Sarcoma service

Referrals from General Practice

If a patient presents to their GP with a soft tissue lump, the GP will arrange an ultrasound scan which should be done on an urgent basis if there is concern that this may be a sarcoma.

If the ultrasound scan shows a mass that needs further investigation under a specialist team, the GP should refer the patient to the Sarcoma service in Sheffield on an urgent basis. The scans will be reviewed in the next Sarcoma Multi-disciplinary meeting (MDT).

If the MDT feels the scans do not show any concerning features of a malignant lesion, a sarcoma out-patient appointment may not be necessary. The referring GP will receive an MDT outcome to inform them of this and we will advise on any further management that may be required.

If our review of the scans suggests further investigations are required, the patient will receive an appointment letter for these. Investigations may include MRI scan, CT scan and a biopsy. The biopsy involves taking a small sample of the lump to be looked at by our pathologists. This procedure is performed under local anaesthetic and the patient will be able to go home on the same day.

The results of these investigations will be discussed in the Sarcoma MDT and decision on the need for and type of treatment will be discussed between the different doctors at the meeting.

The patient will then be seen in clinic by members of the team to discuss results and the treatment plan we recommend.

Referrals from other hospital specialists

The sarcoma service often receives referrals from other hospital specialists who would like an opinion on a lump. In most cases the patient will be aware they they have a lump but sometimes the lump or mass is seen incidentally on a scan being done for another problem. The patient may not be aware they have the lump as it may be sitting within deeper tissue.

The referring specialist doctor will inform the patient of the referral to our service. The scan will be discussed in the Sarcoma MDT and we will then decide if we think further scans and a biopsy (as explained in section above) are indicated. We will contact the patient directly to arrange these.

Results of these additional investigations will then be discussed in the MDT and we will then arrange to see the patient in clinic with the results and to discuss the treatment plan we recommend.

Referrals to the Sheffield specialist sarcoma service

Referrals from General Practice should typically be organised on an urgent 2 week wait basis to the sarcoma out-patient service, using the dedicated 2 week wait proforma which is available to all GPs. The referral should be made after urgent investigation of a suspicious soft tissue mass with an ultrasound scan as per current NICE guidelines.

Referrals from hospital specialists/secondary care should be made on a dedicated Sarcoma service referral proforma, which is available to all Trusts within the region. The referrals should be emailed directly to sht-tr.Cancer-Sarcoma@nhs.net. Any queries about a referral can also be made to that address.

Please note that it is essential that you inform your patient about the referral and the need for further investigations such as biopsy or further imaging tests.
 

The Sheffield specialist sarcoma service is a soft tissue sarcoma service.

The pathways for dealing with suspicious bone sarcomas are outlined below and have been agreed by the Sheffield Specialist Sarcoma Advisory Group, the Royal Orthopaedic Hospital Bone Sarcoma service and Orthopaedic Directorates from all Trusts within the SMYBND Cancer Alliance:

PATHWAY FOR INVESTIGATION OF SUSPECTED BONE MALIGNANCY IN PATIENTS AGED < 40 YEARS

• Usually detected on X-rays or CT/MRI
• Patients referred to Royal Orthopaedic Hospital (ROH) in Birmingham if there is no previous history of malignancy
• Referrals to ROH can ONLY be recommended in an imaging report by a Consultant Radiologist
• Patients should be referred straight to Royal Orthopaedic Hospital (ROH) as 2 week wait from GP via e-RS, selecting the appropriate RAS (Referral Assessment Area) for the Royal Orthopaedic Hospital, Birmingham
• Referral to ROH MDT if from secondary care (via usual mechanism)

PATHWAY FOR INVESTIGATION OF SUPECTED BONE MALIGNANCY IN PATIENTS AGED > 40 YEARS

• Usually detected on X-rays or CT/MRI
• Referrals can ONLY be recommended in an imaging report by a Consultant radiologist
• Referral as a 2WW if from GP via e-RS for Orthopaedics in the nearest Trust to the patient
• Once seen in 2 week wait Orthopaedic clinic, patients will require CT staging chest, abdomen and pelvis and MR of the bone lesion if felt appropriate by the reviewing Orthopaedic surgeon and Radiologist.
• If a primary malignancy at another site is confirmed at CT, then the patient should be referred to relevant site-specific MDT
• If no primary malignancy is found but evidence of disseminated malignancy is detected at CT, the patient should be referred to CUP MDT
• If no primary malignancy is identified, with only a solitary bone lesion after staging CT scan, referral should be made by Orthopaedics to ROH in Birmingham for further investigation if clinically appropriate (fulfilling Inter-provider Transfer requirements).

We do have close links to the Birmingham Bone sarcoma service and are happy to be involved in management of patients on their recommendation such as organising investigations and biopsies in Sheffield. Surgery for patients in the region with Bone sarcoma is performed in Birmingham.

The Sheffield team provide oncology services such as radiotherapy and chemotherapy for bone sarcomas on the recommendation of the Birmingham unit. Patients in the region who have been treated for bone sarcoma are often followed up in a joint clinic with a member of the Birmingham Bone sarcoma team, which takes place on a 3 monthly basis at Weston Park hospital.

Information coming soon

The Sheffield Sarcoma Support Group (SSSG) was formed in 2009 by a small group of sarcoma patients with the support of the sarcoma clinical nurse specialists (CNSs) and consultants, and it remains a patient led group. Its members, including patients and their relatives/carers are drawn from a wide geographical area including Barnsley, Doncaster, Rotherham, Sheffield, North Nottinghamshire, including Worksop and North East Derbyshire, including Chesterfield. The SSSG is so named because its main meetings are held in the large committee room at Weston Park Hospital in Sheffield. Although the group is run by the chairman with the support of its members (including the CNSs), all members have the opportunity to input their ideas on the group’s activities.

The aim of the group is to allow patients and their relatives/carers to meet regularly, on a social basis, and to have discussions on almost any topic of interest. Discussions around sarcoma may be short and do not necessarily dominate the meetings. The SSSG meets on the second Friday of January, March, May, July, September and November. However, these dates may occasionally vary depending on circumstances.

The meetings are held at 6.30 pm and last for about two hours. The evening usually begins with a talk by a guest speaker, which forms the focus for the group to meet. The topics of the talks are wide-ranging and are usually of general interest to the members. We also have an occasional clinical meeting where a member(s) of the sarcoma medical staff reports on advances in sarcoma treatments and research, and inform the group of how patients are reviewed after clinic appointments.

The talks are followed by refreshments and general chat amongst the members of the group, which is where the real support happens.

Further details of the group’s activities may be obtained from the CNSs at Weston Park Hospital or from Barry Davis (barry.davis1848@btinternet.com) and John Beeden (johnbeeden47@btinternet.com).