Clinical Presentation and Tumour Burden in Head and Neck Sarcomas: Implications for Early Diagnosis and Referral

Background/Objectives: Head and neck sarcomas account for 11% of all soft tissue and 9% of all bone sarcomas in the UK. Diagnostic delays are common, with non-specific symptoms and histological misdiagnosis reported in up to 42% of cases. This study aims to evaluate the association between presenting symptoms, symptom duration, and tumour size to inform a tailored HNS diagnostic strategy for early referral to a tertiary centre. Methods: We analysed a retrospective cohort of 425 adult and paediatric patients referred to the London Sarcoma Service between 2002 and 2025. Results: Our cohort analysis identified a median tumour size of 44.00 mm and symptom duration of 3 months. Although symptom duration did not predict tumour size (β = 0.63, p = 0.76), non-specific symptoms (swelling, pain, nasal/oral changes) were significantly associated with larger tumours (OR 1.96–3.66), alongside systemic symptoms (β = 22.90 mm, p = 0.044). Each 1 mm increase in tumour size was also associated with a 2.60% increased chance of a higher-grade sarcoma (OR = 1.03 per mm, p < 0.001). Conclusions: To our knowledge, this is the largest cohort study to characterise diagnostic patterns in HNS. Our findings reveal three critical insights: 1. Current size-based referral thresholds are inadequate. 2. Non-specific symptoms, such as nasal or oral symptoms, are frequently overlooked. 3. The anatomical complexity of the HN region demands early tailored diagnostic strategies. We propose a hypothesis-generating ‘1–2–1’ framework to support earlier clinical suspicion, which requires prospective validation.