Diagnosis and management of soft tissue sarcoma.

Soft tissue sarcomas are a heterogeneous group of tumours of mesodermal origin. Although they are rare, accounting for less than 1% of all malignant tumours, half of patients diagnosed will die from the sarcoma. w1 Lumps are commonly encountered in primary and specialist care, and differentiating benign from possibly malignant lesions can be difficult. The estimated benign:malignant ratio is 100:1. A family doctor will see about one case of soft tissue sarcoma for every 24 years of practice. However, prognosis is related to size at presentation, so early recognition, referral to a specialist (see National Institute for Health and Clinical Excellence (NICE) guidelines), and appropriate treatment improve outcomes. Evidence from cohort studies suggests that patients experience delays in referral, w4 and in the United Kingdom referrals to specialist sarcoma centres often fall outside the recommended two week window for suspected cancer. 4 We review evidence from national guidelines, randomised trials, and observational studies to provide the nonspecialist with a guide to diagnosis, appropriate referral, and management of patients with suspected soft tissue sarcoma, focusing on a multidisciplinary approach. We limit our discussion of management to the treatment of soft tissue sarcoma of the extremities—the most common site.