NICE Draft Suspected Cancer Guidelines

NICE is redrafting its guidelines on suspected cancer. http://www.nice.org.uk/guidance/indevelopment/gid-cgwave0618/consultation. Sarcoma is on pages 272-281 of the Full version. Here are some of the sarcoma guidelines.

Bone sarcoma

Around 500 new bone sarcomas are diagnosed each year in the UK, meaning that a full time GP is unlikely to diagnose more than one bone sarcoma during their career. It is seen in both sexes, and is one of the commoner cancers in children, teenagers and young people.

Pain and loss of function of the affected limb are thought to be the main presenting 6 symptoms of bone sarcoma. However the rarity of this cancer means there are few studies of its clinical features.

Because of the rarity of bone sarcoma, there is no standard diagnostic pathway for primary care. Plain X-ray may show abnormalities suggestive of the sarcoma.

Clinical questions
  • What is the risk of bone sarcoma in patients presenting in primary care with symptom(s)?
  • Which investigations of symptoms of suspected bone sarcoma should be done with clinical responsibility retained by primary care?
Recommendation

Consider an urgent direct access X-ray (within 2 weeks) to assess for bone sarcoma in children and young people with unexplained bone swelling or pain. [new 2015]

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people if an X-ray suggests the possibility of bone sarcoma. [new 2015]

Soft tissue sarcoma

Just over 3,000 new soft tissue sarcomas are diagnosed each year in the UK. A full time GP is likely to diagnose approximately 1 person with soft tissue sarcoma during their career. They occur in connective tissue, so can occur in many parts of the body. Five year survival is highly dependent on the specific site.

The rarity of this cancer means there are few studies of its clinical features. It is believed that most present with a mass, which may be painless, and may become quite large. The main method of diagnosis is by biopsy, which is performed in secondary care.

Clinical questions
  • What is the risk of soft tissue sarcoma in patients presenting in primary care with symptom(s)?
  • Which investigations of symptoms of suspected soft tissue sarcoma should be done with clinical responsibility retained by primary care?
Recommendation

Consider an urgent direct access ultrasound scan (within 2 weeks) to assess for soft tissue sarcoma in people with an unexplained lump that is increasing in size. [new 2015]

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists. [new 2015]

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