Sarcoma – Types & Stages

CyberKnife Treatment in Orange County, CA

Battling cancer is one of the most challenging and difficult processes that one can go through in life – but at Orange County CyberKnife, we’re here to help you succeed and thrive, during and after your cancer treatment. As a leading cancer treatment center serving the Orange County area, we’re proud to offer world-class cancer treatments to our patients, and we strive to prioritize nonsurgical, noninvasive treatments like CyberKnife. We proudly treat a wide variety of cancerous conditions, including all forms and stages of sarcoma.

Types of Sarcoma

Sarcoma is a term that refers to any malignant tumor in the connective tissues of the body, and as such, there are a wide variety of specific tumor types within the umbrella of sarcoma. However, anytime the term sarcoma is in the name of the condition, it’s always a malignant (cancerous) tumor. Soft tissue tumors like sarcoma behave differently than many malignant tumors, acting something like a mix of a cancerous and noncancerous tumor. For this reason, these tumors are called intermediate.

There are more than 50 different types of soft tissue sarcomas, and your doctor will use a variety of diagnostic tests to determine your specific condition. A few of the most common forms of sarcoma include:

  • Adult fibrosarcoma
  • Alveolar soft­part sarcoma
  • Angiosarcoma (includes hemangiosarcoma and lympangiosarcoma)
  • Clear cell sarcoma
  • Desmoplastic small round cell tumor
  • Epithelioid sarcoma
  • Fibromyxoid sarcoma, low­grade
  • Gastrointestinal stromal tumor (GIST) – A type of sarcoma that develops in the digestive tract
  • Kaposi sarcoma – A type of sarcoma that develops from the cells lining lymph or blood vessels
  • Liposarcoma (includes dedifferentiated, myxoid, and pleomorphic liposarcomas)
  • Leiomyosarcoma
  • Malignant mesenchymoma
  • Malignant peripheral nerve sheath tumors (includes neurofibrosarcomas, neurogenic sarcomas, and malignant schwannomas)
  • Myxofibrosarcoma, low­grade
  • Rhabdomyosarcoma – this is the most common type of soft tissue sarcoma seen in children
  • Synovial sarcoma
  • Undifferentiated pleomorphic sarcoma (previously known as malignant fibrous histiocytoma or MFH)

There are many other types of tumors called soft tissue sarcomas, but these are all quite rare. Your doctor will talk with you about your specific form of cancer and what your treatment options look like.

In addition to the list above, there are a number of other common intermediate soft­ tissue tumors, including:

  • Dermatofibrosarcoma protuberans
  • Fibromatosis (also known as desmoid tumor, musculoaponeurotic fibromatosis, and aggressive fibromatosis)
  • Hemangioendothelioma
  • Infantile fibrosarcoma
  • Solitary fibrous tumor

Grades of Sarcoma

For sarcomas, doctors use both a grading and staging system to assess the cancer. The grade of the sarcoma denotes how likely the cancer is to spread. Sarcomas are graded based on three key factors:

  • Differentiation: Differentiation refers to how normal or abnormal the cancerous cells look under a microscope as compared to healthy cells. Tumors are given a score of 1 to 3, with 1 looking similar to healthy cells and 3 meaning the cancerous cells look very abnormal. Certain aggressive forms of sarcoma are given a higher score automatically.
  • Mitotic Count: This denotes how many cancer cells are engaging in mitosis, or division. The tumor is again scored from 1 to 3, with 1 denoting a cancer with few cells seen dividing and 3 denoting a cancer where many or all cells are seen dividing.
  • Tumor Necrosis: This refers to the portion of the tumor that’s made of dead or dying tissue, scored from 0 to 2. The lower the score, the less dying tissue is present in the tumor.

Your cancer doctor will add up factor to determine the overall grade of your tumor. Generally, high grade tumors grow and spread faster than low grade tumors – but in any case, it’s vital to begin treatment as quickly as possible. Sarcoma grades are as follows:

  • GX: We cannot assess the grade right now because we don’t have complete information.
  • Grade 1 (G1): Total score of 2 or 3
  • Grade 2 (G2): Total score of 4 or 5
  • Grade 3 (G3): Total score of 6 or higher

Stages of Sarcoma

Similar to many other forms of cancer, sarcoma is classified on a staging scale that that classifies the seriousness of the cancer. Sarcoma is staged on a TNM system, where T stands for the size of the tumor, N stands for whether or not the tumor has infected nearby (regional) lymph nodes, and M denotes whether or not the tumor has metastasized (spread) to distant regions of the body.

Tumor (T)

T stands for the size of the tumor. Sarcoma is graded based on the following sizes:

  • T1: The tumor is less than 5cm across.
    • T1a: This refers to T1 tumors that are near the surface of the body (superficial).
    • T1b: This refers to T1 tumors that are deep in a limb or in the abdomen.
  • T2: The tumor is more than 5cm across.
    • T2a: Again, this refers to superficial (near the surface of the body) T2 tumors.
    • T2b: This refers to T2 tumors located deeper within the body.

Lymph Nodes (N)

N stands for node, which explains if the cancer has spread to nearby lymph nodes. This is classified as follows:

  • N0: The tumor has not spread to nearby lymph nodes.
  • N1: The tumor has spread to nearby lymph nodes.

Metastasis (M)

Metastasis denotes whether or not the tumor has spread to distant organs, lymph nodes, or parts of the body. Metastasis is classified as follows:

  • M0: The sarcoma has not spread to distant regions.
  • M1: The tumor has spread to distant tissues or organs like the lungs.

Staging Soft Tissue Sarcomas

When all of the above information is collected, your doctor will assign the sarcoma a stage: a holistic classification to determine the size, extent, and seriousness of the cancer. The stage is labeled by Roman numerals I to IV followed by the letter A or B, and it represents a holistic evaluation of the tumor’s grade, the size of the tumor, the status of lymph nodes, and its metastasis. Stages of sarcoma run as follows:


  • Stage IA


      • T1, N0, M0, G1 or GX: This refers to tumors less than 5 cm across that have yet spread to lymph nodes or other areas of the body and have a grade of 1 or an undetermined grade.


  • Stage 1B


      • T2, N0, M0, G1 or GX: This also refers to tumors with grade 1 or an unclassified grade that have not spread to lymph nodes or distant sites, but where the tumor itself is greater than 5 cm across.


  • Stage IIA


      • T1, N0, M0, G2 or G3: These tumors are less than 5 cm across and have not spread to lymph nodes or distant sites, but have a grade of 2 or 3.


  • Stage IIB


      • T2, N0, M0, G2: These tumors are greater than 5 cm across, grade 2, and have not spread to lymph nodes or distant sites.
    • Stage III – may be either of the following:
      • T1, N0, M0, G3: Grade 3 tumors larger than 5 cm across that have not spread to lymph nodes or distant sites, OR
      • Any T, N1, M0, any G: Tumors of any size or grade that have spread to lymph nodes but not to distant sites.


  • Stage IV


    • Any T, Any N, M1, Any G: Stage IV refers to any sarcoma that has metastasized to distant sites – it may be any size or grade, and while it may or may not have spread to nearby lymph nodes, it likely has if it has already metastasized to a distant area.

Schedule a Consultation with Your Orange County Cancer Treatment Center

Sarcoma or any cancerous condition is dangerous at any stage, and no matter what your diagnosis, it’s important to get treatment as quickly as possible. As Orange County’s leading cancer treatment and CyberKnife provider, OC CyberKnife is proud to treat sarcomas at any stage – and if you or a loved one are battling sarcoma, we’re here to help. Contact us today to schedule a consultation or get a second opinion on your cancer treatment. We’ll work with you to design a convenient treatment, beat your cancer, and help get you back to your normal routine.