Sarcomas - rough guide for GPs[1]

Slide 1: 

Sarcomas – a rough guide for GP's Samir Dawlatly 7 Jan 2009

Learning Outcomes/aims : 

Learning Outcomes/aims To relate experience in secondary care to primary care career To try to fulfil Curriculum document statement: “Awareness of rare diseases” in musculoskeletal unit (15_9)

How aware will I have to be of bone cancer & soft tissue malignancy as a GP? : 

How aware will I have to be of bone cancer & soft tissue malignancy as a GP? Most common type of bone cancer is metastatic Bad Boys Kill The Patients breast, bronchus, kidney, thyroid, prostate Incidence of primary bone tumours is 1:10000 A GP may see one in his/her entire lifetime Key is knowing when to refer

Sarcomas and guidelines : 

Sarcomas and guidelines http://www.nice.org.uk/nicemedia/pdf/SarcomaFullGuidance.pdf “Improving Outcomes for People with Sarcoma” “Because of their rarity, bone and soft tissue sarcomas are frequently difficult to diagnose and are characterised by late presentation and delays in diagnosis.” No specific guidelines for primary bone tumour referral There are useful guidelines for soft tissue sarcomas

Soft tissue sarcoma : 

Soft tissue sarcoma As with any suspicious lump: Features suggestive of malignancy in a lump include: • lump >5cm • lump increasing in size • lump deep to the fascia • pain.

Bone sarcomas : 

Bone sarcomas The diagnosis of a malignant bone tumour relies upon timely referral of the patient for an X-ray recognition of the abnormality on the X-ray Symptoms often non-specific Always X-ray patients with bone pain and history of cancer

Who to refer to... : 

Who to refer to... Always refer suspected bone tumours and soft tissue sarcomas below the neck to a bone tumour centre Only three in the UK One is on our doorstep Biopsy has to be done at specialist centre Radiologists are also specialist

What happens to patient : 

What happens to patient Referrals discussed in MDT Nearly everyone has a biopsy – may be USS or CT guided Biopsy has to happen within 2 weeks of referral Results of biopsy take 1 week to 10 days Cases re-discussed at MDT with histology and full imaging

Our role : 

Our role Supportive – for patient and family Can be young (osteosarcoma, Ewing's sarcoma) Surgery can be extensive – e.g. amputation Post-op pain Post-op psychological issues May be asked our advice Assessment of post op wounds for infection Explanation – not all tumours are malignant (schwannomas, chordomas...)

Final thoughts : 

Final thoughts A bone tumour may be the cancer that we miss How would we handle such a situation? May be defendable by Bolam principle but how would we really feel? Am I going to end up referring too many people for X-rays due to my skewed experience?

Slide 11: 

Thank you Any questions or comments?