Publication - Advice and guidance

Scottish referral guidelines for suspected cancer: quick reference guide

Published: 22 Jan 2019
Community Health and Social Care Directorate
Part of:
Health and social care

User-friendly visual aid to the urgent referral criteria as well as routine referral criteria and primary care management and good practice points.

50 page PDF

3.0 MB

50 page PDF

3.0 MB

Scottish referral guidelines for suspected cancer: quick reference guide
Sarcomas and Bone Cancers

50 page PDF

3.0 MB

Sarcomas and Bone Cancers

Urgent suspicion of cancer referral (soft tissue sarcoma)

A soft tissue mass with one or more of the following characteristics:

  • size >5cm
  • increasing in size
  • deep to fascia, fixed or immobile
  • recurrence after previous excision
  • regional lymph node enlargement

Investigation for suspected bone cancer

An X-ray of the appropriate area should be requested on patients who have:

  • unexplained bone pain or tenderness, which is:
  • persistent
  • increasing
  • non-mechanical
  • nocturnal or at rest

If X-ray is suggestive of bone tumour, refer as urgent suspicion of cancer to sarcoma service.

Good practice points

  • Sarcomas of the long bones are usually excluded by normal X-ray but further investigation may be required for spine, pelvis, ribs or scapula
  • If symptoms persist but X-ray is normal, repeat X-ray (following discussions with radiologist) and consider referral
  • Suspected spontaneous or low impact fracture should raise suspicion of underlying malignancy


Email: Cancer Access Team