Before referral 

• Read the Pan-London Suspected Sarcoma Referral Guide to review the pathway and referral criteria.
• See the London and South East Sarcoma Network for more information for referrers.
• Use the appropriate local request form and process to arrange urgent imaging (see How to refer)

X-ray, ultrasound or MRI results should accompany all urgent referrals unless you suspect recurrence of previous sarcoma.

Soft tissue sarcoma

Refer to a local centre for initial urgent direct-access ultrasound; there are several providers.

Refer all suspected non-limb/trunk soft tissue sarcomas to UCLH (intra-abdominal, retroperitoneal, head & neck, urology, breast, skin).

Refer all suspected but not highly suspicious soft tissue sarcomas of limb, trunk and abdominal wall to Wood Green CDC for an urgent direct access MRI. This should follow an ultrasound report (carried out at a local provider) that shows abnormal imaging, or clinical uncertainty where the scan does not confidently confirm a benign diagnosis. The ultrasound would state that lesion appearances are 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).

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).

Soft tissue sarcoma in children

Contact paediatrician on-call urgently.

Bone sarcoma 

All suspected bone sarcomas must be referred to the Royal National Orthopaedic Hospital service only. Before referral, arrange an urgent X-ray for patients with unexplained bone swelling or tenderness not responding to analgesia or night time pain.

Eligibility Criteria

Inclusions

• resident of NCL

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

Locations

Wood Green CDC

University College Hospital (UCLH)

Royal National Orthopaedic Hospital (RNOH)