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Referral and Assessment For Suspected Soft Tissue and Bone Sarcomas PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Referral & Assessment for Suspected Soft Tissue & Bone Sarcomas" by Amit Kumar.

This medical PowerPoint presentation is about soft tissue or bone sarcoma and the requirement for prompt referral and assessment for treatment. When a patient is suspected to have a soft tissue or bone sarcoma, a prompt and thorough referral and assessment is necessary for accurate diagnosis and effective treatment.

Tags : Soft Tissue sarcoma, Bone Sarcoma, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 916 | Downloads : 0

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Slide 1-

Referral & Assessment for Suspected Soft Tissue & Bone Sarcomas Amit Kumar 12th October 2019 Greater Manchester Cancer
Slide 2-

Aims Greater Manchester Cancer Increase awareness of MSK tumours Appropriately manage a patient with a concerning lump / suspected bone tumour
Slide 3-

Objectives Greater Manchester Cancer Background Symptoms & Signs Clinical assessment Initial Management Referral Criteria
Slide 4-

Must Read Greater Manchester Cancer NICE Sarcoma Guidelines Familiarity with 2WW local referral form Sarcoma UK Bone Cancer Research UK
Slide 5-

Introduction Greater Manchester Cancer A rare type of cancer arising from mesenchymal/connective tissue Soft Tissue, Bone or GIST 1% of all primary cancer Approx 5300 per year (15/day) 100 different sub-types. 5 year survival rate for sarcoma is 55%
Slide 6-

Sarcoma Greater Manchester Cancer 40-60 years, young adults, children No significant aetiology Associations: HIV / Kaposis, Neurofibromatosis, other cancers – 2nd hit hypothesis 50% extremities: LL > UL Other: Retroperitoneal, Chest, Gynae, Breast
Slide 7-

World Health Organization classification of tumours Tumours are classified by differentiation and biological behaviour. Adipocytic tumours Fibroblastic/myofibroblastic tumours So-called fibrohistiocytic tumours Smooth-muscle tumours Skeletal muscle tumours Vascular tumours Chondro-osseous tumours Gastrointestinal stromal tumours Nerve sheath tumours Tumours of uncertain differentiation Undifferentiated/unclassified sarcomas.
Slide 8-

Common Sarcomas Soft Tissue Leiomyosarcoma Fibroblastic Sarcoma Liposarcoma Rhabdomyosarcoma Malignant peripheral nerve sheath tumour Angiosarcoma Synovial sarcoma GIST Kaposi’s Bone Ewings Osteosarcoma Chondrosarcoma Chordoma Greater Manchester Cancer
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Greater Manchester Cancer
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Greater Manchester Cancer
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Approach to Patient with a lump History: How long Painful Increasing in size Bigger than 5cm? Previous surgery/Rxt Discharge or skin changes FHx – other cancers: melanoma, lymphoma, lung Ask what has been done: other GP, hospital, private Greater Manchester Cancer
Slide 12-

Symptoms & Signs Symptoms Pain Stiffness Local effects Non weight bearing Vague symptoms Signs Noticeable lump Joint swelling Skin changes Fungating tumour Greater Manchester Cancer
Slide 13-

Clinical Examination
Slide 14-

Greater Manchester Cancer Clinical Examination Look: skin changes, naevi, neurofibromas, multiple lumps Feel/Move: Location – limb, trunk, areas of lymph nodes? Soft or hard Mobile or adherent to deeper structures Size >5cm? Pain Joint function Neurological symptoms
Slide 15-

Greater Manchester Cancer Investigations Basic Work up: Ultrasound: Will rule out most benign MRI (Tumour protocol) Limb Xray CXR Baseline Bloods Bone Profile/Calcium
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Greater Manchester Cancer WHOOPS Do NOT not biopsy Do NOT excise without imaging and discussion If in-advertent incision – biopsy and close
Slide 17-

2WW Referral Criteria Greater Manchester Cancer Lump increasing in size, deep, bigger than 5cm Painful, fungating, previous surgery, Rxt Bone changes on Xray
Slide 18-

2WW Referral Form Greater Manchester Cancer
Slide 19-

Greater Manchester Cancer Sarcoma Service Clinical assessment Imaging Biopsy: Core biospy. No role for FNA Histopathology MDT review locally Regional MDT Management Plan
Slide 20-

Greater Manchester Cancer Treatment Surgical Excision: Marginal, Wide, Amputation Pre or Post op Radiotherapy Chemotherapy Palliative treatment
Slide 21-

Greater Manchester Cancer Pitfalls in patient pathway Delayed referral – biggest cause of litigation Patients referred to non-tumour specialists Poor knowledge of tumours and clinical skills WHOOPS Where are the scans? Urgent? 2WW? Beware the persistent haematoma Not taking a history
Slide 22-

Sarcoma Clinic GP Referral Specialist Referral Soft Tissue Mass/Bone lesion Diagnostic Clinic USS + Bx GMOSS MDT MRI / CT Return to referrer Refer to other specialty GMOSS Greater Manchester & Oswestry Sarcoma Service Soft Tissue & Bone Guidelines Arrange Surgery Sarcoma Diagnostic Triage/MDM
Slide 23-

Current Patient Pathway Greater Manchester Cancer Clinic and/or MDT < 2 weeks Biopsy < 2 weeks Results and MDT 2-3 weeks Back to Clinic Total = Min 6 weeks
Slide 24-

NHS England Greater Manchester Cancer
Slide 25-

Doctor, I have got a lump, what do I do with it? Greater Manchester Cancer History: how long, is it getting bigger and painful Examine to see is it soft, hard, mobile and deep; joint swelling – Xrays? Refer to local sarcoma service if meets criteria Discuss/refer if concerned Its not a pathway for: Unknown malignancy, get seen quicker, small benign proven lumps
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Thank you Greater Manchester Cancer