
General including CBC, liver function tests and electrolytes, creatinine and BUN.
Blood coagulation studies prior to biopsy
To assess extent of primary tumor (local disease)
- MR scan of affected limb
To exclude distant metastatic disease:
- 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
- Needs to be carefully planned by surgeon and treatment team
PRIOR TO THERAPY in any young person there should be a discussion about any potential side effects of treatment on fertility.