Orthopaedic Oncology

Introduction

With regard to musculoskeletal tumor management, the last three decades have taken us from a time of treatment primarily by amputation, with survival for sarcomas still poor, to an era of limb sparing surgeries with improved overall survival.
Frequently the patient who has a musculoskeletal tumor will present to a surgeon after a mass is discovered by self examination or unmasked by imaging studies, obtained because of an injury or even pathological fracture. On careful questioning, many patients will admit to a prodromal course of pain or aching discomfort, although painless masses are also common. It is essential that evaluation be performed by a surgeon who is routinely familiar with all aspects of bone tumor treatment, otherwise mismanagement complicate or preclude treatment options later in the patient’s course of disease.
In our hospital we have an orthopedic oncology unit. On your first visit we attempt to establish the diagnosis in new cases and confirm the diagnosis in already investigated patient for you. Our staff provides the information about the disease as well as the investigations required to reach the final diagnosis. If you have brought blood results, MRI, bone or CT scans, we review all of them. If you have had a biopsy, we consult with our pathologists to review your pathology slides. If you have not had any of these studies, we attempt to schedule all of them during your first visit.
Plain radiograph is the initial investigation performed in all cases. It is often possible to suspect the benign, primary malignant and metastatic nature of these lesions from plain radiographs. Bone and soft tissue tumors are classified by their cell or tissue type and their ability to spread beyond the original site (metastasize). Thus, bone and soft tissue tumors fall into two major categories. They are benign (unable to spread) or malignant (able to spread to other parts of the body, especially to the lungs or other bones). Benign tumors are not life threatening, malignant tumors may be. Metastatic bone tumors are secondary bone tumors which have spread from other organs of the body.
MRI and/or CT scan are often required to know the local extent of both benign and malignant tumors. In malignant tumors, CT scan chest, bone scan, ultrasound or CT abdomen may be required to rule out distant spread or metastasis. After knowing the local and distant extend of the tumor, biopsy is the next step to establish the exact histological diagnosis. We will also schedule a biopsy that day if deemed necessary. A biopsy is a needle aspirate or surgical removal of a small piece of tissue for microscopic examination.