STEP 2: Presentation, initial investigations and referral

Signs and symptoms: The following should be investigated.

For bone sarcoma:

  • persistent non-mechanical pain in any bone lasting more than a few weeks/referred pain/unremitting pain not responsive to analgesics/nocturnal bone pain
  • a mass, swelling, a limp
  • limited mobility or loss of limb function
  • fractures with minimal trauma.

For soft tissue sarcoma:

  • any deep mass or superficial mass with a diameter larger than 5 cm
  • a small but growing mass
  • a rapidly growing change in a mass (over months)
  • a mass where there is no associated history of trauma.

General/primary practitioner investigations should include:

  • medical history and baseline blood tests
  • physical examination including assessing the physical characteristics of the mass and of the regional lymph nodes
  • if there is bone pain, a plain x-ray
  • if there is a soft tissue lump, refer to a specialist.

Referral: All patients with suspected sarcoma should be referred to a specialist sarcoma multidisciplinary team within two weeks and before biopsy.


The lead clinician’s (1) responsibilities include:

  • explain to the patient/carer who they are being referred to and why
  • support the patient and carer while waiting for specialist appointments.

1: Lead clinician – the clinician who is responsible for managing patient care.

The lead clinician may change over time depending on the stage of the care pathway and where care is being provided.