Diagnosing sarcomas 

  • Why have I been referred to The London Sarcoma Service?

    Your GP or hospital consultant has referred you to our service to because they think that you may have a sarcoma. The majority of patients who are referred to us do not have a sarcoma and have another benign condition such as a lipoma or a cyst which may be treated by us or referred elsewhere as appropriate.
     
    As a specialist sarcoma centre our multidisciplinary team have the expertise to quickly investigate your symptoms, give you a diagnosis and ensure that you get the right treatment.
     
    Some benign tumours such as desmoid fibromatosis and giant cell tumours of the bone are also best treated by a specialist sarcoma team.
  • What to expect

    Depending on the nature of your symptoms you will have been referred to either RNOH or UCLH for further diagnostic tests. You may be sent for tests or you may be seen in clinic. Your case will also be discussed by our team of specialists in a multi-disciplinary team meeting who will decide on the next steps.
     

    If your doctor thinks that you might have a bone sarcoma or soft tissue sarcoma of the limb or trunk you will be referred to the Sarcoma Unit at the RNOH for further diagnostic tests. Once the Cancer Coordinator has received the referral letter, you will be contacted with appointments which may include scans and a biopsy. When all the results are available, your case will be discussed at the weekly Sarcoma Multidisciplinary Team Meeting and treatment decisions will be made. You will then be given an appointment to meet one of the consultants to be given your results and a treatment plan. This will be at the Royal National Orthopaedic Hospital outpatient department, either at Stanmore, or in the RNOH's Central London Outpatient Assessment Clinic at Bolsover St.

    To view leaflets and videos about your appointment and diagnostic tests at RNOH please see the useful information section.

    If your doctor thinks that you might have a non limb/trunk sarcoma you will referred to a specialist team at UCLH as appropriate for further investigation.

    If you already have a diagnosis of sarcoma, you may be referred directly to one the sarcoma oncologists at University College Hospital where you will be seen in the out-patient clinic in the UCH Macmillan Cancer Centre to discuss the diagnosis and treatment options.

  • Diagnosis and staging of sarcoma

    The most important part of diagnosis is to take a sample of the tumour, called a biopsy. The biopsy is examined by the pathologist under a microscope, to confirm whether there is cancer, and to decide the type of sarcoma. Most biopsies are done under local anaesthetic using ultrasound or CT scanning to guide the biopsy.

    Specialist diagnostic histopathology is provided by a team of dedicated bone and soft tissue tumour pathologists at RNOH, and also includes molecular genetics to identify characteristic chromosomal translocations and gene mutations (abnormalities of the genetic material at the centre of the tumour cell), now an essential component of a state-of-the-art diagnostic service.

    Scans must be done to find out whether the tumour has spread anywhere else in the body, or whether it is confined to the primary site. This is called staging. Soft tissue sarcomas of the limbs are most likely to spread into the lungs, whereas those of the abdomen or gut may spread into the liver. Bone sarcomas most commonly spread to the lungs and bones. Staging scans may include CT scans, MRI scans, bone scans and PET scans.

      

    The London Sarcoma Service has a large team of musculoskeletal radiologists providing highly specialist expertise in CT, MRI, ultrasound and nuclear medicine in the evaluation of bone and soft tissue tumours.

  • What will happen if I don't have a sarcoma?

    The majority of patients referred to us will not have a sarcoma. Some patients will be discharged back to their GP, some patients may be referred to another hospital for further investigation or treatment and some patients may be treated within our service for a benign condition.