Tumour Bone and Soft Tissue - Paediatric CPC

For clinical advice, please telephone the relevant specialty service. Queries relating to the surgical management of bone tumours can also be directed to the South Australian Sarcoma and Bone Tumour Service. 

Northern Adelaide Local Health Network

• Lyell McEwin Hospital (08) 8182 9000

Southern Adelaide Local Health Network

• Flinders Medical Centre (08) 8204 5511

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

South Australian Sarcoma and Bone Tumour Service

• South Australian Sarcoma and Bone Tumour Service 0493 529 284

Exclusions

• retro-peritoneal tumours – refer to Tumour/Mass - Paediatric Surgery CPC
• spinal tumours – refer to Brain and Spinal Tumours - Paediatric Neurosurgery CPC
• cardiac tumours – refer to Cardiothoracic

Triage categories

Category 1 (appointment clinically indicated within 30 days)

Generally seen within 1 week given urgency of most paediatric cancers. For suspected malignant bone or orthopaedic soft tissue tumours, the SA Sarcoma and Bone Tumour Unit must be contacted — see Contacts for Clinical Advice.

• all tumours or suspected tumours of bone and soft tissue
• suspected bone or soft tissue sarcoma
• benign aggressive tumour e.g. giant cell tumour
• suspected haematological malignancy
• benign tumours such e.g. osteochondromas, bone cysts. May be Category 1 or 2 depending on imaging findings.

Category 2 (appointment clinically indicated within 90 days)

• non-aggressive or benign tumours e.g. osteochondroma. May be Category 1 or 2 depending on imaging findings.

Category 3 (appointment clinically indicated within 365 days)

• nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Do not needle biopsy suspected tumour

• clinical history
  • reason for referral
  • presenting symptoms including onset and duration of symptoms
  • location of mass
  • medical history and medications
  • any past cancer history and treatment
  • allergies
  • if general anaesthetic needed for diagnostics, e.g. magnetic resonance imaging (MRI)
  • height and weight
  • relevant family history
• any imaging completed, including date, provider and location of imaging done
• physical examination, standard

Referrals to the SA Bone and Soft Tissue Tumour Unit should be made using the SA Sarcoma Network Referral Form (PDF 192KB).

Additional information to assist triage categorisation

• imaging including x-ray, computed tomography (CT), MRI, ultrasound (US)
• bloods
  • full blood count (FBE)
  • urea and electrolytes (U&E) 
  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • liver function tests (LFT)

Clinical management advice

• Do not needle biopsy suspected tumour
• All tumours or suspected tumours must be referred urgently and discussed with the local hospital on-call orthopaedic registrar via switchboard.
• If patients are remote, simple imaging can be organised in the form of x-rays and/or ultrasounds to commence appropriate investigation.

Consumer resources

• Children's Cancer – Bone tumours
• Children’s Cancer Institute - Sarcoma
• The Sydney Children’s Hospital Network – Bone Cancers

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

• full name, including aliases
• date of birth
• residential and postal address
• telephone contact number/s – home, mobile and alternative
• Medicare number, where eligible
• name of the parent or caregiver, if appropriate
• preferred language and interpreter requirements
• identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

• impact on employment
• impact on education
• impact on home
• impact on activities of daily living
• impact on ability to care for others
• impact on personal frailty or safety
• identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery, where surgery is a likely intervention.
• Choice to be treated as a public or private patient.
• Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The role of the referring clinician (e.g. General Practitioner, Nurse Practitioner) in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the referring clinician once the transfer of care has occurred.