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Bone sarcoma accounts for 12% of sarcoma diagnoses. Bone sarcoma originates in the bone and is rare; with around 650 diagnoses in the UK each year, bone sarcomas account for just 0.2% of all cancer diagnoses. Incidence rates are highest in people over
75 years of age, however, there is also a peak in younger patients aged 10-19.

Bone sarcoma can affect any bone, but most cases develop in the legs and upper arms. There are several different type of bone sarcoma, the most common types of bone sarcoma are: Chondrosarcoma (37%), Osteosarcoma (30%), Ewing’s sarcoma (14%), and Chordoma
(6%).

Grade Common demographics Where it develops Common sites
Chondrosarcoma Adults over 40 Cartilage cells Upper arm, pelvis, thigh bone
Osteosarcoma Children, teenagers and young people – but can affect adults Osteoblast cells that form the bone Knee, thigh bone, shin bone, pelvis, upper arm, shoulder and skull
Ewing’s sarcoma Children, teenagers and young people – but can affect adults Bone or soft tissue around the bone, or subcutaneous tissue Pelvis, thigh bone, shin bone
Chordoma Adults over 40 Notochord cells – important in the development of the spine before birth Most often in the sacrum, but can occur anywhere along the spine


Bone Sarcoma: Anatomical Site

Bone sarcomas can develop anywhere in the body, but there are more common sites based on the type of bone sarcoma.

Anatomical image of bone sarcoma sites

Source: Cancer Research UK, the world’s leading independent cancer charity dedicated to saving lives through research, influence and information. © Cancer Research UK [2021]. All rights reserved.


Patient case study

The following activity follows the timeline of a patient’s diagnosis of a bone sarcoma.

JamesJames is a 20 year old male who enjoys playing football. He started
experiencing some lower leg pain and swelling. After 18 months, James was diagnosed with osteosarcoma. James’ story is based on the experience of a real patient who supported the development of this module.
Click through the timeline below
to read about his journey.


Presentation of bone sarcoma

The symptoms of bone sarcoma can vary depending on the size and location of the tumour. The most common symptoms are bone pain (particularly at night), a mass or swelling, and restricted movement in a joint. Bone sarcomas can often be mistaken for sports
injuries or growing pains, particularly in children and young adults.

Dr Sarah Taylor, GatewayC GP Lead, discusses the presentation of bone sarcoma with Miss Gillian Cribb, Consultant in Orthopaedic Oncology.

  

Key points for diagnosis:

  • Always consider bone sarcoma if musculoskeletal injuries are not settling. Pain that does not settle and is associated with a lump is a cause for concern and warrants an X-ray
  • Around 25% of X-rays will not pick up a bone sarcoma
  • Pain that gradually gets worse and doesn’t respond to rest, or simple analgesics should raise concerns – and these symptoms should be detailed on the X-ray request card
  • Night pain is a red flag symptom
  • Best practice is always to advise patients to monitor for any change and return to their GP should symptoms persist, change, or worsen

Referral

When discussing referrals with patients it is important to ensure they understand why they are being referred. This honesty will help maintain health practitioner-patient trust and potentially minimise the number of DNAs.

All patients with a suspected or confirmed sarcoma should be referred to a sarcoma specialist centre. Data from the National Cancer Registration and Analysis Service has shown that sarcoma survival rates increase when treated at specialist centres. Information
on Sarcoma Specialist Centres in the UK can be found here.



See the table below for NICE NG12 Guidance on how to refer bone sarcomas.

Symptoms and specific features Recommendation
X-ray suggesting the possibility of bone sarcoma For adults: Consider a suspected cancer pathway referral (for an appointment within 2 weeks) [1.11.1]
For children and young people Consider a very urgent referral (for an appointment within 48 hours) [1.11.2]
Unexplained bone swelling or pain For children and young people: Consider a very urgent direct access X-ray (to be performed within 48 hours) [1.11.3]

NB: In practice, younger people (aged 16 to 24) may be referred using either pathway depending on their age and local arrangements.


Additional resources

Link: Understanding bone sarcoma, Sarcoma UK
Link: Diagnostic Tool – Is it bone sarcoma?, Sarcoma UK (2019)
Link: Information for all healthcare professionals, GPs and medical students, Bone Cancer Research Trust
Link: Sarcoma specialist centres, Sarcoma UK (2021)
Link: Bone and soft tissue sarcoma – Recognition and referral, NICE (2020)
Link: Sarcoma Services (all ages), NHS England (2019)

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