HNY Policy and Pathway Repository - Humber

Suspected sarcoma-soft tissue

Patient will be referred to soft tissue sarcoma Multi-disciplinary Team (MDT) in Leeds. 

• Please note that the sarcoma MDT will only accept referrals if an MRI has been undertaken and that states sarcoma concern.  Escalation to MRI occurs within the local radiology unit.  Please do not refer suspected sarcoma for non-NHS MSK sonography unless they are able to escalate to MRI before referral to the sarcoma MDT.  Referrals sent without an MRI risk pathway delay.  The sarcoma MDT will not resect benign soft-tissue masses.        
   

Suspected sarcoma-bone

Patient will be referred to bone sarcoma Multi-disciplinary Team (MDT) in Birmingham

Please note that Leeds does not host a bone sarcoma MDT.  All referrals need to go directly to Birmingham or risk pathway delay.

https://roh.nhs.uk/referral

See NICE NG12

Consider an urgent, direct access ultrasound scan (to be done within 2 weeks) to assess for soft tissue sarcoma in adults with an unexplained lump that is increasing in size.

Unexplained bone swelling or pain should prompt plain imaging of the symptomatic area.  Pain that is progressive (remains unexplained by benign cause) disturbs sleep and/or daily activities is of concern.

Please note that malignant bone pain in adults is more likely to be metastatic than primary bone tumour.  This suspicion should be higher in individuals that have a prior cancer diagnosis (especially if they received treatments in addition to surgery) and consideration should be given to PSA (in men) and myeloma screen if the pain is predominantly non-lumbar spinal in location.   

If soft tissue sarcoma is suspected then refer for ultrasound

See NICE NG12

Consider a suspected cancer pathway referral 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.

• Please note that the suspected cancer pathway is triggered by the concerning ultrasound and radiology will advise escalation to MRI if appropriate.  If the MRI shows persistent concern then radiology will alert the sarcoma MDT to review the case. 
• If there is persisting clinical concern in the face of reassuring imaging then manage symptomatically and arrange interval ultrasound scan (4-6 weeks) to assess for growth/change.
• The sarcoma MDT is not commissioned to remove benign masses and will not undertake review of imaging that is reported as benign.  It will not review imaging reported as indeterminate without MRI or without evidence of interval growth on serial imaging.

The Radiology Dept will let the referring GP know how the patient will be informed of the result USS/MRI. The referring GP may be involved with informing the patient about the results and the referral to the Leeds MDT.
 

If bone sarcoma is suspected the refer for plain imaging.

X-ray or other imaging suggests bone sarcoma.

Referrals need to go directly to Royal Orthopaedic Hospital, Birmingham.  It is the responsibility of the clinician requesting the abnormal imaging to inform the patient and generate the referral.

https://roh.nhs.uk/referral

Please see above guidance. 

Note that small (<5cm stable), soft, mobile, non-tender lumps do not routinely warrant ultrasound.  Excision of benign soft tissue masses is not routinely commissioned. 

Resection of symptomatic, benign, soft tissue masses will be subject to appropriate Cosmetic/Symptomatic Individual Funding Approval prior to referral to non-sarcoma service.