referral for suspected childhood sarcoma or bone cancer

Last reviewed 01/2018

The Urgent Cancer Referral guidance for sarcomas in children have been updated (1).

Bone sarcoma in children and young people

• consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for children and young people if an X-ray suggests the possibility of bone sarcoma
• consider a very urgent direct access X-ray (to be performed within 48 hours) to assess for bone sarcoma in children and young people with unexplained bone swelling or pain.

Soft tissue sarcoma in children and young people

• consider a very urgent direct access ultrasound scan (to be performed within 48 hours) to assess for soft tissue sarcoma in children and young people with an unexplained lump that is increasing in size
• consider a very urgent referral (for an appointment within 48 hours) for children and young people if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists

The updated guidance does not define the term "unexplained lump that is increasing in size" and local implementation of these guidelines may provide further information. For information only, we have also included the previous NICE guidance which does state more detail regarding clinical features of sarcomas in children and young people (2).

Soft tissue sarcoma (all ages)

• a soft tissue mass in an unusual location may give rise to misleading local and persistent unexplained symptoms and signs, and sarcoma should be considered. These include:
  • head and neck:
    • proptosis
    • persistent unexplained unilateral nasal obstruction with or without discharge and/or bleeding
    • aural polyps/discharge
  • genitourinary tract:
    • urinary retention
    • scrotal swelling
    • bloodstained vaginal discharge.

Refer urgently a child or young person presenting with an unexplained mass at almost any site that has one or more of the following features. The mass is:

• deep to the fascia
• non-tender
• progressively enlarging
• associated with a regional lymph node that is enlarging
• greater than 2 cm in diameter in size.

Bone sarcomas (osteosarcoma and Ewing's sarcoma) (all ages) History of an injury should not be assumed to exclude the possibility of a bone sarcoma.

Refer children or young people with:

• rest pain, back pain and unexplained limp (a discussion with a paediatrician or X-ray should be considered before or as well as referral)
• persistent localised bone pain and/or swelling, and X-ray showing signs of cancer. In this case refer urgently

Reference:

• NICE (June 2015). Suspected cancer: recognition and referral
• NICE (June 2005). Suspected cancer: recognition and referral