Bone & Soft Tissue - USC (2WW)

Soft Tissue Sarcoma - Overview

Features which may suggest a sarcoma: mass greater than 5cm, enlarging, deep to fascia

Benign lumps measuring less than 10cm in diameter, such as an ultrasound confirmed lipoma, can usually be safely observed.

In general:

1. Arrange an urgent direct access ultrasound scan locally (to be performed within 2 weeks) to assess for possible soft tissue sarcoma in adults with an unexplained lump that is increasing in size
2. Arrange a suspected cancer pathway referral for adults who have ultrasound scan findings that are suggestive of soft tissue sarcoma, or if ultrasound findings are uncertain and clinical concern persists.
3. In cases where suspicion is low (e.g. probable stable lipoma or cyst), refer for a routine ultrasound locally, with referral for USC only if the scan does not confirm benign disease

Patients with suspected soft tissue sarcoma should be referred to the NBT Bristol Sarcoma Service for investigation and management at Southmead Hospital.

For patients who meet the agreed USC criteria, complete the 2WW proforma and submit via e-Referral to the Suspected Soft Tissue Sarcoma service.

For non-2WW referrals to sarcoma clinic e.g. Schwannoma, complete the Sarcoma MDT request form and send it to NBT cancerservices@nbt.nhs.uk – with any attachments that you may think the MDT team will find useful, e.g.: referral letters. Please mark for the attention of Amy Dixon. The Sarcoma MDT is currently held every Tuesday and the deadline for all referrals is 10:30am on Friday.

If you have any questions please email cancerservices@nbt.nhs.uk for help

Patients with suspected bone sarcoma should be referred to the Oxford Bone Sarcoma Service. See relevant section below.

Referral - Soft Tissue Sarcoma Service

Please use the Suspected Soft Tissue Sarcoma 2WW Referral Form and refer to NBT via e-Referral

Please can relevant radiology reports be included with the referral if not available on BNSSG ICE

Please submit via: Urgent Suspected Cancer - Sarcoma Malignancies Triage Service - Southmead - RVJ. Select 'send for triage' in eRS rather than selecting a date and time for dummy appointment.

At time of referral please issue the BNSSG Understanding Your Urgent Fast Track Referral patient information leaflet.

Bone Sarcoma - Overview

Advice on diagnostic testing:

Unexplained bone swelling or pain - Consider a very urgent direct access X ray.
Offer an FBC, Calcium Group and ESR to anyone 60 and over with persistent bone pain

Unexplained lump that is increasing in size - Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) requested via ICE 

The adult bone sarcoma service for BNSSG patients is provided by the Oxford Sarcoma Service based at Nuffield Orthopaedic Centre in Oxford and accepts referrals for adult patients aged 16 years and over who meet the Urgent Suspected Cancer criteria.

The service offers consultation with diagnostics and onward referral for treatment as required.

Referrals can now be made through e-Referral under the '2WW /USC Bone' clinic type. Contact details for the Oxford Sarcoma Service can be found by accessing their website.

For children with suspected sarcoma please see Suspected Cancer - Children and Young People Sarcoma.

If advised to refer into MDT, then please submit a USC (2WW) referral to the relevant secondary care team who will ensure that all the required information is available to enable an effective MDT discussion.

Referral - Bone Sarcoma

Please use the Suspected Bone Sarcoma 2WW Referral Form. for referrals into this service. As much detail as possible should be included with the referral and can be typed into the free text section of the form or added as a separate letter.

NBT Sarcoma Advice & Guidance

Please send all Advice & Guidance requests to the Sarcoma Service 2WW SarcomaService2WW@nbt.nhs.uk

Resources

Refer to the NICE cancer guidelines 2015 for Sarcoma.

The following guidelines have been developed by the SWAG Soft Tissue Sarcoma Advisory Group for ultrasonographers to follow when scanning soft tissue masses:

Ultrasound screening of soft tissue masses in the trunk and extremity - a BSG guide for ultrasonographers and primary care

SWAG region lipomatous tumour Pathway

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.