Bone cancer and sarcoma referral guidelines

Our guidelines will help you refer patients with suspected bone cancer and soft tissue sarcoma.

About these guidelines

We have developed Rapid Referral Guidelines to support GPs with practical referral recommendations for children, young people and adults with symptoms of suspected cancer. The guidelines are endorsed by NICE and summarise the NG12 guidelines for suspected cancer. They can help you decide if a referral is:


Non urgent

Non urgent

Requires routine referral or tests.


Urgent

Urgent

Required within two weeks.


Very urgent

Very urgent

Required within 48 hours.


Please note, these guidelines aim to share learning and good practice but, out of necessity, they are brief in nature. They are not a substitute for your own clinical judgement or advice provided to you by a specialist.

Macmillan and NICE will not accept any liability for any type of loss caused by someone acting on information contained in the guidelines, unless liability is enforced by law.

We have recommendations on patient support, safety netting and the diagnostic process.

You can also download a copy of the guidelines (PDF).

Bone sarcoma referral guidlines

Very urgent

Very urgent direct access


Consider a very urgent direct access X-ray (appointment within 48 hours) for any child or young person with unexplained:

  • bone swelling
  • OR bone pain.
Very urgent

Very urgent referral


Consider very urgent referral for children and young people (appointment within 48 hours) with an X-ray that suggests the possibility of bone sarcoma.

Very urgent

Urgent referral


Consider urgent referral (appointment within two weeks) in adults with an X-ray that suggests the possibility of bone sarcoma.

Soft tissue sarcoma referral guidelines

Very urgent

Very urgent direct access


Consider very urgent direct access ultrasound scan (performed within 48 hours) for children and young people with an unexplained lump that is increasing in size.

Non urgent

Urgent direct access


Consider urgent direct access ultrasound scan (performed within two weeks) for adults with an unexplained lump that is increasing in size.

Very urgent

Very urgent referral


Consider very urgent referral (within 48 hours) in children or young people with:

  • ultrasound scan findings that are suggestive of soft-tissue sarcoma
  • OR ultrasound scan findings that are uncertain and clinical concern persists.
Non urgent

Urgent referral


Consider urgent referral (within two weeks) for adults with:

  • ultrasound scan findings that are suggestive of soft-tissue sarcoma
  • OR ultrasound scan findings that are uncertain and clinical concern persists.

Glossary

In these guidelines, we use the below terms in the way they are described.

This is consistent with NICE's NG12 guidance for suspected cancer.

  • Children – from birth to 15 years.
  • Young people – people aged 16–24.
  • Direct access – when a test is performed and primary care retain clinical responsibility throughout, including acting on the result.
  • Immediate – an acute admission or referral occurring within a few hours, or even more quickly, if necessary.
  • Suspected cancer pathway referral – the patient is seen within the national target for cancer referrals (two weeks at the time of publication of the 2015 NICE guidance).