Bone sarcomas
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.
