Bone 2ww Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.


REFERRAL GUIDELINES FOR SUSPECTED BONE CANCER (All patients will be seen within 2 weeks of referral)

  • Refer a patient who presents with symptoms suggesting bone cancer as detailed in the NICE guidance below. If you have concerns about a patient's symptoms and /or signs, consider a discussion with the local specialist.
  • Only refer when patient is available to attend an appointment within the next 14 days.


Urgently investigate increasing, unexplained or persistent bone pain or tenderness, particularly pain at rest (and especially if not in the joint), or an unexplained limp

Please refer to NICE referral guidelines for suspected cancer

Red Flags


Referral Criteria

Immediate X-ray:

  • Refer for an immediate X-ray a patient with a suspected spontaneous fracture.
  • If the X-ray:
    • Indicates possible bone cancer, refer urgently
    • Is normal but symptoms persist, follow up and/or request repeat X-ray, bone profile tests or referral.

Urgent 2ww:

  • Refer urgently if:
    • A patient presents with:
    • bony swelling
    • increasing in size
    • regional bony pain or tenderness

if Xray that suggests possibility of bone sarcoma

  • 2ww rerferral for adults
  • Appointment within 48hrs for child or young person

Consider very urgent X ray (within 48 hours) in any child or young person with:

  • unexplained Bone swelling, or Bone pain
  • PLEASE NOTE: The Mid Yorkshire pathway includes a review of radiographs and initiation of further appropriate investigations with CT and/or MRI. Local pathways are diagnostic. Orthopaedic clinical assessments will also be undertaken, and if needed, referral/liaison on to Royal Orthopaedic Hospital, Birmingham for concerning lesions will be made.

Referral Instructions:

Supporting Information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 05.2019
  • Ref No: CA1 – 05.2017
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