SPECIALIST SARCOMA CENTRES
There are three specialist sarcoma centres for London: Royal Marsden Hospital, Royal
National Orthopaedic Hospital and University College London Hospital. If sarcoma is suspected GPs should refer the patient directly to a sarcoma service rather than delay by arranging local direct access imaging. As stated in ‘ Improving outcomes for people with sarcoma ’ (NICE, 2006), CT/MRI scan and biopsy offer the greatest accuracy for early diagnosis.
BONE SARCOMA
Urgent referral is indicated if an x-ray suggests the possibility of bone sarcoma. Referrals are to the bone tumour diagnostic centre at Royal national Orthopaedic Hospital. A normal plain x-ray does not exclude a bone sarcoma as changes may not be apparent in early stages.
Risk factors for bone sarcoma:
 Paget’s disease of the bone

Bone exposure to ionising doses of radiation

Li Fraumeni syndrome

Hereditary retinoblastoma

Hereditary multiple exostoses (HME)
 Ollier’s disease or Mafucci’s disease
Clinical features:
Suspicious X-ray showing:

Spontaneous fracture

Bone destruction

Swelling or tenderness

New bone formation

Periosteal elevation
SOFT TISSUE SARCOMA
The London and South East Sarcoma Network Sarcoma Advisory Group does not recommend the use of urgent ultrasound to exclude a soft tissue sarcoma undertaken in departments outside of sarcoma diagnostic centres as those inexperienced in sarcoma

imaging may not interpret findings definitively and the time taken to repeat the investigation may delay the diagnosis.
Risk factors for soft tissue sarcoma:

Prior radiotherapy

Li –Fraumeni syndrome

Neurofibromatosis
 Familial adenomatosis polyposis (Gardner’s syndrome)
Clinical features:
Unexplained soft tissue lumps with one or more of the following features should be considered for the suspected sarcoma pathway:

>5cm in size

Increasing in size

Deep to fascia

Fixed/immobile

Painful

Recurrence following Excision, please describe