Duke Health Referring Physicians


Early Assessment of Masses, Lesions Encouraged by Duke Sarcoma Team

Delayed diagnosis, treatment may increase risk of metastatic cancer

Lower extremity malignant fungating tumor

Clinical leaders of the Duke Sarcoma Center encourage referring physicians to adopt a proactive approach when encountering masses or lesions that are not commonly treated by family practitioners, general surgeons, or other specialists.

Approximately a year after formal creation of the sarcoma center, which partners with the Duke Cancer Center, the sarcoma team is reaching out to regional physicians to encourage assessment and early treatment for unusual presentations.

“Our objective is prompt diagnosis and treatment,” says Brian E. Brigman, MD, PhD, an orthopaedic surgical oncologist and director of the center. Soft tissue masses larger than 5 cm, or deep soft tissue masses should be evaluated. Painful lesion of bone should likewise be evaluated. “If their patients have a mass, a bone lesion, or any sort of bone or soft-tissue tumor that the physician is concerned about, we want to help assess those patients while working closely with the referring physician,” Brigman says. “Creating a collaborative approach with referring physicians is important to our approach.”

Sarcoma presentations are challenging for many reasons, Brigman says. The group of diseases referred to as sarcoma involve more than 100 different types of cancers and can occur anywhere in the body, in patients of any age. Sarcomas are cancers that affect the supporting tissue of the body. They can occur in bone, muscle, fat, or other tissues. 

“Because they occur anywhere in the body, can affect people of any age, and have more than 100 different subtypes, they are very challenging to diagnose and cure,” Brigman explains. “This work requires a true team approach. Patient outcomes are better when they’re treated by an integrated subspecialized sarcoma team, which includes adult and pediatric medical oncologists, radiation oncologists, radiologists, pathologists and a variety of surgeons including orthopaedic, general, thoracic and urologic.”

To refer a patient

To refer a patient, call 1-800-MED-DUKE or log in to Duke MedLink.

Offering access to clinical trials

The sarcoma team also offers access to clinical trials thorough its association with the Sarcoma Alliance for Research through Collaboration, a group of leading U.S. centers dedicated to improving care of patients through research and clinical trials.

The Duke team often becomes involved when the conditions are discovered late in the growth cycle, he adds. Many are diagnosed incidentally as a result of increasing girth or because of patient concerns about a painful lesion. Others are discovered as a painless mass, Brigman adds.

“Bone and soft-tissue sarcomas are rare, and as a result, many general practitioners in pediatrics, family practice, orthopaedic, or general surgery may see only one or two in their career,” Brigman adds. “These tumors are often overlooked, which often results in worse outcomes for the patient.”

Another challenge the sarcoma center team encounters is unintentional mismanagement of a cancerous presentation, Brigman says. “We do respond to situations in which a physician assumes the tumor is benign and the patient ends up undergoing an inappropriate surgery. This can complicate definitive treatment and may result in an amputation. That is a real problem for many our patients.”

Approximately 15-20 percent of patients referred to the Duke Sarcoma Center present following an initial procedure that complicates a corrective treatment plan, Brigman adds.

“Sarcomas can occur anywhere in the body, but we find about 60 percent of them in the extremities,” he says.

The Duke Cancer Center has treated patients with sarcoma for years, says Brigman, but the creation of the Duke Sarcoma Center and their designation as a center of excellence was another significant step, he says, in the team’s continuous efforts to create a distinctive experience for patients.

“Since we’ve stated the center, our goal has been to continue working to optimize the patient experience by integrating every member of our team more closely and ensuring that, as a team, we are always focused on the patient experience."