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Patient Education

Leiomyosarcoma Staging

A practical overview of how leiomyosarcoma is staged, how grading works, and how staging informs treatment planning and follow‑up care.

Start with Staging BasicsView Treatment Table

Testing Your Tumor for Cancer-Related Genes

Molecular/genomic testing for sarcoma-related genes may not be for everyone, but by staying informed and continuing to ask important questions about such testing availability allows you to self-advocate. Make sure that every avenue for testing your tumor tissue is explored — potentially making a difference in the cutting-edge treatment options and targeted therapies/immunotherapies that might be available to you.

The Role of Genetic Test in Soft Tissue Sarcoma

The Role of Genetic Test in Soft Tissue Sarcoma

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Historical information on genomic testing for sarcomas: PubMed article

How is Leiomyosarcoma Staged?

The process of finding out how far leiomyosarcoma has spread is called staging. In sarcoma staging, doctors also evaluate the appearance of the tumor under the microscope and judge how fast the cancer seems to be growing. The stage of a sarcoma is the most significant factor in determining each patient’s prognosis and in selecting treatment options.

The information needed to stage sarcomas includes biopsies and imaging tests of the main tumor (usually with CT or MRI scans) and other parts of the body where the cancer may have spread. When examining the biopsy sample, the pathologist determines the cell type and grade and estimates how rapidly it will grow and spread.

T = Tumor sizeN = Lymph node spreadM = MetastasisG = Grade (FNCLCC)

Grade (G) and the FNCLCC System

In soft tissue sarcomas, grade is part of the tumor’s stage. Under the French (FNCLCC) system, grade is based on three factors:

  • Differentiation: how closely cells resemble normal cells (score 1–3)
  • Mitotic count: how many cells are actively dividing (score 1–3)
  • Tumor necrosis: how much of the tumor is dying tissue (score 0–2)

The scores are added to determine the grade. Higher-grade cancers tend to grow and spread faster than lower-grade cancers.

Staging the Tumor Once It Is Found

From the NCCN Guidelines for Patients (2020): Sarcoma Patient Guidelines (PDF)

Stage
Primary Treatment Options
Follow Up Care
Stage 1 (1A/1B)
Low-grade tumor surgery. Recommendations for more treatment depend on margins and fascia involvement.
Rehabilitation if needed. Imaging (CT/CT‑PET), lung surveillance, genetic test of tumor, regular imaging of primary site, blood work.
Stage 2 (Grade 2–3)
Surgery; surgery following radiation; radiation followed by surgery. Treatment depends on location, size, and overall health.
Regular imaging every 3–6 months for 2–3 years; every 6 months for 2 years; then annually.
Stage 3 (III A/B)
Surgery followed by radiation/adjuvant chemo; chemo or radiation before surgery, then radiation boost ± chemo.
Same as Stage 2 follow-up.
Stage 4 (Confined)
Treatment as in Stages 2–3. Surgery to remove metastases ± chemo or radiation, SBRT, ablation, embolization, or observation.
Imaging cycles as in Stages 2–3; regular imaging of primary site.
Stage 4 (Widespread)
Chemotherapy, radiation therapy/SBRT, surgery, or observation if no symptoms.
Same follow-up as Stage 4 confined.

Recurrence

Location
Treatment Options
Local
Testing; treatment based on stage; more treatment as listed above.
Isolated
Regional disease or lymph nodes, regional node dissection with or without radiation, with or without chemotherapy, SBRT, isolated limb infusion/perfusion plus surgery.
Widespread
Palliative chemotherapy, palliative radiation therapy, SBRT, ablation, embolization, or observation if no symptoms.

Treatment Planning & Quality of Life

Treatment planning is important in the first steps of care. All such planning is always case-specific — it is not a “one size fits all” situation. Being proactive in your care is important, which means knowing as much as you can and asking the right questions along the way.

For quality of life maintenance/rebuilding: discuss integrative medicine and survivorship care planning with your oncologist. Sarcoma centers may have supportive resources available in survivorship clinics for patients and families.