Current RMA Instruments
| Reasonable Hypothesis SOP | 66 of 2020 |
| Balance of Probabilities SOP | 67 of 2020 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 170.1 – 170.9, 170.01, 170.02
- ICD-10-AM Codes: C40, C41
Brief description
This SOP covers a range of cancer types, with osteosarcoma being the most common. Bone cancers are rare. About half occur in people under age 20, with a second peak in people over age 60.
Confirming the diagnosis
Diagnosis requires histology from biopsy or surgery. Imaging may show a characteristic appearance, but is not sufficient to confirm the diagnosis.
The relevant medical specialist is an oncologist or orthopaedic surgeon.
Additional diagnoses covered by SOP
- Angiosacroma of bone
- Chondrosarcoma of bone or skeletal cartilage (including ribs)
- Ewing’s sacroma of bone
- Fibrosacroma of bone
- Malignant fibrous histiocytoma of bone
- Osteoblastoma
- Osteosarcoma
Conditions not covered by SOP
- Chondrosarcoma of: bronchus; ear; eyelid; larynx; nose; or trachea* - soft tissue sarcoma SOP
- Giant cell tumour of bone (benign)#
- Leukaemia, lymphoma or myeloma affecting bone*
- Metastatic neoplasms within bone - use SOP for primary site
- Soft tissue sarcoma* of extraskeletal tissues
* another SOP applies
# non-SOP condition
Clinical onset
The typical presentation is with localised pain, often of several months duration. There may be a lump or mass present at the site of the pain. In adults the condition tends to arise at a site of existing bone pathology (e.g. Paget's disease, a bone infarct or a site of irradiation).
Clinical worsening
The only SOP worsening factor is for inability to obtain appropriate clinical management. Disease modifying treatment is available (surgery and chemotherapy). Outcomes largely depend on extent of disease and disease spread at presentation. Patients with localised disease have a favourable prognosis, while those with limited pulmonary metastatic disease may also respond well to treatment and be long-term survivors.