There are five red flag features of soft tissue sarcomas:

  • Pain
  • Increase in size
  • Size >5 cm (‘bigger than a golf ball’)
  • Deep to the deep fascia
  • Recurrence of a swelling after surgical excision

Suspected sarcomas should be referred as 2ww to a regional sarcoma centre. Biopsying or arranging scanning locally (even urgently) only delays referral unnecessarily.

NB: Although pain is a red flag symptom, painless sarcomas are actually more common than painful ones.

There are four red flag features of bone sarcomas:

  • Bone pain
  • Pain that occurs at night
  • Pain unrelieved by analgesia
  • Bony swelling

First-line investigation is plain radiography in two planes. Also request urgent FBC, ESR/PV, and baseline biochemistry.

Note that benign bone lesions (osteochondromas) can rarely undergo malignant transformation, so beware of recent changes in a longstanding lump.

(BMJ learning module – ‘Lumps, bumps and sarcomas’)



About Dr Sarah

I'm a GP with a husband and two young children.
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