oct ewj 24 online - Flipbook - Page 32
Delays in Sarcoma Diagnosis:
The Issues Around Oncological
Delays and Negligence
by Mr Amit Kumar F.R.C.S Tr&Orth (Ed)
Consultant Orthopaedic & Oncological Sarcoma Surgeon
If asked to name a type of cancer, most people would
likely reply with one of the more common cancers like
bowel, breast, or lung. It is very unlikely they would
say sarcoma, which is probably because it is so rare
compared to other types of cancer, accounting for just
1% of all adult cancers. As a result, awareness of
sarcoma is equally low.
The ultrasound scan was performed with the report
by a Sonographer suggesting that there was a
cystic-looking lesion at the back of his knee and the
likely diagnosis was a Baker’s cyst.
Therefore, it is still important to be aware of sarcoma
cancers and their signs and symptoms; as is the case
with many other cancer types, the sooner sarcoma is
diagnosed, the easier it is to treat, with better expected
outcomes.
The patient continued to have ongoing left knee pain
and was assessed by the local hospital as now after
three months the whole leg was swollen and increasing pain. After clinical assessment, he was discharged
with a presumed ruptured Baker’s cyst. No further
investigations were performed.
The patient was reassured by the General Practitioner
(GP) on the basis of this report and was discharged.
Sarcomas are derived from connective tissue and can
be either soft tissue, bone, or gastrointestinal stromal
tumours (GIST) and can affect any parts of the body
and occur at any age.
He then continued to have pain and then sought an
opinion from an Orthopaedic Surgeon, privately.
Now at six months after initial presentation, he had
significant left lower limb swelling from the distal posterior thigh, across the back of the knee (popliteal
fossa) to his proximal calf. He had pain on weight
bearing and had to use a walking stick. Examination
revealed a tense solid mass coming from his popliteal
fossa into his proximal calf.
Its rarity, it can be very rare for a GP or clinician in
hospital to see a case in their working life. There are
15 soft tissue and bone tumours centres around the
UK and, through NHS England cancer pathways,
appropriate referral streams via suspected cancer twoweek-wait to the sarcoma centres are in place for
diagnostics and onward management in a Multidisciplinary Team (MDT).
Suspecting a possible tumour, the clinician arranged
an MRI scan for further diagnosis which revealed a
large soft tissue heterogenous mass in the popliteal
fossa extending into the proximal calf (gastrocnemius
muscles) suspected of a soft tissue sarcoma.
Case examples (partly fictitious):
Case number 1
A 72-year-old gentleman presented to his doctor with
knee pain, especially at the back. He had a swelling of
the back of his knee in the popliteal fossa and after
clinical assessment, a soft tissue fluctuant swelling was
found behind his knee. The working diagnosis was a
Baker’s Cyst and he was sent for an ultrasound scan in
the community.
EXPERT WITNESS JOURNAL
Following referral and review at the local Sarcoma
Service MDT meeting, it was concluded limb salvage
was not possible and that an above-knee amputation
would be the only curative measure for sarcoma.
The patient had surgery and recovered but later
developed distant spread with chest metastases. The
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