There are five red flag features of soft tissue sarcomas:
- 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’)