Patients with sarcoma present to their general practitioners either with unremitting pain (bone) or a painless growing lump (soft tissue).
1. Referral
Patients with sarcoma present to their general practitioners either with unremitting pain (bone) or a painless growing lump (soft tissue). After preliminary investigations to confirm a lump or bone abnormality, general practitioners often refer patients to an orthopaedic surgeon, a general surgeon, or a specialist bone and soft tissue sarcoma expert. The appropriate management from this point is referral to a tumour centre or bone and soft tissue sarcoma expert for investigation, biopsy and treatment if required.
2. Diagnosis
Diagnosis is made after obtaining a history, performing a physical examination and obtaining investigations including a biopsy. Investigations are best performed prior to biopsy to avoid biopsy artefact from confounding the results of anatomic imaging. Appropriate imaging delineates the local manifestation of the tumour as well as any systemic spread. Relevant imaging includes plain radiographs of the affected limb or body part, MRI scan of the body part, CT chest and nuclear scans.
3. Pathology
Biopsy for histologic examination is best performed after anatomic imaging of the tumour. The safest form of biopsy is an image-guided biopsy to target the most metabolically active area of the tumour and to avoid areas of necrosis. Pre-biopsy MRI or CT scan is very useful to plan biopsy. Biopsy should be performed in line with the operative incision to allow excision of the biopsy track. Discussion of the position of the biopsy track with a bone and soft tissue sarcoma surgeon is strongly recommended to avoid complications and to allow optimal positioning of the biopsy site. This is best undertaken under the supervision of or after consultation with a bone and soft tissue tumour surgeon.
4. Determination of treatment (achieving multidisciplinary care)
The results of the imaging and biopsy are discussed in a multidisciplinary setting where expert opinions related to the diagnosis and subsequent treatment can be offered.
