SYNOVIAL SARCOMAS

Synovial sarcomas are a rare form of soft tissue cancer that often develop in the tendons surrounding arm and leg joints. While predominantly teenagers and young adults are afflicted with this type of cancer, it can also manifest itself in adults as well. The cancerous cells initially cluster in a small growth and then rapidly increase in size. These cells can then spread to other areas of the body if left untreated. As this cancer only occurs in approximately one-percent of the population each year, its diagnosis remains a challenge for many family physicians. However, early detection of the disease and aggressive and sometimes experimental treatment of the tumors can increase patient’s survival rates and lessen the chances of limb amputation.   

Diagnosing sarcomas

The difficulty many family and orthopedic physicians face in diagnosing synovial sarcomas is that the symptoms of the disease may be non-existent or mimic other ailments.  If the tumor is in the arm or leg, the patient may experience stiffness in his or her joints or limited movement that is similar to a muscle strain or tendinitis. If the growth manifests itself in someone’s head or neck, the person’s breathing or swallowing may be hindered or his voice altered. Even when the tumor is detected by a physician, if the patient is pain free, the mass may be considered harmless. Additionally, if the mass is deep-seated, it may not be visible except on an x-ray or magnetic image, and therefore, may go undetected. Either scenario means that the tumor could be left untreated, possibly allowing the cancer cells to spread to other parts of the body resulting in a terminal illness versus a treatable condition. This is why proactive, rather than reactive care and treatment is critical.

To determine if a tumor is cancerous, a physician should often consider ordering a CT scan or MRI, depending on the location of the tumor. Once the images have been evaluated by a qualified radiologist, biopsies of all tumors will often be performed and assessed by a pathologist to determine if they are benign or malignant. Even if the initial results come back benign, this type of cancer can rapidly grow, spread, or change in nature. Many years after the initial diagnosis, tumors can reoccur locally in the nearby lymph nodes or the cells may spread to other areas of the body. Therefore, patients should insist that these tests be repeated every six months and that they be continually evaluated by a qualified physician.

Even with a diagnosis of synovial sarcomas, due the rareness of the cancer, some medical experts do not agree on the most effective way to combat the condition. Some favor the use of radiation, surgery, or chemotherapy or a combination or all three. The most popular treatment is the removal of the entire tumor. The lack of a uniform standard of care, the difficulty of diagnosis among those who are unfamiliar with the condition, and the fact that many forms of synovial sarcomas are resistant to commonly used chemotherapy drugs, has led to a high fatality rate among those impacted by the disease.

Early detection of synovial sarcomas remains key to the effective and successful treatment of the disease. Those who suspect that they or a loved one may have this type of cancer or have a tumor that has been diagnosed as harmless, should insist on continual testing and monitoring by qualified health care professionals.  

A D’Orazio Peterson Case Study

CM originally contacted our office shortly after receiving a diagnosis of a synovial sarcoma.  CM was in his early 20’s, and was a brilliant young man.  He had originally sought treatment from an orthopedic surgeon for complaints of pain with a lump behind his knee.  The doctor diagnosed it as a cyst.

Approximately one year later CM went back to the doctor, again complaining about the lump and continued pain.  The physician ordered an ultrasound guided aspiration of the mass.  Unfortunately, however, the needle that was used for the aspiration caused too much pain, so the aspiration was not performed.  The doctor read the ultrasound report as not indicating any significant change in the mass.  In reality, the mass had more than doubled in size.

In a note following the visit the doctor referenced ordering a follow up CT.  This never happened.

Several months later CM noticed that the mass had grown significantly.  He went back, and at this point another physician diagnosed his synovial sarcoma.  At the time of the diagnosis there was hope that the condition would not spread.  CM underwent surgery which resulted in a “drop foot” and left him with a limp.

At this point CM contacted us.  While we were in the process of reviewing the case with our medical expert, CM received some bad news.  The cancer had metastasized, and there was likely no cure. 

CM lived at home with his mother.  She was his closest friend.  He wanted to make sure that she would be okay.  We took his case.

CM passed away several months later.  His mother was devastated, as you would expect.  We pursued the case against the orthopedic surgeon, alleging that he failed to properly consider whether CM’s mass could have been anything other than a benign cyst.  We took a deposition of the doctor, after which we retained one of the country’s foremost experts in synovial sarcomas to serve as an expert witness in our case.

After we took the doctor’s deposition, and notified the defense of our intention to call the foremost sarcoma expert on behalf of our case, the defense asked if we would agree to mediation.  Given the extreme psychological toll that the case would have on CM’s mother if we went to trial, we agreed.  The case was resolved for a very significant amount of money at mediation.

We had two goals in the case.  First, to fulfill CM’s wishes and make sure that his mom was taken care of.  We did this the only way we could, by obtaining a significant settlement.  Second, we wanted to be sure that the next time a patient came in to the office of this particular orthopedist, or any of his partners, with a sarcoma or similar malignant tumor, they would think twice and perform the necessary tests to rule out cancer.  We hope that we achieved this goal as well.  We believe we did. 

If you have any questions about synovial sarcoma or believe you have been misdiagnosed, contact us today.