After you’ve been referred to the Sarcoma team through your family doctor, you may be seen at one of the clinics located at either Princess Margaret, or Mount Sinai. Pediatric patients are seen at Sick Kids hospital, click here for a link to their oncology clinic page.
The physician in charge of your care will require a detailed medical history, a list of medications (bring a list with you!), symptoms, and any imaging you may have done previously. You may be asked by the doctor’s medical assistant to bring a copy of your imaging on disk with you to your clinic visit, or your Pocket Health code for the electronic copy. Our medical team will likely do a physical examination and may send you to get some blood drawn for routine testing. The next step before your next visit may require more information to help confirm your diagnosis. To help your care team better understand the site of concern and to help characterize your tumour, three steps may be required:
- Tumor Board Discussion
Part of your diagnosis may include grading. Grading a tumor is done by looking at the tumor cells and growth, with low grade tumors growing slowly and high grade tumors quickly growing. This information will help your medical team to determine which treatment to offer you.
Once you’ve received your diagnosis your sarcoma care team will look at the whole body through imaging to find out the extent of cancer and if it has spread to other tissues. This is called “Staging” of the cancer and can involve a combination of a physical examination, and medical imaging (MRI, CT, x-ray, ultrasound or PET). Staging cancer is important to determine what treatment may be beneficial.
Imaging includes a set of radiology tests, where you may be required to take more than one type of test. There are four types of scans you may asked to complete:
Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging method that uses sound waves to produce images of structures within your body.
- CT scan
A computerized tomography (CT) scan creates cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. CT scan images provide more-detailed information. Nearly all parts of the body can be imaged and may be required again during your treatment planning. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
Magnetic resonance imaging (MRI) uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body. Like CT scans, MRI can create cross-sectional images or 3D images that can be viewed from different angles.
- PET/CT scan
An experienced radiologist (specialist in X-ray interpretation) will review your pictures to determine where the tumour is and may give some indication of the type of sarcoma it may be. At times, to help us characterize the tumor better, we need to repeat the tests for higher quality pictures. Some tests may require you to hold off on the consumption of foods and liquids, or remove certain jewelry/objects that contain metal. However, more specific details will be provided for you before your appointment.
Since there are more than 50 types of sarcoma, in most cases, it is important to DIAGNOSE which type of sarcoma you have, before recommending a treatment plan. A diagnosis of sarcoma is usually made by a thorough examination of a small piece of tissue after a biopsy or excision of the tumor by an expert sarcoma pathologist. This can include many specialized molecular tests since sarcoma is a rare cancer and the process of diagnosis may take several weeks due to the complexity of this process.
When you are first seen in the clinic, you may have already had a biopsy. In that case, the tissue will be obtained and reviewed at our center which may take a number of weeks. In some cases, a repeat biopsy may be necessary.
All new patients are discussed at a weekly meeting where the entire sarcoma team, including surgeons, radiologists, pathologists, medical oncologists and radiation oncologists will review your case and formulate an individualized treatment plan. These meetings are called “Multidisciplinary Cancer Conferences (MCC)” and are useful for the patient’s care team to have interactive and focused discussions on a treatment plan to ensure that all options are being explored for the patient.