Sarcomas and Bone Cancers

Urgent suspicion of cancer referral (soft tissue sarcoma)

  • Soft tissue mass with one or more of the following characteristics:
    • size >5cm
    • increasing in size
    • deep to fascia, fixed or immobile
    • recurrence after previous excision
    • regional lymph node enlargement

Investigation of suspected bone cancer

An X-ray of the appropriate area should be requested on patients who have:

  • unexplained bone pain or tenderness, which is:
    • persistent
    • increasing
    • non-mechanical
    • nocturnal or at rest

If x-ray is suggestive of bone tumour, refer as urgent suspicion of cancer to sarcoma service.

Good Practice Points

  • Sarcomas of the long bones are usually excluded by normal x-ray but further investigation may be required for spine, pelvis, ribs or scapula
  • If symptoms persist but x-ray is normal, repeat x-ray (following discussions with radiologist) and consider referral
  • Suspected spontaneous or low impact fracture should raise suspicion of underlying malignancy
Full Guideline