Soft tissue lump service at Highgate Hospital

What is a soft tissue lump service?

A soft tissue lump service is a clinic that assesses new or unusual lumps and bumps, most of which turn out to be harmless, to work out what they are and whether they need any further action. Where a lump could be a rare cancer called a sarcoma, the service can arrange the right tests and refer you on to specialists quickly.

What conditions does it assess?

This service assesses lumps and bumps that could be:

• a lipoma, one of the most common lumps, made of harmless fat cells under the skin or in the muscle
• another benign, non-cancerous, soft tissue tumour
• an indeterminate tumour, which can grow locally but doesn't spread elsewhere
• a soft tissue sarcoma, a rare cancer of the muscles, tendons, fat, blood vessels or nerves
• a benign or cancerous bone tumour, including cancer that has spread to the bone from elsewhere.

What are the benefits of this service?

Most lumps are not harmful, so a big benefit of this service is reassurance, confirming quickly that a lump is nothing to worry about. Where something more serious is found, prompt assessment means you can be referred to the right specialist team quickly, since early diagnosis matters for the best possible outcome with rare cancers such as sarcoma.

Are there different types of assessment?

Assessment usually involves a combination of:

• a clinical examination by a doctor experienced in soft tissue lumps
• imaging, such as an ultrasound or MRI scan
• a core needle biopsy, taking a small tissue sample, if imaging alone can't confirm what the lump is.

You may see different specialists depending on what's suspected. There's a crossover between soft tissue lumps and skin conditions, so if your history suggests a skin specialist, a dermatologist, would be more appropriate, you may be redirected to one instead.

If a sarcoma is confirmed or suspected, you'll be referred to a specialist multidisciplinary team, a group of experts including surgeons, radiologists, oncologists, pathologists and clinical nurse specialists.

What happens before your assessment?

You can usually be referred by your GP or, at some private clinics, refer yourself, with or without a GP letter. Certain features make a lump more likely to need investigating, based on national guidance: it's larger than 5cm across, a little bigger than the short side of a credit card, it sits deep beneath the skin, or it's painful, recurrent, or growing quickly.

Once you've been referred, you'll usually be asked about your symptoms and any previous investigations, and an appointment will be arranged, often alongside imaging such as an ultrasound or MRI.

What happens during your assessment?

1. You make contact, either through your GP or directly, and discuss your symptoms and any previous investigations.
2. An appointment is arranged, often alongside imaging such as an ultrasound or MRI.
3. At your clinical assessment, a doctor examines the lump, and a core needle biopsy may be taken if needed to help confirm what it is.
4. Your results are reviewed, and your team plans your treatment, refers you on to a specialist service, or discharges you with a diagnosis and reassurance.

What happens afterwards?

There's no hospital stay for the assessment itself, and if you have a needle biopsy, this is a minor procedure you can go home after. Afterwards:

• if your lump is confirmed as benign, you often won't need any further treatment, though surgery might be considered if it's causing troubling symptoms
• if a sarcoma or other cancer is confirmed, you'll be referred to a specialist multidisciplinary team, who will plan your treatment
• if your assessment points to a skin condition rather than a soft tissue lump, you may be redirected to a dermatologist instead.