Urgent Suspected Cancer: Sarcoma

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Under Review — this page was due to be reviewed by Tuesday, 02 June 2026. The information shown here may be outdated.

When making an urgent suspected cancer (USC) referral (previously known as two-week waits or 2WW), please ensure your patient understands that they have been referred on a suspected cancer pathway and that they should make themselves available for diagnostic tests and outpatient appointments for the next 28 days.

Before referral 

Review the pathway and referral criteria: Pan-London Suspected Sarcoma Referral Guide

Visit the London and South East Sarcoma Network for more information.

Eligibility Criteria

Inclusions

  • resident of north central London

Exclusions

Do not refer the following benign conditions to either Wood Green CDC or Royal Marsden or London Sarcoma Service (RNOH/UCLH):

  • subcutaneous lipomas
  • sebaceous cysts/epidermoid cyst
  • ganglions
  • giant cell tumours of the tendon sheath
  • pigmented villonodular synovitis (PVNS) of a joint
  • post-traumatic or inflammatory phenomena such as fat necrosis, abscess
  • fibromas
  • normal variant anatomy
  • lymphangiomas/haemangiomas/all vascular malformations
  • chest wall/rib asymmetry
  • tenosynovitis of the wrist (for wrist mass)
  • sternoclavicular joint degeneration
  • osteochondromas(unless suspicious of malignant degeneration)
  • indeterminate lesions of skin
  • fibrous dysplasia
  • simple bone cysts

How to Refer

EMIS form

Referral methods: e-RS

Imaging needed before referral for USC

  • Complete the prerequisite imaging referral for the patient at a local site offering GP DA imaging before referral for USC. See Related Services list below, or search for 'imaging for USC sarcoma bone' or 'imaging for USC sarcoma soft tissue' to find an imaging location and refer.

  • Refer all highly suspected suspicious soft tissue sarcomas of limb, trunk and abdominal wall to Wood Green CDC for an urgent direct access MRI. This referral should only be made after a local ultrasound shows abnormal findings or the report is unclear and cannot confidently confirm a benign lesion. The ultrasound report should describe the lesion as one of the following: 

    • concerning for a malignant soft tissue tumour 
    • heterogenous and vascular
    • deep to the fascia and not in keeping with a lipomatous tumour
    • an indeterminate lesion in an individual who has a condition which predisposes them to malignant soft tissue tumours (for example neurofibromatosis).
  • Refer all suspected bone sarcomas (patients with unexplained bone swelling or tenderness not responding to analgesia or night time pain) for urgent X-ray.
  • X-ray, ultrasound or MRI results should accompany all urgent referrals unless you suspect recurrence of previous sarcoma.

Referral to USC faster diagnostic standard pathway (formerly 2WW)

  • Where imaging supports USC sarcoma referral, complete the PAN London Suspected Sarcoma Referral form
    • Refer all suspected non-limb/trunk soft tissue sarcomas (intra-abdominal, retroperitoneal, head & neck, urology, breast) to University College London Hospitals (UCLH).
    • Highly suspicious, confirmed soft tissue sarcomas or recurrence of a previous sarcoma should be referred directly to the tertiary centres at either the Royal Marsden Hospital or the London Sarcoma Service (Royal National Orthopaedic Hospital/University College London Hospitals) on the urgent suspected cancer (USC) faster diagnostic standard pathway (formerly 2WW).
    • All suspected bone sarcomas must be referred to the Royal National Orthopaedic Hospital service only. 

Soft tissue sarcoma in children

  • Following discussion with the paediatrician on-call, complete the Pan London Suspected Children's Cancer form.

Where to find the forms

  • NCL Global Documents > Urgent Suspected Cancer (formerly 2WW)

Review date: Tuesday, 02 June 2026