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General sarcoma

Ewing sarcoma

 

 

Rhabdomyosarcoma

Non-RMS

 

 

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Osteogenic Sarcoma

 

 

Investigation

 

Laboratory Investigations:

Complete Blood Count (CBC)

Usually normal

Biochemistry

Usually normal

Alkaline Phosphatase

(ALP)

50% have elevated ALP, may be related to prognosis

ESR and CRP

Elevated in osteomyelitis

Calcium and Phosphate

Usually normal

 

Imaging:

Local imaging should be completed prior to any biopsy as the edema from the biopsy can make the images uninterpretable.

Systemic imaging can be withheld until after the biopsy confirms the diagnosis, but if there is a high index of suspicion then it can facilitate care to get the investigations booked in advance.

Local Imaging

Plain X-rays
  • Gold standard for diagnosis

 

CT scan
  • Does not usually add anything over X-ray in limb OS
  • Useful in pelvis, head and neck

 

MR scan
  • Shows extent of soft tissue mass
  • Usually non-specific findings
  • Essential for surgical planning

 

Systemic Imaging

Chest X-ray
  • Easily available
  • Detects metastases >5-10mm
  • Often used for post-treatment monitoring

 

Chest CT
  • More sensitive than Chest X-ray, but higher radiation dose
  • May have false-positives with small nodules
  • All patients should have a baseline Chest CT

 

Bone Scan
  • Detects bone metastases
  • NOT useful for deciding if a lesion is malignant or not

 

PET-CT
  • Still unproven, but increasingly used.
  • More sensitive for soft tissue masses than a bone scan
  • May have a role in assessing treatment response

Link:

 

 

Investigations to assess baseline function prior to chemotherapy:

Creatinine clearance

Cisplatinum likely to affect renal function

Echocardiogram

Adriamycin associated with risk of cardiomyopathy

Audiology

Cisplatinum associated with high frequency sensory-neural hearing loss

 

 

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