9 synovial sarcoma questions, answered

Synovial sarcoma is one of the rarest types of cancer. This type of soft tissue sarcoma can arise almost anywhere in the body, including the joints. Synovial sarcoma most commonly occurs in the extremities, particularly in the thighs, knees, feet and forearms. However, it also can occur in the head, neck and trunk.

We spoke with Dejka M. Araujo, M.D., and sarcoma research intern Michelle G. Yeagley to learn more about diagnosis, treatment options and the latest research on synovial sarcoma. 

What are common synovial sarcoma symptoms? At what point should someone see a doctor?

Most synovial sarcoma patients discover their tumor from a lump, and for some, related pain. It’s important to see a doctor if you find a lump or have persistent, unprovoked pain in a soft tissue, such as the muscle of an extremity or from within your abdomen. Synovial sarcoma may also occur in the lungs, so see your doctor if you notice shortness of breath.

Tell us about the types of synovial sarcoma and the differences between them.

There are two major types: monophasic, which is made up of only spindle cells, and biphasic, which is made up of both spindle cells and epithelial cells. There isn’t a difference in aggression or treatment between the types.

Are certain patients more likely to develop synovial sarcoma than others?

We don’t see a clear pattern, but synovial sarcoma can occur at any age, with a tendency to occur in young adults. We also see it in men slightly more often than women.

How is synovial sarcoma typically diagnosed?

Synovial sarcoma can be found in the soft tissues by an MRI, or in the lungs with an X-ray or CT scan. However, an official diagnosis can only be made by a pathologist after obtaining tissue samples through biopsy or surgery.

What can patients do to prepare for an initial doctor’s visit regarding synovial sarcoma?

Do your research. If possible, see a doctor who specializes in sarcoma and works at a cancer center that has surgeons, radiation oncologists and pathologists who also specialize in sarcoma. The first surgery to remove a synovial sarcoma tumor may determine a patient’s prognosis. If the diagnosis was made after the tumor was removed, make sure the doctors got all the cancer out. If you’re still not confident, get a second opinion.

How is synovial sarcoma typically treated?

At present, surgery is the most effective treatment, but radiation and chemotherapy may extend the time before recurrence and metastasis when used in conjunction with surgery.  

Is there a risk for metastasis and if so, where?

Yes, synovial sarcoma often does spread to other parts of the body. The lungs are the most common, and usually the first, site of metastasis for synovial sarcoma. Metastasis to the brain, bone, lymph nodes and local organs are all possibilities.

Can you tell us about new synovial sarcoma clinical trials?

MD Anderson has two clinical trials that synovial sarcoma patients may be eligible for. The first is for HLA-A2+ patients with unresectable, metastatic and recurrent synovial sarcoma expressing NY-ESO-1. Eligible patients are treated with chemotherapy and given T cells genetically engineered to recognize NY-ESO-1. The hope is that these T cells will kill the cancer cells.

Another study, which is open to patients with various types of sarcoma, is trying to determine if we can successfully treat sarcoma by combining checkpoint inhibitors MEDI4736 and tremelimumab.

Is there anything else you want patients to know about synovial sarcoma?

Synovial sarcoma can be inactive for a long time before it grows again to a size that can be detected by a scan. So make sure you continue to get your regular scans and follow-ups with your doctor, even if you’ve had no evidence of disease for many years. That way, if your cancer does return, we can find it as early as possible, when it’s more treatable.