Suspected Bone Tumour

SUSPECTED BONE TUMOUR

Malignant primary bone tumours are rare, there are approximately 50 new cases per year in Scotland (600 in the UK). A full time GP is unlikely to diagnose more than one bone sarcoma during their career.

Bone metastasis (most commonly Prostate, Breast, Lung, Renal and Thyroid Cancer), haematological malignancy, metabolic bone diseases and benign bone tumours are much more common.

Bone cancers of the long bones are usually excluded by normal X-ray, but further investigation may be required for spine, pelvis, ribs or scapula. Consideration should be given to referral if bone symptoms persist, but the X-ray is normal (see below for referral pathway).

Assessment

Location	Knee, pelvis and shoulder are the most common sites for Primary Bone Sarcoma
Symptoms / signs	Persistent localised bone pain, swelling, bony mass, reduced function
Xray	Request urgent USC X-ray of the appropriate body part where there is unexplained bone pain+/-tenderness, which is: – Persistent or worsening for ≥ 6weeks) – Nocturnal or at rest – Interfering with ADL In the presence of a normal Xray a bone tumour is unlikely – see below for advice regarding specific situations
Bloods	FBC, U+E, Bone profile, myeloma screen and appropriate tumour markers – thyroid, lung, breast, renal and prostate cancer commonly metastasise to bone. (often normal in primary bone tumours, hence DO NOT delay X-ray investigation )

MM & MA 14/01/26

Who to refer as USC:

Suspected bone tumour on USC Xray

Adults, children and young people

Who not to refer as USC Sarcoma:

Unexplained bone pain +/- swelling with normal Xray but ongoing concern

Urgent referral to Musculoskeletal service according to site of pain (for example Arthoplasty for hip and knee, Shoulder etc)

Child or young person (age 15 and under)

USC referral the Paediatric Orthopaedic Service, Royal Hospital for Children and Young People, Edinburgh.
Occasionally primary bone tumours have a normal Xray, particularly in Ewing’s Sarcoma.

Adult with history of cancer or red flag symptoms

Recommend GP arranges bloods: (full blood count, calcium, phosphate, renal function, ESR, PTH, Vit D3, myeloma screen, appropriate tumour markers – thyroid, lung, breast, renal and prostate cancer commonly metastasise to bone)
Urgent referral to Musculoskeletal service according to site of pain.

Adult with no history of cancer or red flag symptoms

Recommend GP arranges bloods: (calcium, phosphate, renal function, PTH and Vit D3)
Consider refer to Musculoskeletal service according to site of pain.

Metastatic bone disease

Treatment is best coordinated via the appropriate MDT for the primary tumour in question and should be referred via this team.

We work as part of an MDT and provide surgical treatment for issues related to bone metastasis

Cancer of unknown primary

Refer Oncology

How to refer:

Complete the Musculoskeletal Tumour Service referral form via SCI Gateway
- Lauriston Buildings >> Orthopaedics – Sarcoma
Refer as Urgent Suspected Cancer

RIE Orthopaedic Sarcoma Nurse Specialist: Ashleigh Brown, ashleigh.brown@nhslothian.scot.nhs.uk

CANCER REFERRAL GUIDELINES (www.cancerreferral.scot.nhs.uk)

SARCOMA UK (www.sarcoma.org.uk)

http://www.edinburghorthopaedics.org/