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, haematological malignancy, metabolic bone diseases and benign bone tumours are much more common.
Assessment
| Location | Knee, pelvis and shoulder are the most common sites for Primary Bone Sarcoma |
| Symptoms / signs | Pain, swelling and reduced function |
| Xray | Urgent Xray should be carried out prior to referralIn 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) |
Who to refer:
Suspected bone tumour on urgent Xray
- Adults, children and young people
Who not to refer:
Unexplained bone pain +/- swelling with normal Xray but ongoing concern
Child or young person (age 15 and under)
- Urgent 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)
