Orthopaedic Oncology – Bone Cancer Treatment
Orthopaedic Oncology (Orthopaedic Oncosurgery) is a specialisation of Orthopaedics that deals with tumours of the bones-joints and soft tissues (muscles, fat) of the limbs (shoulder, arm, elbow, forearm, wrist, hands, hip, thigh, knee, leg, ankle, feet).
These tumours can be of two types. They can be either benign (tumours that do not spread outside the bone) or malignant (tumours that spread outside the bone, especially to the lungs and other bones). The malignant tumors are also called as sarcomas(bone cancer).
Tumours in the soft tissues (muscles, fat) can also be benign or malignant. Both benign and malignant tumours have a good chance of cure if they are detected early and are treated by a trained orthopaedic oncology surgeon.
Then there are cancers of other organs- breast, kidney, thyroid, prostate, lung,stomach-which spread to any of the 206 bones in the body. This spread (called as metastasis) weakens the bones and causes pain and fractures(called pathological fracture).
Even the diagnosis of most of these tumours is confusing. A systematic approach is required right from the beginning. This includes proper x rays, MRI scans and if required other scans like a PET/CT/Bone Scan. Most important for the diagnosis is a well planned and correctly executed biopsy. This biopsy is preferably done closed(without any skin incision).
Once the biopsy confirms that the bone/soft tissue has a tumour, the further management plan is chalked out by the Orthopaedic Oncologist along with the medical oncologist and radiation oncologist, if it is a malignant tumour (sarcoma).
Some tumours require chemotherapy (looked after by the medical oncologist) and radiation therapy(given by the radiation oncologist), apart from surgery which is done by the orthopaedic oncologist/oncology surgeon.
An Orthopaedic Oncologist/Oncosurgeon is involved in a variety of surgeries, which are undertaken in the treatment of bone tumour patients. The goal of these long and tedious surgeries is to remove not only the tumour but also to give the patient a functional and useful limb.
An Orthopaedic Oncologist/Oncosurgeon is, therefore, involved in the treatment of:
- Swellings (both bony and soft tissue) of the limbs, pelvis and spine
- Benign bone tumours like Giant cell tumour (GCT), Fibrous dysplasia, Enchondromas.
- Malignant bone tumors, that are cancers of the bone, also called as Sarcomas. These include Osteosarcoma, Chondrosarcoma, Ewings sarcoma and many others.
- Benign and malignant soft tissue tumours of the limbs, spine and pelvic areas like lipoma, liposarcoma, leiomyosarcoma and many others.
- Cancers from other organs that spread to the bone and cause pain or fractures. (Metastasis to the bone or Secondaries to the bone)
- Pathological Fractures
- Recurrent tumours
- Revision Megaprosthesis
- Limb Salvage
- Cystic lesions of the bone-Simple bone cysts and aneurysmal bone cysts.
- Langerhan Cell Histiocytosis and rare lesions of the bone.
- Advanced surgeries like ECRT (Extracorporeal radiation therapy) where the bone containing the tumor is operated and removed in the operation theatre. It is then sent to the radiation department immediately, where radiation treatment is given for 25 minutes, while the patient is still in the operation theatre under anaesthesia. After receiving the bone back, it is put back into the body with a metal implant(plate).
- Undiagnosed pain in the limbs, spine, pelvis.
- Undiagnosed bone or soft tissue problems are seen on X rays, CT Scan, MRI or PET-CT Scan.
- Biopsy (Keyhole), diagnosis, decision making/management and surgery if required, of bone pain and swellings.
As we head into the next generation of patient care and medical achievements, it is now recognised and understood that Orthopaedic Oncology is a specialised branch that should be handled by experts who are well trained in this difficult sub-speciality. To get the best treatment outcomes and patient satisfaction in bone tumours, a fellowship-trained Orthopaedic Oncosurgeon is recommended.
The difference between saving a limb or not and reducing the chances of recurrence of bone tumours is the reason for choosing a specialist Orthopaedic Oncosurgeon.
+10yrs experience & a good orthopaedic oncologist could help avoid amputation too.
Dr Rajeev Reddy
MBBS, D Ortho, DNB Ortho, FOLS, FMO, FAGE, MNAMS
Apollo Hospitals, Jubilee Hills, Hyderabad, India