Synovial sarcoma is a rare type of cancer, found in less than 1% of soft tissue sarcomas, that develops in the soft tissues near joints.
Synovial sarcoma is a rare type of cancer that arises from cells in the soft tissues of the body, most commonly in the arms, legs, or feet near joints, though it can occur in other locations as well. Synovial refers to the lining of a joint. While it's named "synovial," this sarcoma actually originates from cells resembling those found in joints and tendons, but not directly from synovial cells themselves.
It's a type of sarcoma. Sarcoma cancers form in connective tissues like muscles, tendons, fat, nerves, and blood vessels. While synovial cancer can affect people of any age, it's most often diagnosed in young adults and adolescents. It's a very uncommon cancer, accounting for less than 1% of all soft tissue sarcomas. It tends to grow aggressively and can spread (metastasize) to other parts of the body, most commonly the lungs.
AHN Sarcoma Center of Excellence
The AHN Sarcoma Center of Excellence is made up of a team of multiple health care experts walking you through every step of your cancer diagnosis and treatment. At AHN, we see you and your unique needs, and we offer options that are tailored to you.
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At AHN, we strive to make your treatment course as painless as possible. We can take care of appointment scheduling, imaging planning, and other aspects of care coordination for our patients so you have time to focus on healing and recovery.
Synovial sarcoma symptoms and signs
Common symptoms include a painless lump or swelling, pain or discomfort, and limited range of motion if it's near a joint. Synovial sarcoma often develops subtly, and its symptoms can be mistaken for other, more common conditions. This often leads to delays in diagnosis.
Common signs and symptoms associated with synovial sarcoma:
- Noticeable lump: It is often slow growing and typically develops gradually over months or even years. It’s commonly found around the knee, wrist, ankle, shoulder, or hip, though it can occur near any joint. It can be small and pea-sized or grow quite large. The shape can be round, irregular, or even feel like a deep, ill-defined mass.
- Pain: Pain often starts gradually and worsens over time. It may initially be worse with activity or movement of the nearby joint but can become constant as the tumor grows. Pain that's more pronounced at night is a common concern.
- Swelling: You'll usually notice swelling around the tumor site, which can be persistent.
- Limited range of motion: As the tumor enlarges, it can interfere with the movement of the nearby joint, making it difficult to bend, straighten, or rotate it fully.
- Other potential symptoms: While less common, you might also experience:
- Numbness or tingling: If the tumor compresses nearby nerves.
- Weakness: In the affected limb or area.
- Visible veins: Enlarged or more visible veins around the tumor site.
Causes and risk factors
Unfortunately, there isn’t a well-established cause for developing synovial sarcoma. Research shows that synovial sarcoma occurs when genetic changes or abnormalities occur in the body. This is called genetic translocation, meaning a piece of a DNA chromosome breaks off and attaches to another chromosome. Synovial sarcoma can occur in people of any age, race, or gender. It does seem to occur more often in adolescents and young adults.
Synovial sarcoma screening and diagnosis
There are no established screening tests for synovial sarcoma. It often presents with nonspecific symptoms, leading to delayed diagnosis.
If you are experiencing any unusual or persistent symptoms, it's essential to consult a health care professional for proper evaluation.
Medical history and physical exam
Your doctor will ask about your symptoms, medical history, and family history of cancer. They will also examine you physically, focusing on the area of concern.
Imaging tests
These tests help visualize the tumor and its characteristics. Common imaging tests include:
- X-ray: Provides initial information about bone involvement.
- Ultrasound: Useful for evaluating soft tissue masses and their relationship to surrounding structures.
- MRI: Provides detailed images of the tumor, helping determine its size, location, and extent of spread.
- CT scan: May be used to assess for tumor metastasis (spread) to the lungs or other organs.
- PET scan: Helps identify active tumor cells and assess for distant metastasis.
Biopsy
This is the most crucial step in diagnosing synovial sarcoma. It involves taking a small sample of the tumor tissue and examining it under a microscope. The biopsy sample is analyzed by a pathologist, who looks for specific features characteristic of synovial sarcoma.
Biopsy methods include:
- Fine-needle aspiration (FNA): Using a thin needle to collect cells from the tumor.
- Core needle biopsy: Using a larger needle to obtain a core of tissue.
- Surgical biopsy (open biopsy): Surgically removing a portion or all of the tumor.
Genetic testing of the tumor tissue is also important to confirm the diagnosis and identify specific genetic changes that can guide treatment decisions.
Types and stages of synovial sarcoma
Synovial sarcoma is a rare type of cancer that arises in cells around joints and tendons, though it rarely originates within the joint itself. There are several recognized subtypes and a staging system to classify the disease.
Types of synovial sarcoma include:
- Biphasic: This type shows both spindle cells (long, narrow cells) and epithelial-like cells under a microscope.
- Monophasic spindle cell: Consists mainly of spindle cells. It's the most common subtype and can be harder to diagnose.
- Monophasic epithelial: Primarily made up of epithelial-like cells. This subtype is very rare.
- Poorly differentiated: Lacks the clear features of the other subtypes, making it difficult to classify.
Staging helps determine how far the cancer has spread. Synovial sarcoma often uses a staging system like this (though your doctor will give you the most specific information for your diagnosis):
- Stage 1: The tumor is localized and usually smaller than 5 centimeters.
- Stage 2: The tumor is still localized but larger than 5 centimeters.
- Stage 3: The tumor may be any size and has spread to nearby lymph nodes.
- Stage 4: The cancer has metastasized (spread) to distant parts of the body, such as the lungs, bones, or liver.
Synovial sarcoma treatment
Synovial sarcoma is a rare type of cancer that can be challenging to treat. Treatment plans are individualized and depend on several factors, including the stage of the cancer (size, location, and spread), the patient's overall health, and their preferences. Here's a general overview:
Surgery
The primary treatment for localized synovial sarcoma is surgery to remove the tumor and a margin of surrounding healthy tissue. If the tumor is in a limb, limb-sparing surgery is often preferred over amputation whenever possible.
Main surgical approaches for synovial sarcoma include:
- Wide local excision: This approach approach involves removing the tumor along with a margin of healthy tissue (the "wide" margin) to ensure all cancerous cells are removed. This method is often used for smaller tumors that haven't spread.
- Limb-sparing surgery (limb salvage): Whenever possible, surgeons prefer limb-sparing techniques to remove the tumor while preserving the affected limb's function. This approach may involve complex reconstructions using grafts, flaps, or prosthetics.
- Amputation: In cases of very large tumors, tumors in locations that make limb salvage impossible, or when the tumor can't be removed with a clear margin, amputation of the affected limb may be necessary. However, this is generally a last resort.
- Lymph node dissection: If the cancer has spread to nearby lymph nodes (usually determined through imaging or biopsy), the surgeon removes those lymph nodes. This helps assess the extent of the spread and can improve long-term outcomes.
Radiation therapy
This uses high-energy rays to kill cancer cells. It may be given before surgery to shrink the tumor (neoadjuvant), after surgery to destroy any remaining cancer cells (adjuvant), or alone if surgery is not an option. Radiation therapy plays a significant role in the management of synovial sarcoma, often used in conjunction with surgery and sometimes chemotherapy.
External beam radiation therapy (EBRT)
This is often the most common type of treatment used. Radiation beams are targeted at the tumor from outside the body. Before EBRT begins, you undergo a simulation process. This involves precise imaging (usually CT scans) and potentially the creation of customized immobilization devices to ensure you're in the exact same position for each treatment session.
Radiation oncologists use specialized software to meticulously plan the radiation beams' angles, intensities, and doses. This ensures the tumor receives the optimal radiation dose while minimizing exposure to surrounding healthy tissues. Your radiation oncologist can discuss the potential benefits and risks of EBRT, tailoring the treatment plan to your specific situation and goals. It's essential to communicate openly about any side effects you experience so they can be managed effectively.
EBRT for synovial cancer includes:
- Adjuvant EBRT (post-surgery): After surgical removal of the tumor, adjuvant EBRT targets any remaining microscopic cancer cells, aiming to reduce the risk of local recurrence.
- Neoadjuvant EBRT (pre-surgery): EBRT is sometimes given before surgery to shrink the tumor, making surgical removal easier or enabling a less extensive operation.
- Palliative EBRT: In cases where the synovial sarcoma is advanced or metastatic (spread to distant sites), palliative EBRT may be used to relieve symptoms like pain or pressure caused by the tumor.
EBRT is typically delivered in multiple small doses called fractions, usually over several weeks. This fractionation approach allows healthy cells time to repair between treatments, minimizing side effects.
While EBRT is designed to target cancer cells, some healthy cells in the treatment area can be affected. Side effects vary but may include:
- Skin reactions: Redness, dryness, itching, or peeling in the treated area, similar to a sunburn.
- Fatigue: Feeling tired and lacking energy, which can be temporary or persist for weeks to months after treatment.
- Appetite changes: Loss of appetite or changes in taste.
- Localized swelling: Swelling in the area being treated.
Brachytherapy
Brachytherapy, while less common than external beam radiation therapy (EBRT) for synovial sarcoma, can be a valuable treatment option in certain cases. It involves placing radioactive sources directly inside or near the tumor bed, delivering a high radiation dose to a very localized area. Brachytherapy might be considered for primary synovial sarcomas that are small, well-defined, and in a location where radioactive sources can be safely and effectively placed. It can be particularly beneficial for treating local recurrences after initial surgery and/or EBRT, especially in previously irradiated areas where delivering additional external radiation might be challenging.
Brachytherapy isn't suitable for all synovial sarcomas. The tumor's size, location, and accessibility for source placement are crucial factors.
Brachytherapy allows for a high radiation dose to be delivered directly to the tumor while sparing surrounding healthy tissues. This increases the chances of local tumor control. Compared to traditional EBRT, which is typically delivered over several weeks, brachytherapy often involves a shorter treatment course.
Brachytherapy usually requires a surgical procedure to implant the radioactive sources, which adds complexity. While generally well-tolerated, brachytherapy can cause side effects similar to those of EBRT, such as localized pain or discomfort, swelling, and fatigue.
Chemotherapy
This involves using drugs to kill cancer cells. It might be used:
- Before surgery to shrink the tumor.
- After surgery to reduce the risk of recurrence.
- To treat synovial sarcoma that has spread to other parts of the body (metastatic).
Targeted therapy
These drugs are designed to target specific molecules involved in the growth and spread of cancer cells. Research is ongoing to determine the effectiveness of targeted therapies in synovial sarcoma. Targeted therapies can cause side effects, though they often differ from those of traditional chemotherapy. This is a rapidly evolving field, so staying informed about the latest research and clinical trials is essential.
Synovial sarcoma FAQs
Synovial sarcoma is a rare cancer that can be hard to spot. Knowing some frequently asked questions and what to look for can help identify changes to the body that may be caused by synovial sarcoma.
What are the warning signs of synovial sarcoma?
Synovial sarcoma can be tricky to detect early, as symptoms can be vague or similar to other conditions. However, here are some warning signs to be aware of:
- A lump or swelling: This is often the most common sign. It's usually located near a joint, but can occur anywhere in the body.
- Pain: The lump may or may not be painful. Pain can also develop later as the tumor grows and presses on nerves or other tissues.
- Limited range of motion: If the tumor is near a joint, it can restrict movement and make it difficult to use the affected limb.
- Numbness or tingling: If the tumor presses on a nerve, it can cause numbness, tingling, or weakness in the affected area.
- Change in size of a lump: Any lump that grows or changes in size should be checked by a doctor.
What are the first synovial sarcoma symptoms?
The first symptoms of synovial sarcoma are often subtle and can be easily dismissed. Often, the most common initial symptoms include:
- A painless lump: This is often the first sign that people notice. The lump may be small and deep, making it difficult to feel at first.
- Vague aches or pains: Some people may experience vague aches or pains in the affected area before a lump is even noticeable.
- Tenderness: The area around the tumor might be tender to the touch.
What is the life expectancy with synovial sarcoma?
Life expectancy for synovial sarcoma varies depending on several factors. The stage of the cancer, tumor size and location, the patient’s age, and how they respond to treatment all impact the life expectancy of someone with synovial sarcoma.
What does a synovial sarcoma lump look like?
A lump is often found near a joint such as the knee, ankle, or elbow, but can be found anywhere in the body. The lump may feel firm or rubbery and can sometimes cause visible swelling or discoloration of the skin. It is crucial to see your doctor if you notice any new or unusual lumps, pain, or other concerning symptoms.
Contact us
To make an appointment you can:
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Please bring all relevant imaging on CD or through PowerShare with correlating reports for review by our team to your initial appointment.