Sarcoma Stages

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Staging is a process physicians use to find out how much cancer is in your body and if it has spread. Having this information allows your care team to choose the best treatment options to recommend to you.

Knowing the sarcoma stage also helps your care team better understand your prognosis. Your prognosis is how serious your disease is and how likely it is to spread. Sarcoma staging can be complicated, and it can be measured differently depending on your subtype.

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Stages of Soft Tissue Sarcoma

Roman numerals I (one) through IV (four) are used to describe the stage. Some stages can be subdivided even more, based on the unique features of your diagnosis. If the number is lower, it means the cancer is less advanced. If it is stage IV sarcoma, it means the cancer has spread (metastasized) to distant parts of the body, such as the lungs.

For sarcoma staging, knowing the grade of the tumor is important. The grade tells your physician how the cancer might act or how likely it is to spread. If the tumor is low grade, it means that when the cells are examined in a lab, they look a lot like normal cells and usually grow slowly. If it is high grade, it means the cells look very abnormal and are more likely to spread quickly. Medium grade means the cells are somewhere in between normal and abnormal.

Sarcoma Staging Tests

To find out the stage of your sarcoma, you will need imaging tests and a biopsy. Imaging tests give your care team a visual of your tumor, so they can see how big it is and how far it has spread. The biopsy confirms that there are cancer cells and show how abnormal the cancer cells look.

Imaging Tests for Sarcoma Staging

Sarcoma staging includes having imaging tests such as:

  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) scans
  • Positron emission tomography (PET) scans
  • Bone scans

If your sarcoma is in a bone and you are over 40 years old, your physician will recommend that you have a CT scan of your lungs and abdomen. You’ll also need a total body bone scan to see if the cancer may have started somewhere else in the body and spread to the bones.

Biopsy for Sarcoma Staging

During a biopsy for sarcoma staging, a small sample of the tumor is removed, either through a surgery or guided by an X-ray machine.

The sample is sent to a lab. In the lab, a specialized physician called a pathologist will check the size of the sarcoma, see if it has spread to nearby lymph nodes or if it has traveled to distant organs like the lungs.

Sarcoma Stages FAQs

The TNMG staging system is another way to describe how far sarcoma has spread. (This system is used for many other types of cancer, too. You may also see the similar TNM staging system.) The letters stand for:

  • Tumor (T): The size of the main tumor and any spread of cancer into nearby tissue
  • Nodes (N): The number of nearby lymph nodes where cancer has spread
  • Metastasis (M): If cancer has spread (metastasized) to other parts of the body
  • Histological grade (G): Determines how normal the sarcoma cells look

In the TNMG system, there will be a symbol after each letter to give details; for example, T1N0M0G1. In T1, the 1 indicates the size of the tumor (small). In N0, the 0 means there’s no sign of cancer in nearby lymph nodes. In M0, the 0 means cancer hasn’t spread to distant parts of the body. In G1, the tumor is slow-growing and slower to spread. If you would like to know the stage of your cancer in the TNM system, ask your Fred Hutch care team.

Common treatments by stage may include:

  • Stage I soft tissue sarcoma: Surgery, surgery with radiation therapy and high-dose radiation therapy and typical treatment options. Chemotherapy is typically not given to people with stage I soft tissue sarcoma because of the low chance of metastatic cancer.
  • Stage II and stage III soft tissue sarcoma: Surgery, surgery with radiation therapy, radiation and/or chemotherapy followed by surgery and high-dose radiation therapy are options.
  • Stage III (advanced) soft tissue sarcoma: Surgery and lymphadenectomy (lymph node dissection) and surgery with neoadjuvant or adjuvant therapy. Neoadjuvent therapy means treatment given before the primary treatment (in this case surgery). It typically can be chemotherapy. Adjuvent therapy is the opposite in that it is therapy given after the primary treatment.
  • Stage IV (metastatic) soft tissue sarcoma: Chemotherapy, targeted therapy or immunotherapy and surgery may be options.

Researchers at Fred Hutch and beyond are always looking for better ways to treat sarcoma of all stages. Clinical trials are going on to test new drugs or new combinations of drugs. You can always ask your care team if there is a clinical trial that may be an option for you.