Tests for soft tissue sarcoma

Usually you begin by seeing your family doctor who will examine you and ask about your general health. Your doctor will ask you about your symptoms. This will include what they are, when you get them and whether anything you do makes them better or worse.

Your doctor will ask you to lie down for a physical examination. The doctor will feel the area where there is pain or swelling. It may feel tender, or it may be possible to feel a lump. After your examination, your doctor may need to refer you to hospital for tests and X-rays or you may be referred directly to a specialist in a hospital that has teams that diagnose and treat sarcoma.

If you see a specialist, you will be asked about your medical history and symptoms. The specialist will then examine you by feeling the area that is painful or swollen. You may be asked to have blood tests and a chest X-ray to check your general health. Then your tests will be arranged in the outpatient department. You are most likely to be asked to have a core needle biopsy to take a sample of the lump to examine under the microscope.

A core needle biopsy takes a sample of cells from the lump. The doctor uses a needle with a special cutting tool on the end. You will have a local anaesthetic injection to numb the area before they put the needle in. If the lump is near the surface of your body and easy to get to, the doctor will probably just feel it to guide the needle in. If the lump is deeper or harder to feel, the doctor will use an ultrasound scan or CT scan to see where the needle is going and guide it to the right place. The doctor puts the sample of tissue into a small pot. They send it to the laboratory so that it can be examined under the microscope to look for cancer cells.

This procedure can be uncomfortable and your doctor may prescribe mild painkillers for you. If the lump turns out to be non cancerous (benign), you may not need any more treatment. If it is cancer, your doctor will talk over the treatment options with you.

A surgical biopsy is usually done if a core biopsy has not given a definite result or if the lump is deep in the body. Surgical biopsy means using a surgical knife (scalpel) to open the area and take a tissue sample from the lump. Or, if the lump is small enough, the surgeon may remove it completely. Depending on the scale of the biopsy operation, you may have this done under local or general anaesthetic.

FNA isn't used as much as surgical biopsy or core needle biopsy. Some hospitals don't use it at all, but some do. But we've included it here because you may have one in some circumstances.

FNA means putting a thin needle into the lump to take a sample of cells. If the lump is near the surface of your body and easy to get to, the doctor will probably just feel it to guide the needle in. If the lump is deeper or hard to feel, the doctor will use an ultrasound scan or CT scan to guide the needle into the right place. The doctor then sucks out some fluid into a syringe. The fluid will contain cells. This procedure is usually no more uncomfortable than a blood test but if you prefer, you can have a local anaesthetic injection before the needle aspiration.

When the cells and fluid are put under a microscope, the pathologist can tell if they are benign (not cancer) or cancer cells. If the fluid does not contain enough cells, you may be asked to have a core needle biopsy or a surgical biopsy.