A new diagnostic pathway has been developed for adult soft tissue sarcoma referrals in London, using a Hub and Spoke service model.

The ‘hubs’ will be delivered at tertiary services providing treatment and clinical oversight. The Hubs are the Royal Marsden Hospital (RMH) and the London Sarcoma Service, which is a joint service between the Royal National Orthopaedic Hospital (RNOH) and University College London Hospitals (UCLH).

The ‘spokes’ will deliver sarcoma local diagnostics services, from further imaging to pathology. The London Spokes are:

• North east London (a pilot for imaging and out patient referrals only)
  • Barts Health, Royal London Hospital (A Soft Tissue Sarcoma (NOT BONE) Urgent Suspected Cancer Assessment Service RAS – (RLH) – Barts Health NHS Trust – R1H) ***NEW***
    
• West London 
  • Chelsea and Westminster Hospital (Urgent Suspected Cancer – Sarcoma RAS Chelsea and Westminster Hospital RQM01)
  • West Middlesex Hospital (RAS – Urgent Suspected Cancer – Sarcoma West Middlesex Hospital RQM91)
  • Kingston Hospital
  • Croydon Health Services (USC Soft Tissue Sarcoma CAS (USC proforma only) DO NOT ATTEND @ Croydon University Hospital – RJ6)
• North central London, RNOH will act as a spoke for NCL 
  • RNOH Bolsover Street (Suspected Cancer Services Sarcoma RAS Service – Surgical – 16 years+ – Generic – RNOH B (RAN) telep
  • RNOH Stanmore (Suspected Cancer Services Sarcoma RAS Service – Surgical 16 years+ Generic RNOH S (RAN) tele clinics UCLH (2ww Sarcoma – UCLH – RRV)
• Southeast London
  • patients should be referred to the hub or spoke most convenient for the patient.
• Out of London referrals:
  • patients should be referred to the hub or spoke most convenient for the patient.

The London Sarcoma Service Hub, RMH Hub and all Spoke services are open to receive urgent suspected sarcoma cancer referrals from general practices in all London Integrated Care Systems and the wider referral geography.

Action for referrers

• Adult patients with a mass that could be a soft tissue sarcoma based on clinical evaluation (soft tissue lump with one of the following features: increasing in size, size>5cm, painful) should be referred for a direct access urgent ultrasound.  Please see Sarcoma clinical guidelines for healthcare professionals: https://sarcoma.org.uk/healthcare-professionals-hub/clinical-guidelines/
• Areas that have GP direct-access MRI soft tissue, please continue to use this service as per local guidelines
• Based on the ultrasound report and the clinical findings patients with:
  
  • A mass which could be a soft tissue sarcoma or another tumour (e.g. lymphoma) should be referred to one of the Spoke services for further evaluation, depending on the clinical picture and and/or patient choice.
  • Masses which are highly suspicious of or confirmed as soft tissue sarcomas should be referred directly to one of the Hubs.

For further information, please contact england.tcstlondon@nhs.net