Information for GPs

Adults with an unexplained soft tissue lump in the extremities or trunk wall that is increasing in size should have an urgent ultrasound scan (within 14 days) and be subsequently referred on a Urgent Suspected Cancer pathway if sarcoma is suspected or if findings are uncertain and clinical concern persists [NICE NG12 guideline]. Other features of lumps that may cause clinical concern are:

Size > 5 cm

Deep to fascia, fixed or immobile

Painful

Suspected recurrence after previous excision

 

Please only refer your patient if an ultrasound scan has been performed

Details of the name & location of where the scan was conducted & radiology reports need to be attached to the referral.

***If you are unable to organise a timely ultrasound scan and there is significant clinical concern, please use Advice and Guidance to highlight your concerns and enable a discussion with a specialist sarcoma clinician***

We use ultrasound images to triage referrals and enable straight to test pathways that expedite diagnosis for patients

 

There are now two referral pathways for lumps; urgent suspected cancer pathway (previously known as 2WW) and routine:

Referrals must be made via ERS using the appropriate referral form.

For referral guidance, please refer to the information available on F12. If you have any further queries, please contact the Sarcoma Clinical Advisor via Advice & Guidance, by email on Lynsey.Green@nuh.nhs.uk or phone 07812268743.

Urgent Suspected Cancer Pathway

Following an Urgent Suspected Cancer referral, the first contact with patients will be virtual. During this appointment we will explore the clinical history, explain the outcome of our triage review and notify of any next steps that are recommended.

   

Routine Pathway

Criteria:

•             Lipoma >7cm

•             Lipoma in deep location e.g. intra-muscular

•             Possibility of ALT (atypical lipomatous tumour) has been raised in Radiology report

•             Recurrence of previously resected lipoma

•             Routine referral recommended by reporting radiologist for other presumed benign lesion

 

For superficial lipomas <7cm, reassure patient and advise to monitor for change or growth. If patient is seeking excision please refer to Local PLCV and if funding agreed refer routinely to local appropriate surgical service.

Please refer to the British Sarcoma Group (BSG) Guidelines: BSG guidance for ultrasound screening of soft tissue masses in the trunk and extremity (britishsarcomagroup.org.uk)

If ultrasound report has described a lipoma and suggested referral to sarcoma service but the above criteria are not met, or if clinical concern persists despite a reassuring ultrasound report, please contact us via Advice & Guidance in the first instance.

Please note that guidelines suggesting referral for lumps greater than 5cm applies only to indeterminate lesions, this does not apply to radiologically diagnosed lipomas.  

IF REFERRING ROUTINELY TO THE SARCOMA SERVICE, PLEASE INFORM PATIENT THAT THE FIRST CONTACT WILL BE VIA LETTER. Referrals will only be accepted if an ultrasound scan has been performed and the result available.

 

 

 

 

 

 

 

 

Adults with increasing, unexplained or persistent bone pain or tenderness, particularly pain at rest (and especially if not in the joint), or an unexplained limp or spontaneous fracture, should have an urgent x-ray (within 14 days) [NICE NG12 guideline]

• X-ray features of bone sarcoma include bone destruction, new bone formation, soft tissue swelling and periosteal elevation
  • Refer directly to Royal Orthopaedic Hospital Birmingham if X-ray and/or cross-sectional imaging suggests the possibility of bone sarcoma Oncology (cancer) (roh.nhs.uk)
  • Please seek advice from Radiology if you are unsure how to interpret the findings
• Patients with imaging suggestive of non-specific bone tumour should be urgently referred to the appropriate local service
  • Metastases- known primary cancer team / Non-specific - vague symptoms pathway
  • Myeloma/Lymphoma- Haematology
  • Acute fracture or neurology- discuss with Trauma & Orthopaedic/Spinal services