Suspected bone tumour: the MDT pathway

When an urgent assessment matters

Persistent or night bone pain, progressive swelling, pain after minor loading, possible pathological fracture, new neurological symptoms or a growing deep mass require assessment. A suspected fracture or inability to bear weight warrants urgent care.

The specialist pathway

1. Two-view radiographs of the affected region where feasible.
2. MRI of the entire involved bone and compartment including adjacent joints. CT is valuable for cortex, mineralisation and pelvic lesions.
3. Previous imaging and DICOM for longitudinal comparison.
4. MDT review before biopsy where primary malignant bone sarcoma is suspected, so the route and target are planned.
5. Biopsy with expert pathology when indicated.
6. Stage according to histology, including chest CT for confirmed malignant bone sarcomas where indicated.
7. Shared treatment planning including expected function and rehabilitation.

Documents to bring

Why specialist treatment matters

Unplanned biopsy or surgery can compromise definitive excision and limb preservation. A dedicated team coordinates surgeons, radiologists, pathologists, medical and radiation oncologists and rehabilitation specialists.

Questions for the MDT

• Which diagnosis is proven versus only suspected?
• Is pathology review or molecular testing needed?
• What is the fracture risk and permitted weight bearing?
• Is systemic treatment indicated before surgery?
• Which limb-sparing and reconstructive approaches are realistic?
• How will recurrence and implant complications be monitored?

Clinical sources

• UK guidelines for the management of bone sarcomas, 2025
• ESMO-EURACAN-GENTURIS-ERN PaedCan, Bone Sarcoma CPG
• NCI Osteosarcoma Treatment (PDQ)
• NCI Ewing Sarcoma Treatment (PDQ)

Clinical images and videos from the author’s archive. Patient identifiers have been removed. Diagnoses are stated only where supported by source records. This information does not replace an individual multidisciplinary decision.