Multiple international studies have examined which symptoms that should raise suspicion of sarcoma in soft tissue), and in bone. However, these studies are all performed in highly specialized care units. In the recently implemented cancer pathway for sarcomas the following five symptoms/clinical findings are defined as inclusion criteria for the cancer patient pathway referral program: Soft tissue tumours > 5 cm, soft tissue tumours in or profound of the fascia, palpable bone tumour, deep persisting bone pains without other obvious orthopaedic reasons, fast growing soft tissue tumours.

The prevalence and predictive values of alarm symptoms in primary care have been investigated for other cancer forms, but not for sarcomas.Studies on alarm symptoms of sarcoma in primary care are greatly lacking, and thus, the inclusion criteria for the sarcoma pathway are based mainly on evidence derived from specialist care. This might cause problems when applying the chosen criteria in primary care. Furthermore, the implementation of criteria may exclude patients without alarm symptoms, so it is of great importance that the selected criteria are the correct ones.

Sarcoma patients frequently experience some degree of delay before referral to a specialized centre. This delay can be caused by both patient and doctor. It is the common perception that an early cancer diagnosis is associated with better survival, and sarcomas have the needed features for this relationship to be true. The existing literature, however, is mixed and confusing, and there is a lack of trial evidence. The association between symptom interval and survival differs depending on the type of cancer.

Some sarcoma studies report that a long symptom duration improve survival, and others that the risk of death is increased with longer symptom duration. There have been many attempts to reduce the delay time before diagnosis of sarcomas. The UK and the Netherlands have introduced guidelines on diagnosing sarcomas, but this did not have the desired effect, as compliance to these guidelines was generally low.

The recent development in Denmark is the implementation of cancer patient pathways in 2009, as a governmental initiative and demand. The cancer patient pathway describes the standard pathway for the patient through the health care system, and defines the maximal time period between referral, first appointment at the sarcoma centre, decision of treatment and treatment start.


Our studies show that introduction of cancer patient pathways shortens the duration the diagnostic process of sarcomas (Heidi Dyrop). In a PhD thesis Heidi Dyrop further investigate the symptoms, routes and time to diagnosis for patients with a suspected sarcoma.                 

The research are performed in collaboration with Department of Oncology , Research Unit of General Practice, Aarhus University.


 Dr. Johnny Keller, senior Consultant, MD, DMSc


Dr. Peter Holmberg Jorgensen, MD, DMSc


Dr. Bjarne Hauge Hansen, MD


Dr. Thomas Baad Hansen,, MD, PhD


Dr Michael Bendtsen, MD, PhD


PhD student Heidi Dyrop