Sarcomas and Bone Cancers

Soft tissue sarcomas

Approximately 140 people are diagnosed with soft tissue sarcomas in Scotland each year. Around 90% are diagnosed in people aged 40 years or older and almost 60% in people over the age of 65. These tumours are frequently missed or only referred after repeat presentations.

In adults, soft tissue masses that are superficial, painless, less than 5cm and static in size are unlikely to be malignant.

Primary bone cancer

Approximately 50 people in Scotland are diagnosed with cancer of the bone every year.

Osteosarcoma

Osteosarcoma is the most common type of primary bone cancer. It can occur at any age but is most commonly found in teenagers and young adults. Osteosarcoma typically presents with persistent localised bone pain. The most common sites are around the knee joint and upper arm.

Ewing’s sarcoma

The incidence of Ewing’s sarcoma peaks at 10–15 years of age, and rarely occurs under the age of 5 years or over the age of 30 years. Arising in any bone, the most commonly affected sites are the pelvis, lower limb bones and chest wall. The predominant symptoms are persistent pain and swelling of the affected area. Ewing’s sarcoma is frequently misdiagnosed as osteomyelitis.

Chondrosarcoma

Chondrosarcoma is most often found in adults over the age of 40 years and is rare under the age of 20 years. The most common sites involved are the pelvis, femur, and shoulder girdle. Clinical presentation is usually a bony mass with pain often as a late feature.

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