NICE guidance suggests the following:
1.13 Bone cancer and sarcoma General recommendations 1.13.1 A patient who presents with symptoms suggesting bone cancer or sarcoma should be referred to a team specialising in the management of bone cancer and sarcoma, or to a recognised bone cancer centre, depending on local arrangements. 1.13.2 If a primary healthcare professional has concerns about the interpretation of a patient’s symptoms and/or signs, a discussion with the local specialist should be considered. 1.13.3 Patients with increasing, unexplained or persistent bone pain or tenderness, particularly pain at rest (and especially if not in the joint), or an unexplained limp should be investigated by the primary healthcare professional urgently. The nature of the investigations will vary according to the patient’s age and clinical features. • In older people metastases, myeloma or lymphoma, as well as sarcoma, should be considered. Specific recommendations Bone tumours 1.13.4 A patient with a suspected spontaneous fracture should be referred for an immediate X-ray. 1.13.5 If an X-ray indicates that bone cancer is a possibility, an urgent referral should be made. 1.13.6 If the X-ray is normal but symptoms persist, the patient should be followed up and/or a repeat X-ray or bone function tests or a referral requested.
The UK guidance on the management of bone sarcomas states the following:
- bone destruction,
- new bone formation,
- periosteal swelling,
- soft tissue swelling.
References UK guidelines for the management of bone sarcomas. NICE referral guidelines for suspected cancer 2005