Prompt referral to a tertiary centre when suspicious of the diagnosis of sarcoma:

• Evaluation by a member of the specialized multi-disciplinary team
• Investigations as outlined below
• Discussion in a multidisciplinary forum
• Management as planned by TEAM

In general, the Sarcoma Group supports the following principles of referral:

• Any patient with a bone lesion or soft tissue mass that on general history and physical examination is not diagnosed to be benign should be referred to or discussed with the Musculoskeletal Tumor and Sarcoma Group of the BC Cancer Agency.
• Primary referral is preferable even before the appropriate investigations have been ordered. The working diagnosis of "mass" or "hole-in-bone" is sufficient for referral.
• Some benign soft tissue and bone tumors are extremely difficult to treat. For this reason, the referral of benign disease is also encouraged.
• If the patient requires surgical management, and the referring surgeon is comfortable performing with the recommended procedure, the patient will be referred back to that surgeon for surgery after a diagnosis is made. Generally clear communication between outside (referring) doctors and BCCA attending doctors is required so that the appropriate arrangements can be made for the individual patient.
• If for any reason primary care is mandatory outside the Agency in the local community and the patient cannot be referred to the Agency, then strict adherence to first principles of investigation and biopsy are absolutely essential.

1) Adult Patients(>16 years) – After referral to BC Cancer Agency

Primary referral – untreated patients

• Patients are generally seen within 5 –10 working days after referral. More urgent situations require personal contact with one of the oncologists on the Team. If any pertinent Xrays have been done it is very important that they be available for the New Patient Appointment. If there is any doubt that films will not be at BCCA, then arrangements for the patient to pick up and bring them should be made.
• At the first visit, the patient is seen in consultation by an oncologist who will arrange all pertinent investigations usually for during the next 10 working days. These investigations might include MR and CT of the local area, CT-guided biopsy of lesion, if indicated, CT lungs and bonescan, if indicated.
• Discussion at the Musculoskeletal Tumor and Sarcoma Conference (Mondays at 0800h) is planned for 10 to 15 working days after the new patient visit. At that time the specialized team of surgeons, radiation oncologists, medical oncologists, pathologists, and radiologists reviews all pertinent records, investigations and pathology with representation by Videolink from all FOUR Agency sites. The Team makes management decisions.
• Referring physicians and surgeons are welcome to participate at the Conference.
• Patients are generally informed of the plans within the next day or two. Recommendations are communicated to the referring doctor in a timely fashion by phone and/or formal Conference note.
• Whenever possible the patient will be advised to return to his or her own community for subsequent treatment. However if care is required at a tertiary centre such a recommendation will be made to the primary physicians.

Secondary referral – after diagnosis and some management

Referral to the Agency after the diagnosis of musculoskeletal tumor or sarcoma, either recent or remote, should be accompanied by all available information on the patient at the time of referral. This information might include clinical and laboratory information, investigations and X-rays, surgical observations and pathologic material. Because of short intervals to new patient appointments –imaging is best carried to the appointment by the patient so it is available for the consulting doctor at the time of the appointment.

2) Children (<17 years)

Any patient less than seventeen years of age at PRESENTATION should be referred to the Paediatric Oncology Division of the Cancer Agency located at the BC Children's Hospital(BCCH) or the Paediatric orthopedic surgeon at the BCCH (Dr. Ken L. B. Brown, (604) 875-2642 ). The principles of treatment (particularly in regard to biopsy and surgical treatment) remain the same but there are certain unique characteristics of these tumours recognized in this age group.

3) Tertiary Triage Criteria

All patients should be referred to a tertiary cancer center either BC Cancer Agency or the BC Children's Hospital. Below are the numbers to contact if you are referring a new patient:

Organization	Clinic	Phone	FAX
BC Cancer Agency	Vancouver Cancer Clinic	(604)877-6066	(604)708-2005
	Fraser Valley Cancer Clinic	(604)930-4004	(604)675-7222
	Cancer Clinic of the Southern Interior	(250)712-3969	(250)979-4001
	Vancouver Island Cancer Clinic	(250)370-8228, Local 2439	(250)519-2001
BC Children's Hospital	Oncology clinic	(604)875-2116