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Stages of Childhood Soft Tissue Sarcoma
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After childhood soft tissue sarcoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.
The process used to find out if cancer has spread within the soft tissue or to other
parts of the body is called staging. There is no standard staging system for childhood soft tissue sarcoma. Two methods that are commonly used for staging are based on the amount of tumor remaining after surgery to remove the tumor and/or the grade and size of the tumor and whether it has spread to the lymph nodes or other parts of the body. It is important to know
the stage in order to plan treatment.
The following tests and procedures may be used in the staging process:
- Sentinel lymph node biopsy may be used to stage childhood soft tissue sarcoma. This is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
The results of the sentinel lymph node biopsy and CT scan are viewed together with the results of
the diagnostic tests and initial surgery to determine the stage of the soft tissue sarcoma.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
One method used to stage childhood soft tissue sarcoma is based on how much cancer remains after surgery to remove the tumor and whether the cancer has spread:
Nonmetastatic childhood soft tissue sarcoma
In nonmetastatic childhood soft tissue sarcoma, the cancer has been partly or completely removed by surgery and has not spread to other parts of the body.
- Group I: The tumor has been completely removed by surgery.
- Group II: After surgery to remove the tumor, there are remaining cancer cells that can be seen only with a microscope.
- Group III: After surgery, there is tumor remaining that can be seen with the eye.
Metastatic childhood soft tissue sarcoma
- Group IV: The cancer has spread from where it started to other parts of the body (metastasis).
Another method used to stage childhood soft tissue sarcoma is based on the size of the tumor and whether cancer has spread to lymph nodes or other parts of the body.
This staging system is based on the following:
- The size of the tumor.
- Whether the tumor has spread to the lymph nodes.
- Whether the tumor has spread to other parts of the body.
Sometimes the stages used for adult soft tissue sarcoma are used for childhood soft tissue sarcoma:
Stage I
In stage I, the tumor is any size, low-grade (likely to grow and spread slowly), and may be either superficial (close to the skin's surface) or deep.
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| Pea, peanut, walnut, and lime show tumor sizes. |
Stage II
In stage II, the tumor is high-grade (likely to grow and spread quickly) and either:
Stage III
In stage III, the tumor is high-grade, larger than 5 centimeters, and deep.
Stage IV
In stage IV, the tumor is any size, any grade, and has spread to nearby lymph nodes and/or to other parts of the body.
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