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REMEDY : BNSSG referral pathways & Joint Formulary

Suspected Bone & Soft Tissue Cancer

Checked: 25-08-2021 by vicky.ryan Next Review: 25-08-2022

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 2WW 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 2WW 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 North Bristol NHS Trust nhs.net account – cancerservices@nhs.net with any attachments that you may think the MDT team will find useful, e.g.: referral letters. Please mark for the attention of Adrianna Nowak. 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 ring the following extensions for help

  • MDT co-ordinator - Amy Dixon, 0117 4140427

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 Sarcoma 2WW Referral Form. and refer to NBT via e-Referral

At time of referral please issue the relevant BNSSG 2WW Patient Information Leaflet - COVID-19 edition, which is available in English and 14 additional languages.

There is also an Easy Read version of the 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 Two Week Wait 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 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.

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

If primary care would like advice from a specialist team to enable them to manage a patient in the community please use the following contact details.

Email responses will be returned within 7 calendar days.

If a response has not been received within 7 calendar days please escalate this via Outpatients.Appointments@nbt.nhs.uk 

Nice Guidelines

Refer to the NICE cancer guidelines 2015 for Sarcoma.