Sarcoma Suspected Cancer Referral - Nwlcn.nhs.uk

WEST LONDONWEST LONDON CANCER NETWORK
URGENT SUSPECTED SARCOMA REFERRAL FORM
For use by all Cancer Networks without a designated local diagnostic clinic. Please tick the box of the
hospital you are referring to and fax this form to the relevant Urgent Referral Team within 24 hours.
Guidelines are on the reverse side.
BONE
Royal National Orthopaedic Hospital
Fax: 020 8909 5709
Tel: 020 8909 5584/5600
SOFT TISSUE
Royal National Orthopaedic Hospital
Fax: 020 8909 5709
Tel: 020 8909 5584/5600
University College London Hospital
Fax: 020 7380 9932
Tel: 020 7380 9599
Royal Marsden Hospital
Fax: 0207 808 2232
Tel: 0207 808 2785/811 8081
SECTION 1 – PATIENT INFORMATION. PLEASE COMPLETE ALL FIELDS IN BLOCK CAPITALS.
Patient details
GP Details
NHS No:
Dr:
Surname:
Address:
First Name:
Age / D.O.B: Tel: Fax:
Address:
Email:
Date of decision to refer:
Postcode:
Tel day: Tel eve: Signature:
Have you informed the patient that you suspect Sarcoma
Y / N
Have you told the patient they will be seen within 2 weeks
Y / N
Has the patient had a previous diagnosis of cancer Y / N (Specify if known)
Has the patient previously visited this hospital Y / N First language:
Hospital number (if known):
Interpreter required Y / N
SECTION 3 – CLINICAL INFORMATION. PLEASE TICK THE RELEVANT BOXES.
REASON FOR URGENT 2 WEEK WAIT REFERRAL
SUSPECTED PRIMARY BONE TUMOUR Specify Site:
Suspicious X-ray showing -
Spontaneous fracture
Bone destruction
New bone formation
Soft tissue swelling
Periosteal elevation
SOFT TISSUE SARCOMA-
Soft tissue mass with one or more of the following
>5cm in size painful increasing in size
deep to fascia fixed or immobile
recurrence following excision, please describe
Additional clinical information – Please provide as much information as possible. Continue on separate sheet if
required.

Refer urgently patients:
Bone Tumour
• Whose X-ray indicates possible bone cancer.
Use this proforma to refer urgently (2 Week Wait).
Soft Tissue Sarcomas
• With a palpable lump that
o Is rapidly increasing in size
o Is painful or painless
o Is deep to the fascia, fixed or immobile
o Is greater than 5cm in diameter
o Recurs after a previous excision.
Use this proforma to refer urgently (2 Week Wait)
Do not refer HIV-associated Kaposi’s sarcoma with this form
Investigations and other referrals:
• Refer for an immediate X-ray a patient with suspected spontaneous fracture.
o If the X-ray suggests possible bone cancer, refer urgently as above.
o If the X-ray suggests metastatic disease or a benign tumour, refer to your local orthopaedic
service.
o If the X-ray is normal but symptoms persist, follow up and / or request repeat X-ray, bone
function tests or make a non-urgent referral.
• Urgently investigate increasing, unexplained or persistent bone pain or tenderness, particularly
pain at rest (and especially if not in the joint), or an unexplained limp. Consider whether the patient
has a history of previous malignancy. In older people metastases, myeloma or lymphoma, as well
as sarcoma, should be considered.
o If you suspect metastatic disease, refer to your local orthopaedic service.
o If you suspect myeloma or lymphoma, refer urgently to your local Haematology service using
the Haematology Urgent Suspected Cancer Referral proforma.
o If you suspect bone sarcoma, refer urgently as above.
Patient information and support:
Consider the information and support needs of patients and the people who care for them while they
are waiting for the referral appointment. Resources for GPs to use are available from the Cancer
Network on (blank phone number), or visit our website (website address)
Final Approved by the London and South East England Sarcoma Network, 17 June 2009.