sarcoma (urgent referral guidance for suspected cancer)

Last reviewed 07/2021

The NICE guidance concerning referral of possible sarcomas has been updated (1). There is no detail in the guidance as to clinical size of "unexplained lump" in consideration of a soft tissue sarcoma - the new guidance suggests an urgent ultrasound if there is an "unexplained lump increasing in size" but there is no other definition e.g. fixed or mobile.

In this page on GPnotebook there is inclusion of the previous definitions of changes suggestive of a soft tissue sarcoma. Local implementation of this guidance may provide greater definition of terms such as "unexplained lump increasing in size".

Bone Sarcoma in adults

• consider a suspected cancer pathway referral (for an appointment within 2 weeks) for adults if an X-ray suggests the possibility of bone sarcoma

Soft tissue sarcoma in adults

• consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for soft tissue sarcoma in adults with an unexplained lump that is increasing in size
• consider a suspected cancer pathway referral (for an appointment within 2 weeks) for adults if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists

Notes:

• from previous guidance there is definition of features of a sarcoma. This is presented for the information of the reader but local implementation of the NICE guidance may define information such as this:

  • refer urgently if is suspect sarcoma (2)

    • a patient presents with a palpable lump that is:
      • greater than about 5 cm in diameter
      • deep to fascia, fixed or immobile
      • increasing in size
      • painful
      • a recurrence after previous excision
    • if a patient has HIV, consider Kaposi's sarcoma and make an urgent referral if suspected

    Urgently investigate increasing, unexplained or persistent bone pain or tenderness, particularly pain at rest (and especially if not in the joint), or an unexplained limp. In older people metastases, myeloma or lymphoma, as well as sarcoma, should be considered.

Reference:

• NICE (June 2015). Suspected cancer: recognition and referral
• NICE (June 2005). Referral Guidelines for Suspected Cancer