Synovial sarcoma grows relatively slowly, which is one of the reasons why symptoms may not be noticed right away.
What is synovial sarcoma?
Synovial sarcoma is a rare type of cancer that develops in the soft tissue around the joints in the hip, knee, ankle, or shoulder. It affects 1% of the total population and can be seen in all ages, although it most often affects men under age 40.
Small tumors, about 5 cm, have a favorable prognosis, but larger tumors are more likely to metastasize (spread to distant sites in the body) and recur.
If synovial sarcoma does metastasize, it typically affects the lungs, although it can also spread to the brain, bone, lymph nodes, and other organs.
There are two types of synovial sarcoma based on the type of cells it contains:
- Monophasic: Consists of spindle cells
- Biphasic: Consists of both spindle and epithelial cells
There is no distinction between the categories in terms of aggressiveness or treatment.
What are the symptoms of synovial sarcoma?
Symptoms of synovial sarcoma develop over time. Tumors often develop unnoticed for up to 2 years and cause symptoms that are misdiagnosed.
Typical symptoms include
- Lump on the hip, knee, ankle, or shoulder
- Pain in the hip, knee, ankle, or shoulder
- Appearance of swelling in the hip, knee, ankle, or shoulder
How is synovial sarcoma diagnosed?
Your doctor will take your complete medical history and perform a physical examination to diagnose synovial sarcoma. Tests may also be ordered to confirm the diagnosis and determine the extent of the disease:
- Radiological tests: X-ray, computer tomography, magnetic resonance imaging, and ultrasound of the abdomen to detect lumps.
- Biopsy: Sample of tissue is collected from the tumor and studied under a microscope to assess the characteristics of the lump.
What are the 4 stages of synovial sarcoma?
- Stage I: Irrespective of the size, the tumor is localized to the area and has not metastasized to nearby lymph nodes or distant areas.
- Ia: Tumor is 5 cm or smaller
- Ib: Tumor is larger than 5 cm
- Stage II: Tumor is 5 cm or smaller. Cancer has not been spread to adjacent lymph nodes or distant tissues.
- Stage III
- IIIa: Tumor is larger than 5 cm but smaller than 10 cm. No metastasis to the adjacent lymph nodes or distant tissues.
- IIIb: Tumor may be of any size and has spread to surrounding lymph nodes but not distant locations.
- Stage IV: Tumor may be of any size or grade. It may or may not have spread to lymph nodes, but it has spread to other sites such as the lungs.
What are treatment options for synovial sarcoma?
Treatment for synovial sarcoma depends on the stage of the cancer as well as your age and overall health.
- Surgery: Surgical removal of the tumor is the preferred treatment for synovial sarcoma. Once the tumor has been removed, some normal surrounding tissue is removed to maximize the chances of removing all cancerous cells. Surgery may be combined with radiation and chemotherapy to reduce the risk of recurrence and metastasis.
- Chemotherapy: Chemotherapy uses powerful drugs to kill cancer cells or prevent them from multiplying and producing additional cancer cells. Chemotherapy medication can be injected into the bloodstream or administered orally. Combination therapy employs more than one form of chemotherapy at the same time. Chemotherapy can also be administered before surgery to shrink the tumor or after surgery to eradicate any cancer cells that may have been left behind. It may be used alone to treat synovial sarcoma that has spread or is difficult to reach with surgery.
- Radiotherapy: Radiation therapy uses high-energy X-rays or other types of radiation to destroy or stop cancer cells from developing. This treatment can be performed before surgery to reduce the tumor or after surgery to eradicate any cancer cells that may have been left behind.
- Immunotherapy: Drugs that stimulate immune cells are administered to increase the development of healthy immune cells that can fight cancerous cells.
- Targeted therapy: Targeted therapy drugs limit the growth of cancer cells by targeting certain unique properties of cancer cells.
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What is the prognosis of synovial sarcoma?
Over the last few decades, advances in surgery, chemotherapy, and radiation have improved the prognosis of synovial sarcoma. Outcomes vary depending on the following factors:
- Age at time of diagnosis
- Size of the tumor
- Grade of the tumor (appearance of tumor cells under the microscope)
- Whether the tumor is accessible and easily removable through surgery
- Spread of the tumor
Generally, the 5-year survival rate for synovial sarcoma ranges from 36%-76%. Survival rates decrease in more advanced stages of the cancer.
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Memorial Sloan Kettering Cancer Center. Synovial Sarcoma. https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/types/synovial-sarcoma
National Institutes of Health. Synovial Sarcoma. https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-soft-tissue-tumors/synovial-sarcoma
American Cancer Society. Soft Tissue Sarcoma Stages. https://www.cancer.org/cancer/soft-tissue-sarcoma/detection-diagnosis-staging/staging.html
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