A common problem facing clinicians treating rare diseases is a DELAY in DIAGNOSIS.
Sarcomas certainly do not escape this curse. One of the bigger liability risks in musculoskeletal tumors is a delay in diagnosis. It increases the anxiety of both the patient and the uninformed initial evaluating physician. Many studies have documented the problem and have advocated for increased education and training. In general,” it is hard to see something the mind does not know of.” Sarcoma is almost never on the differential diagnosis list for masses evaluated by primary care physicians and other clinicians. Most masses are attributed to lipomas, hematomas, DVTs, and ganglions. Yes, these lesions are 100 fold more common, but one needs to be alert to the possibility of sarcoma.
A good rule of thumb for soft tissue masses is that if the mass is the size of a golf ball (4cm) or larger it should be evaluated for the possibility of being a sarcoma.
So how do we hasten the time to diagnosis?
My belief is that both the community and physicians need to be educated on signs and symptoms of sarcomas. Any growing mass, especially when larger than a few centimeters, sarcoma should be considered. Not every mass needs an urgent MRI, but every mass should have a follow-up plan for observation and patients should be instructed to return if the size increases or the symptoms change. More studies are needed to evaluate referral patterns and how to shorten the time to referral to a sarcoma specialist.
Attached are a few recent articles discussing the issue and how we can do a better job.
room for improvement; refer if mass is bigger than golf ball
