Alarm symptoms of soft-tissue and bone sarcoma in patients referred to a specialist center

Acta Orthop. 2014 Dec;85(6):657-62. doi: 10.3109/17453674.2014.957086. Epub 2014 Sep 1.


Background and purpose: The Danish Cancer Patient Pathway for sarcoma defines a set of alarm symptoms as criteria for referral to a sarcoma center. This may exclude cancer patients without alarm symptoms, so we investigated the presence of alarm symptoms (defined as being indicative of a sarcoma) in patients who had been referred to the Aarhus Sarcoma Center.

Patients and methods: We reviewed the medical records of all 1,126 patients who had been referred, with suspected sarcoma, from other hospitals in the period 2007-2010 for information on symptoms, clinical findings, and diagnosis. Alarm symptoms were analyzed for predictive values in diagnosing sarcoma.

Results: 179 (69%) of 258 sarcoma patients were referred with alarm symptoms (soft-tissue tumor>5 cm or deep-seated, fast-growing soft-tissue tumor, palpable bone tumor, or deep persisting bone pain). The remaining 79 sarcomas were found accidentally. "Size over 5 cm" for soft-tissue tumors, and "deep persisting bone pain" for bone tumors had the highest sensitivity and positive predictive value. Of the 79 sarcoma patients who were referred without alarm symptoms, 7 were found accidentally on imaging, 5 were referred with suspected recurrence of a sarcoma, 64 were referred with a confirmed histological diagnosis, and 3 were referred for other reasons.

Interpretation: Defined alarm symptoms are predictive of sarcoma, but one-third of the patients were found accidentally. Further studies on presenting symptoms in primary care are needed to assess the true value of alarm symptoms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bone Neoplasms / diagnosis*
  • Bone Neoplasms / epidemiology
  • Cancer Care Facilities / statistics & numerical data*
  • Critical Pathways / statistics & numerical data
  • Denmark / epidemiology
  • Female
  • General Practice / statistics & numerical data
  • Humans
  • Incidental Findings
  • Male
  • Middle Aged
  • Neoplasms / diagnosis
  • Neoplasms / epidemiology
  • Osteosarcoma / diagnosis*
  • Osteosarcoma / epidemiology
  • Predictive Value of Tests
  • Prevalence
  • Referral and Consultation / statistics & numerical data*
  • Sarcoma / diagnosis*
  • Sarcoma / epidemiology
  • Sensitivity and Specificity
  • Soft Tissue Neoplasms / diagnosis*
  • Soft Tissue Neoplasms / epidemiology
  • Young Adult