UK guidelines for the management of soft tissue sarcomas

Overview

These UK guidelines describe best practice for the diagnosis and management of soft tissue sarcomas in adults. Because these tumours are rare and varied, care should be centralised in specialist sarcoma multidisciplinary teams.

Recognising a suspicious mass

A soft tissue lump that is large, deep to the fascia, growing or painful should be treated as possibly malignant. Ultrasound is a useful first test, and suspicious lesions need MRI and referral to a sarcoma service before any surgery.

Diagnosis and staging

Core needle biopsy, planned by the specialist team, is the standard diagnostic approach. Sarcoma-expert pathologists should review the samples, as molecular testing is often needed for an accurate subtype diagnosis. Staging includes chest imaging, plus additional imaging for subtypes that spread in unusual ways.

Treatment

Surgical excision with adequate margins is the main treatment for localised disease. Unplanned excision of an unrecognised sarcoma should be avoided and, if it happens, the patient should be referred for further treatment. Radiotherapy, before or after surgery, reduces local recurrence in selected patients. Chemotherapy is used for chemosensitive subtypes and advanced disease. Retroperitoneal sarcomas need management in specialist centres.

Follow-up

Follow-up is tailored to tumour grade and site, focusing on local recurrence and lung metastases.