Synovial sarcomacancer arising from bones and/or soft tissue, also known as malignantcancerous, may grow and spread to other areas of the body synovioma, is a rare type of sarcoma that develops in the soft tissuetissue/the material that joins, holds up or surrounds inside body parts such as fat, muscle, ligaments and lining around joints surrounding joints in the body. It is named for its resemblance to synovial tissuea group of cells that work together to perform a function, which is generally found around tendonsa type of connective tissue that connects muscle to bone and helps to keep joints lubricated. Despite its name, synovial sarcomas do not develop from synovial tissue.
In most cases, synovial sarcomas are found next to large joints in the body, such as the knees. They are also commonly found in the head, neck, arms, and legs. In rare cases, they may develop from soft tissue in the abdomenstomach, stomach area, belly, lung, bladdera hollow, muscular sac in the pelvis that stores urine, and vagina.
Synovial sarcomas are more common in males, and tend to be diagnosed in teenagers and young adults. However, anyone can develop this disease.
Types of Synovial Sarcoma
There are four primary types of synovial sarcoma, which are classified by their cellular appearance under the microscope.
Biphasic Synovial Sarcoma
Biphasic synovial sarcoma is a less common subtype of synovial sarcomas that have two types of cellsthe basic structural and functional unit of all living things in the tumoura tissue mass that forms from groups of unhealthy cells called spindle cells and epithelial cells. These tumours are often aggressive, likely to metastasise, and can have a good prognosisto predict how a disease/condition may progress and what the outcome might be when found early.
Monophasic Fibrous Synovial Sarcoma
Monophasic fibrous synovial sarcomas are the most common type of synovial sarcomas that contains only spindle cells within the tumour. These tumours are often aggressive, likely to metastasise, and can have a good prognosis when found early.
Monophasic Epithelial Synovial Sarcoma
Monophasic epithelial synovial sarcoma is a very rare subtype of synovial sarcoma that contains only epithelial cells within the tumour. This type of tumour is often misdiagnosed for adenocarcinomas, which are cancers arising from mucus-producing glands in organs. There is limited information on the aggressiveness and prognosis of this subtype.
Poorly Differentiated Synovial Sarcoma
Poorly differentiated synovial sarcomas are a less common type of synovial sarcoma with varying cellular components. These tumours are often aggressive, likely to metastasise, and can have a good prognosis when found early.
Treatment
If a synovial sarcoma is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for synovial sarcomas may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence to remove as much of the tumour as possible.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
Because of how rare synovial sarcomas are, there has been limited research done into the riskthe possibility that something bad will happen factors of this disease.
Symptoms
Synovial sarcomas may appear asymptomatic in the early stages of disease. As the tumour progresses, the following symptoms may appear:
- A massa growth of cells that come together to make a lump, may or may not be cancer that may be painful or painless.
- Bleeding from the nose, vagina, rectumthe last section of the large intestine/bowel that holds waste until it is ready to be removed from the body, or throat (if the tumour is in the area).
- Tingling, numbness, and/or pain in affected area if the tumour is compressing a nerve.
- Proptosisbulging or protrusion of one or both of the eyes out of the eye sockets, also known as exophthalmos (if tumour is behind eye).
- Drooping of the eyelid (if tumour is behind the eye).
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have a synovial sarcoma, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- X-raya type of medical imaging that uses x-ray beams to create detailed images of the body .
- Bone scana type of medical imaging that uses a radioactive tracer to detect bone conditions or abnormalities.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
