Scottish referral guidelines for suspected cancer: quick reference guide

Sarcomas and Bone Cancers

Urgent suspicion of cancer referral (soft tissue sarcoma)

A 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 for 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