GP Referrals and Advice
The Referral Process
Any suspected sarcoma should be sent to your local hospital on a faster cancer time pathway referral. Any child or young adult with a possible bone or soft tissue sarcoma should have an acute referral made to the local hospital, and should be seen and worked up before referral as appropriate to the two National Sarcoma Centres.
Bone Sarcoma
Bone sarcoma can present at any age. Persistent bone pain, night pain, worsening symptoms or palpable mass should be referred for an x-ray and on to the local hospital on a faster cancer time pathway.
Soft Tissue Sarcoma
Any lump greater than 5cm or deep to deep fascia or increasing in size, should be referred in to the local hospital on a faster cancer time pathway. Any concerning Ultrasound scan (USS) should also be referred to in the same fashion. Any lump in a patient with previous sarcoma or radiation therapy should also be treated as suspected sarcoma. USS can be useful if it can be accessed quickly.
Retroperitoneal Sarcoma
Any unexplained increase in abdominal girth, fullness or lump should be considered for a retroperitoneal sarcoma and be referred in on a Faster cancer pathway. Pain in the loin area and loss of appetite can also be symptoms of retroperitoneal sarcoma.
Children
Any limb or back pain in a young person which is not resolving should raise concern. Night pain, mild fever and a limp can also be symptoms of bone sarcoma. These children should have an xray, and be referred on as appropriate.
Investigations
Simple investigations can be helpful in either bone or soft tissue sarcoma. USS in the case of soft tissue lumps and plain X-ray in the case of bone are quick and safe investigations which can be accessed by family doctors or allied health professionals and help diagnose sarcoma early.
Imaging Guidelines
Xray
Plain xrays of the affected area are helpful and often required in cases of suspected bone sarcoma or metastatic cancer. At least 2 views of the area of concern should be ordered and the results followed up.
Ultrasound Scan (USS)
These are useful in suspected soft tissue sarcoma. Often they can reliably predict benign lipoma or cysts, and can raise concern in cases of heterogeneous lesions of vascular lesions. They often complement MRI, but waiting for one should not slow a referral. USS guidelines are available below.
Magnetic Resonance Imaging (MRI)
In some areas these can be ordered straight from the community, and are considered the gold standard in the diagnosis of bone and soft tissue sarcoma. They are complemented by USS and plain x-ray.
Other imaging modalities
PET CT, CT Chest, whole body MRI and Nuclear medicine scan can all have a place in the diagnosis and staging of sarcoma. They are usually ordered or recommended by the sarcoma MDM teams when appropriate.
Frequently Asked Questions
When should I refer a soft tissue lump?
Any lump bigger than a golf ball and deep to deep fascia should be referred for further investigation on a cancer pathway.
What if I haven’t heard back?
If you are concerned then repeat the referral or call the local hospital on call team for advice.
I have a child or young adult with a concerning xray, where do I refer?
All children and young adults with an x-ray concerning for sarcoma should be referred to acute orthopaedics or paediatric at your local hospital.
Where can my patients get information?
Please direct your patient to this web site, or to their sarcoma clinical nurse specialist if they are known to one of the sarcoma services.