Determining Diagnosis

First Office Visit

Your first office visit may be overwhelming because we are attempting to confirm a diagnosis for you. You meet many members of our staff, hear quite a bit of information and may have a number of tests performed. Your first visit maybe tiring, somewhat confusing and stressful depending on your situation.

If you brought blood results, MRI, bone or CT scans, we review all of them. If you have had a biopsy, we consult with our pathologists to review your pathology slides. If you have not had any of these studies done, we attempt to schedule all of them during your first visit.

Plain x-rays, CT scans of the tumor area and of your chest, MRI, PET and bone scans are called staging studies. These are the common studies performed to 'workup' a patient with a questionable tumor of the soft tissues or bone. They assist us in determining whether your tumor is benign or malignant, and whether the malignant ones (sarcomas) have traveled to other sites of your body. When a sarcoma has traveled, this is called a metastasis. If sarcomas metastasize, the most common site is the lung.

Your Care Team

• Diagnostic Radiologist: Reviews all x-rays and scans showing the tumor
• Pathologist: Examines biopsied tissue and determines diagnosis
• Orthopedic Oncology Surgeon: Removes all types of tumors, performs limb-sparing surgeries, as well as pelvic and spine reconstruction
• Advanced Practitioners (Nurse Practitioners & Physician Assistants): Coordinate all aspects of care, including assist in surgery
• Medical Oncologist: Coordinates chemotherapy, trails, on-going surveillance visits and survivorship issues
• Radiation Oncologist: Coordinates and deliveries all types of radiation
• Surgical Oncologist: Works in conjunction with orthopaedic oncology surgeons, mainly to protect the abdominal organs (bowel, bladder, vessels, etc.) due to the complex nature of tumor surgery
• Plastic Reconstructive Surgeon: Works in conjunction with orthopaedic oncology surgeon to repair the defects caused by tumor removal
• Fellows: Physicians who have completed residency and are specializing in cancer care
• Residents: Physicians who are still in specialized field of training
• Nurses: Provide care 24/7 following surgery
• Rehabilitation Specialist: These healthcare providers include physical medicine & rehabilitation physicians, physical therapists and occupational therapists, who all help you regain mobility, strength and endurance needed for daily work and recreational activities and adapt/adjust to limitations
• Nutritionist (Registered Dietician): Evaluate caloric intake and provides counseling to overcome side effects of surgery and treatment (i.e. weight loss, poor appetite, nausea/vomiting, etc.)
• Psychiatrists, psychologists, social workers & nurse case managers: Help you and your loved ones cope with the emotional and practical concerns of having cancer and navigate the health care system

Typically, your orthopaedic oncology surgeon can determine if a tumor is benign or malignant from viewing your scans and x-trays.

Most benign tumors are treated conservatively (monitoring) or with surgery. Read more about benign bone tumors or benign soft tissue tumors.

If your surgeon determines that you most likely have a malignancy, you will undergo a biopsy and additional staging studies.

Biopsy

On the day of your appointment, we may schedule a biopsy, if deemed necessary. A biopsy is a needle aspirate or surgical removal of a small piece of tissue for microscopic examination. There are four types of biopsies which are done to make a diagnosis:

Final Pathology/Histology

Histology refers to a pathologist looking at tissue cells under the microscope to determine diagnosis. Most soft tissue sarcomas have a number of histological subtypes. It usually takes 1-2 weeks to confirm a final diagnosis.

Staging Studies

During your work-up to determine the type of tumor you have, you will hear your physicians use the term “initial staging studies.” This means the different types of radiographs used for diagnosis, including x-rays, MRI, CT, PET and bone scans.

If diagnosed with a malignant tumor, you will hear the term “restaging studies.” These are the scans used to evaluate whether a malignant tumor has recurred or spread.

In addition to the two major categories of benign or malignant, bone and soft tissue tumors are further classified or staged. The stage of a lesion depends on three factors:

1. The grade of the tumor which is a microscopic evaluation of the tumor cell's biologic behavior and aggressiveness, that is, its ability to grow and extend beyond its natural barrier (capsule).
2. Whether the tumor stops in its area (compartment) or grows and penetrates out of the compartment.
3. Whether or not there are metastases.

A biopsy which involves the microscopic evaluation of the tumor cell's biologic behavior will determine the grade. Pathologists grade malignant tumors ranging from low grade (1) to high grade (3). Low grade tumors are made of cells whose behavior is not aggressive, that is they seldom spread beyond their local site (Grade 1/3). Intermediate to high grade tumors are made of cells that behave very aggressive and most often than not spread to other parts of the body (Grade 2 or 3).

Patients must undergo many scans (MRI, CT, bone or PET) called staging studies. These scans are done to evaluate the extent of the tumor, locally or at distant sites. The tumor is then staged which helps determine the best treatment plan for that type of tumor. Many of these imaging studies need to be done prior to the biopsy. In most circumstances the biopsy is the last part of the staging process.

Many of our patients have expressed confusion about staging and grading of tumors because of information read in books or found on the internet. Hopefully the above information will help you understand how tumors are staged and graded.

Frequently Asked Questions

FAQs from your Initial Consultation

FAQs from your Biopsy