• A patient who presents with symptoms suggesting bone cancer or sarcoma should be referred to a team specialising in the management of bone cancer and sarcoma, or to a recognized bone cancer centre, depending on local arrangements (D).
• If a primary healthcare professional has concerns about the interpretation of a patient's symptoms and/or signs, a discussion with the local specialist should be considered (D).
• Patients with increasing, unexplained or persistent bone pain or tenderness, particularly pain at rest (and especially if not in the joint), or an unexplained limp should be investigated by the primary healthcare professional urgently. The nature of the investigations will vary according to the patient's age and clinical features (C [DS]).
• In older people metastases, myeloma or lymphoma, as well as sarcoma, should be considered.

• A patient with a suspected spontaneous fracture should be referred for an immediate X-ray (B [DS]).
• If an X-ray indicates that bone cancer is a possibility, an urgent referral should be made (C [DS]).
• If the X-ray is normal but symptoms persist, the patient should be followed up and/or a repeat X-ray or bone function tests or a referral requested (C [DS]).

• In patients presenting with a palpable lump, an urgent referral for suspicion of soft tissue sarcoma should be made if the lump is:
• Greater than about 5 cm in diameter.
• Deep to fascia, fixed or immobile.
• Painful.
• Increasing in size.
• A recurrence after previous excision.
• If there is any doubt about the need for referral, discussion with a local specialist should be undertaken (C).

The referral timelines used in this guideline are as follows:

• Immediate: an acute admission or referral occurring within a few hours, or even more quickly if necessary.
• Urgent: the patient is seen within the national target for urgent referrals (currently 2 weeks).
• Non-urgent: all other referrals.