New soft tissue sarcoma hub and spoke services

A new diagnostic pathway has been developed for soft tissue sarcoma referrals in London. Services will be divided into ‘hubs’ (tertiary services providing treatment and clinical oversight) and ‘spokes’ (services delivering local diagnostics, from further imaging to pathology).

The hubs are the Royal Marsden Hospital and the London Sarcoma Service, which is a joint service between the Royal National Orthopaedic Hospital (RNOH) and University College London Hospitals (UCLH).

In north east London, the spoke is in development at Mile End.

In West London, the spokes are located at Chelsea and Westminster NHS Foundation Trust (West Middlesex and Chelsea sites) and Croydon Health Services.

The location of the spoke for North Central London is to be determined.

Any suspicious soft tissue sarcomas should be referred to a spoke of the nearest hub, depending on the clinical findings on ultrasound and/or patient choice.

Any highly suspicious or confirmed soft tissue sarcomas should be referred to one of the hubs directly.

Sending urgent referrals

When a patient presents to you with symptoms consistent with a suspected soft tissue sarcoma, you should refer the patient for an Urgent Direct Access Ultrasound.

Once the ultrasound and report have been received, generate an Urgent Suspected Cancer (USC) soft tissue referral on eRs, including an ultrasound (USS), in line with the NG12 Guidelines. The report from the ultrasound will help you direct the USC referral to the right service, as follows:

  • For ‘confirmed’ or ‘highly suspicious’ soft tissue sarcoma: refer directly to a Hub.
  • For ‘suspicious’ soft tissue sarcoma or ‘further diagnostics’ to confirm sarcoma: refer to a Spoke.

Occasionally, the Hub clinical team reviewing the USC referrals may redirect a referral to one of the Spokes to conduct further investigations. When this happens, both you (the referring GP) and the patient will be informed by the redirecting team.

If you cannot get direct access to an urgent ultrasound, please ensure you tick the box on the USC form to explain why you believe there is a high clinical risk of soft tissue sarcoma. 

The pan-London USC referral form for sarcoma is currently being redesigned to reflect the diagnostic pathway changes. It is expected that all USC referral forms will be recirculated in October 2023.

For more information about sarcoma

Sarcoma UK website: Healthcare professionals hub | Sarcoma UK

Gateway C’s Sarcoma free training module: https://www.gatewayc.org.uk/courses/sarcoma/

The Sarcoma UK Support Line is available for patients and healthcare professionals. It is open Mon-Fri 10am-3pm on 0808 801 0401. You can also email them on supportline@sarcoma.org.uk and expect a response within two business days.

Further information about direct access urgent ultrasound
  • Direct access urgent ultrasound should be available with a turnaround time of two weeks from time of referral
  • The direct access form should clearly state that the ultrasound is for suspected soft tissue Sarcoma
  • Rapid diagnostic clinics would not normally be used for sarcoma referrals.
  • London region Imaging Programme, together with the London & South East Sarcoma Network, is developing a protocol and education package for sonographers so that ultrasound reporting will have one of four outcomes:
    • low suspicion - return to primary care with advice & guidance on next actions
    • medium suspicion – refer to local sarcoma diagnostic service OR tertiary centre if local service is too far away, for MRI and possible excision biopsy
    • high suspicion sarcoma – refer direct to tertiary sarcoma service (London Sarcoma Service for bone and soft tissue, RMH for soft tissue only)
    • high suspicion of a different cancer – refer direct to appropriate MDT