GP Connect feature from Sock it to Sarcoma! Improving outcomes for our community.
For many GPs, sarcoma may be low on the radar as a possible diagnosis, as they may only see one throughout their entire career. Sarcoma Awareness Month (throughout July) is a good opportunity to ask yourself the question – could it be sarcoma?
Often when a patient presents with vague symptoms of bone pain, unexplained restricted movement, or a lump somewhere around the body that has grown, it may well be nothing sinister and the patient can be safely reassured. BUT, it is also possible that an existing and developing sarcoma may be the cause.
What is sarcoma?
Sarcoma are a group of rare mesenchymal tumours found in the bone and soft or connective tissues. Named after the tissues from which they arise, sarcomas can be found in any age demographic and in any part of the body, including the abdomen, skin and reproductive organs.
Primary bone sarcomas (not to be confused with metastatic bone tumours) are more commonly found in young people, in the limbs or pelvis whilst soft tissue sarcomas are more often, but not exclusively, found in adults.
Although sarcoma is considered a rare cancer, in 2021, 2345 Australians received a sarcoma diagnosis.
Sarcoma is the second most commonly diagnosed childhood tumour group. It is also predicted to cause the greatest number of cancer-related deaths in the 15-24 age group when 2021 statistics become available. Many sarcomas can be treated by surgery alone, but a patient may require a combination of surgery, chemotherapy and/or radiation.
Overall, two out of five people will not survive more than five years post-diagnosis but sarcomas diagnosed early and treated at a multi-disciplinary sarcoma specialist centre can have much better outcomes. In young people, delayed diagnosis becomes even more crucial because of the aggressive nature of the disease, seriously impacting not just the necessity for more radical treatment but also long-term survival outcomes.
Common symptoms of primary bone tumours include:
- Bone pain, particularly severe at night
- Restriction in joint movement
- Mass or swelling
- Limp
Symptoms of soft tissue tumours include:
- Lump, which may or may not be painful
- Lump increasing in size
- Lump deep to the fascia
- Abdominal pain
What to do?
Suspected bone sarcoma:
- Order an X-ray (within two weeks or, if a child, within 48 hours) and if the X-ray suggests bone sarcoma or if findings are uncertain and clinical concern remains, refer the patient urgently to WA State Sarcoma Service
- Radiographs may appear normal in patients with early bone sarcoma. However, to eliminate referred pain, a full limb X-ray is recommended.
Suspected soft tissue sarcoma:
- Order an urgent ultrasound (within two weeks or, if a child, within 48 hours) and if the scan suggests soft tissue sarcoma or if findings are uncertain and clinical concern remains, refer the patient urgently to WA State Sarcoma Service
- An MRI is more effective for investigating large deep lumps. MRI and biopsy (core needle) should only be performed under the direction of a sarcoma specialist.
GPs can contact the WA State Sarcoma Service for clinical advice on 0466 442 639.
Community support for people diagnosed with sarcoma is available at Sock it to Sarcoma! on 08 9427 1744.
References:
- AIHW 2021