Understanding Greater Manchester Cancer: Referral, Assessment & Management for Suspected Sarcomas
This content provides comprehensive information on Greater Manchester Cancer referral and assessment for suspected soft tissue and bone sarcomas. It covers objectives, background, symptoms, signs, clinical assessment, initial management, and referral criteria. Essential guidelines and key points on sarcoma classification, common types, and WHO tumor classification are outlined. The document emphasizes the importance of early detection, familiarity with referral forms, and awareness of different subtypes of sarcomas, aiming to improve patient outcomes and increase survival rates.
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Greater Manchester Cancer Referral & Assessment for Suspected Soft Tissue & Bone Sarcomas Amit Kumar 12thOctober 2019
Greater Manchester Cancer Aims Increase awareness of MSK tumours Appropriately manage a patient with a concerning lump / suspected bone tumour
Greater Manchester Cancer Objectives Background Symptoms & Signs Clinical assessment Initial Management Referral Criteria
Greater Manchester Cancer Must Read NICE Sarcoma Guidelines Familiarity with 2WW local referral form Sarcoma UK Bone Cancer Research UK
Greater Manchester Cancer Introduction A rare type of cancer arising from mesenchymal/connective tissue Soft Tissue, Bone or GIST 1% of all primary cancer Approx 5300 per year (15/day) 100 different sub-types. 5 year survival rate for sarcoma is 55%
Greater Manchester Cancer Sarcoma 40-60 years, young adults, children No significant aetiology Associations: HIV / Kaposis, Neurofibromatosis, other cancers 2nd hit hypothesis 50% extremities: LL > UL Other: Retroperitoneal, Chest, Gynae, Breast
World Health Organization classification of tumours Tumours are classified by differentiation and biological behaviour. Adipocytic tumours Fibroblastic/myofibroblastic tumours So-called fibrohistiocytic tumours Smooth-muscle tumours Skeletal muscle tumours Vascular tumours Chondro-osseous tumours Gastrointestinal stromal tumours Nerve sheath tumours Tumours of uncertain differentiation Undifferentiated/unclassified sarcomas.
Greater Manchester Cancer Common Sarcomas Soft Tissue Leiomyosarcoma Fibroblastic Sarcoma Liposarcoma Rhabdomyosarcoma Malignant peripheral nerve sheath tumour Angiosarcoma Synovial sarcoma GIST Kaposi s Bone Ewings Osteosarcoma Chondrosarcoma Chordoma
Greater Manchester Cancer Approach to Patient with a lump History: How long Painful Increasing in size Bigger than 5cm? Previous surgery/Rxt Discharge or skin changes FHx other cancers: melanoma, lymphoma, lung Ask what has been done: other GP, hospital, private
Greater Manchester Cancer Symptoms & Signs Symptoms Pain Stiffness Local effects Non weight bearing Vague symptoms Signs Noticeable lump Joint swelling Skin changes Fungating tumour
Greater Manchester Cancer Clinical Examination Look: skin changes, naevi, neurofibromas, multiple lumps Feel/Move: Location limb, trunk, areas of lymph nodes? Soft or hard Mobile or adherent to deeper structures Size >5cm? Pain Joint function Neurological symptoms
Greater Manchester Cancer Investigations Basic Work up: Ultrasound: Will rule out most benign MRI (Tumour protocol) Limb Xray CXR Baseline Bloods Bone Profile/Calcium
Greater Manchester Cancer WHOOPS Do NOT not biopsy Do NOT excise without imaging and discussion If in-advertent incision biopsy and close
Greater Manchester Cancer 2WW Referral Criteria Lump increasing in size, deep, bigger than 5cm Painful, fungating, previous surgery, Rxt Bone changes on Xray
Greater Manchester Cancer 2WW Referral Form
Greater Manchester Cancer Sarcoma Service Clinical assessment Imaging Biopsy: Core biospy. No role for FNA Histopathology MDT review locally Regional MDT Management Plan
Greater Manchester Cancer Treatment Surgical Excision: Marginal, Wide, Amputation Pre or Post op Radiotherapy Chemotherapy Palliative treatment
Greater Manchester Cancer Pitfalls in patient pathway Delayed referral biggest cause of litigation Patients referred to non-tumour specialists Poor knowledge of tumours and clinical skills WHOOPS Where are the scans? Urgent? 2WW? Beware the persistent haematoma Not taking a history
GMOSS Greater Manchester & Oswestry Sarcoma Service Soft Tissue & Bone Guidelines GP Specialist Referral Referral Return to referrer Soft Tissue Mass/Bone lesion Diagnostic Clinic USS + Bx Sarcoma Diagnostic Triage/MDM Refer to other specialty Arrange Surgery Sarcoma Clinic MRI / CT GMOSS MDT
Greater Manchester Cancer Current Patient Pathway Clinic and/or MDT < 2 weeks Biopsy < 2 weeks Results and MDT 2-3 weeks Back to Clinic Total = Min 6 weeks
Greater Manchester Cancer NHS England
Greater Manchester Cancer Doctor, I have got a lump, what do I do with it? History: how long, is it getting bigger and painful Examine to see is it soft, hard, mobile and deep; joint swelling Xrays? Refer to local sarcoma service if meets criteria Discuss/refer if concerned Its not a pathway for: Unknown malignancy, get seen quicker, small benign proven lumps
Greater Manchester Cancer Thank you
