For referring clinicians

1 / Referral scope

State the concern and the reason for referral.

The scope includes benign tumours, giant cell tumour, metastases, bone and soft tissue sarcomas, and pelvic tumour resections. A regular multidisciplinary tumour board, sarcoma pathology review, medical oncology, dedicated plastic and reconstructive surgery, and rehabilitation support care at Kannur.

• An unexplained enlarging soft tissue mass, or uncertain ultrasound with persistent concern.
• Findings suspicious for a bone tumour.
• Confirmed tumour, suspected recurrence or unexpected sarcoma after excision.
• Metastatic bone disease with pain or fracture concern.

Further reading: [1] [2] [6]

2 / Diagnostic planning

Discuss a suspected sarcoma before biopsy or excision.

Plan imaging and biopsy before definitive surgery. The biopsy target and route must account for possible later resection. Seek specialist advice before routine excision of an uncertain mass.

For a pathological fracture through a suspected primary bone tumour, prioritise immobilisation, pain control and urgent specialist discussion before unplanned internal fixation.

Further reading: [2] [3]

3 / Referral checklist

Prepare the clinical question and available records.

Make an enquiry through WhatsApp or professional email, even if some records are pending. You can send scans and reports through either route. Include the clinical question and what is available:

• Age, site, symptom duration, growth, examination and cancer history.
• Original imaging, preferably complete DICOM studies, with dated reports.
• Biopsy or excision reports, including immunohistochemistry or molecular results.
• Operation notes, previous cancer-treatment summaries, medicines and comorbidities.
• Referrer contact details, the question and any urgent concern.

4 / Previous procedures

Make prior biopsy and surgery details clear.

Give the procedure date, site, incision, biopsy route and drain details. Identify the laboratory holding slides and tissue blocks; confirm transfer requirements with the receiving clinician.

Unexpected sarcoma after excision may require pathology review, imaging of the surgical bed and staging before further treatment is selected.

Further reading: [3] [4]

5 / Urgent clinical assessment

Use emergency care when the clinical situation requires it.

In an adult with a current or past cancer diagnosis, new limb weakness, difficulty walking, sensory loss or bladder or bowel dysfunction may indicate spinal cord compression. Arrange immediate emergency assessment rather than waiting for a website reply.

Sudden severe focal bone pain or inability to use a limb, particularly with a known bone lesion, warrants urgent assessment for fracture.

Further reading: [2] [5] [6]