Introduction
Sarcomas are malignant tumours of mesenchymal origin.
Classification
Types
May be either bone or soft tissue in origin.
Bone sarcoma include:
Soft tissue sarcoma are a far more heterogeneous group and include:
Malignant fibrous histiocytoma is a sarcoma that may arise in both soft tissue and bone.
May be either bone or soft tissue in origin.
Bone sarcoma include:
- Osteosarcoma
- Ewings sarcoma (although non bony sites recognised)
- Chondrosarcoma - originate from Chondrocytes
Soft tissue sarcoma are a far more heterogeneous group and include:
- Liposarcoma-adipocytes
- Rhabdomyosarcoma-striated muscle
- Leiomyosarcoma-smooth muscle
- Synovial sarcomas- close to joints (cell of origin not known but not synovium)
Malignant fibrous histiocytoma is a sarcoma that may arise in both soft tissue and bone.
Epidemiology
- Incidence: 1.00 cases per 100,000 person-years
- Peak incidence: 20-30 years
- Sex ratio: more common in males 1.5:1
| Condition | Relative incidence |
|---|---|
| Osgood-Schlatter disease | 200.00 |
| Sarcomas | 1 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
Certain features of a mass or swelling should raise suspicion for a sarcoma these include:
- Large >5cm soft tissue mass
- Deep tissue location or intramuscular location
- Rapid growth
- Painful lump
Referral criteria
NICE cancer referral guidelines for sarcomas suggest the following:
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for adults if an X‑ray suggests the possibility of bone sarcoma.
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for children and young people if an X‑ray suggests the possibility of bone sarcoma.
Consider a very urgent direct access X‑ray (to be performed within 48 hours) to assess for bone sarcoma in children and young people with unexplained bone swelling or pain.
Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for soft tissue sarcoma in adults with an unexplained lump that is increasing in size.
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) 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.
Consider a very urgent direct access ultrasound scan (to be performed within 48 hours) to assess for soft tissue sarcoma in children and young people an unexplained lump that is increasing in size.
Consider a very urgent referral (for an appointment within 48 hours) for children and young people if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists.
Bone sarcoma in adults
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for adults if an X‑ray suggests the possibility of bone sarcoma.
Bone sarcoma in children and young people
Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for children and young people if an X‑ray suggests the possibility of bone sarcoma.
Consider a very urgent direct access X‑ray (to be performed within 48 hours) to assess for bone sarcoma in children and young people with unexplained bone swelling or pain.
Soft tissue sarcoma in adults
Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for soft tissue sarcoma in adults with an unexplained lump that is increasing in size.
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) 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.
Soft tissue sarcoma in children and young people
Consider a very urgent direct access ultrasound scan (to be performed within 48 hours) to assess for soft tissue sarcoma in children and young people an unexplained lump that is increasing in size.
Consider a very urgent referral (for an appointment within 48 hours) for children and young people if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists.