Step 1: Take a History

Objective :

Rapidly growing mass is a red flag

A 40 year old man comes to your office because he noticed a “bump” in the back of his thigh. “Doc, can you take this bump out?”

You ask him to tell you more about it.

Tip 1

Open ended questions establish which symptoms are most important to the patient and promote good rapport. More direct questions can follow later.

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He volunteers:

  • No history of trauma or injury
  • The mass has been there for 2 months
  • It is getting bigger, but it isn't painful
  • It doesn't interfere with his activities at all
  • There are no other symptoms associated with it
Tip 2

Soft tissue sarcomas are usually painless. Sometimes they grow quickly, but not always.

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You want to know more, so you ask him about...

...Any other lumps?

Tip 3

He denies this. Often people with lipomas, etc. have more than one lesion.

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...Weight loss or appetite changes?

Tip 3

He says not that he has noticed.

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...Fevers/chills or night sweats?

Tip 3

None of these Type B symptoms.

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...What other treatments has he had?

Tip 3

None so far.

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...Other Health?

Tip 3

Healthy, no known medical problems. Doesn’t smoke, occasional alcohol.

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...Family history of cancer ?

Tip 3

Not that he knows of.

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More Info Next Step

A large, deep growing mass should raise the suspicion of a sarcoma. If this was small and superficial we would be less worried. As seen with osteosarcomas, Type B symptoms are very unusual with soft tissue sarcomas as well.