Bone Cancer
What is bone cancer
Orthopaedic Oncology is a specialized field of orthopaedics that focuses on the diagnosis and treatment of bone and soft tissue tumours, both benign and malignant. This area involves a multidisciplinary approach, often working with medical oncologists, radiation oncologists, pathologists, and rehabilitation specialists to provide comprehensive care for patients with musculoskeletal tumours.


Common Conditions in Orthopaedic Oncology
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Primary Bone Tumors:These are tumors that originate in the bone itself and can be benign (non-cancerous) or malignant (cancerous). Common types include:
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Osteosarcoma: The most common type of bone cancer, usually affecting the long bones (e.g., femur, tibia).
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Ewing Sarcoma: A type of cancer that typically occurs in children and adolescents, often in the pelvis or long bones.
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Chondrosarcoma: A cancer that develops in cartilage cells, often occurring in the pelvis, ribs, or long bones.
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Giant Cell Tumor of Bone: A usually benign tumor that can be aggressive, often occurring around the knee.
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Soft Tissue Tumors:These tumors arise in the soft tissues surrounding bones, such as muscles, fat, nerves, and blood vessels. Common types include:
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Liposarcoma: Cancer that arises in fat cells, often found in the limbs or abdomen.
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Rhabdomyosarcoma: A malignant tumor of skeletal muscle tissue, often occurring in children.
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Synovial Sarcoma: A rare tumor that typically occurs near joints, especially in young adults.
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Metastatic Bone Disease:Cancer that spreads to the bone from other parts of the body, such as breast, prostate, or lung cancer. This condition can cause pain, fractures, and other complications.
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Surgical Treatment: Involves stabilizing fractures, removing metastatic lesions, or performing joint replacement in cases of significant bone loss.
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Benign Bone Lesions:Non-cancerous conditions such as:
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Osteochondroma: A benign bone growth that usually occurs near the growth plates of long bones.
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Enchondroma: A benign tumor made of cartilage, often found in the small bones of the hands and feet.
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Aneurysmal Bone Cyst: A blood-filled cyst that can cause swelling and pain, often occurring in children and adolescents.

Diagnosis and Evaluation
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Imaging Studies:
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X-rays: Initial imaging to assess bone structure.
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MRI: Provides detailed images of bone and soft tissue, helpful in assessing the extent of tumors.
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CT Scans: Used for evaluating complex cases or assessing metastases.
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Bone Scintigraphy (Bone Scan): Helps detect areas of increased bone metabolism, indicating possible tumors.
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Biopsy:
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A critical step in diagnosing bone or soft tissue tumors. This can be performed percutaneously (through the skin) using imaging guidance or surgically to obtain tissue samples for pathological evaluation.
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Blood Tests:
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Certain blood markers (e.g., alkaline phosphatase, lactate dehydrogenase) may be evaluated, especially in the context of bone tumors.
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Surgical Treatments
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Tumor Resection:The primary treatment for malignant tumors, where the tumor and a margin of healthy tissue are surgically removed. This can involve:
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Wide Resection: Removal of the tumor with a surrounding margin of normal tissue to ensure complete removal.
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Limb-Salvage Surgery: In cases where tumors are located in limbs, techniques are used to remove the tumor while preserving the limb, often followed by reconstruction using implants or bone grafts.
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Amputation: In certain cases, particularly with extensive tumors or those involving significant bone loss, amputation may be necessary. This decision is made based on tumor location, size, and involvement with surrounding structures.
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Joint Replacement: In cases where the tumor affects the joints (e.g., hip, knee), joint replacement may be performed after tumor removal to restore function.
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Cryoablation and Radiofrequency Ablation: Minimally invasive techniques used to destroy tumor cells using extreme cold or heat. These methods can be used for both benign and selected malignant tumors.
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Reconstruction:After tumor removal, reconstructive techniques may be needed, including:
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Endoprosthetic Reconstruction: Involves the use of metal implants to replace the bone that has been removed.
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Bone Grafting: Using the patient’s own bone (autograft) or donor bone (allograft) to reconstruct the defect left after tumor removal.

Adjuvant Therapies
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Chemotherapy: Often used in conjunction with surgery for malignant bone tumors, especially in osteosarcoma and Ewing sarcoma, to reduce tumor size or treat metastatic disease.
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Radiation Therapy: May be used as an adjuvant treatment for certain tumors or for pain control in metastatic bone disease. It can also help shrink tumors before surgery.
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Targeted Therapy: Involves using medications that specifically target cancer cell pathways. This is more common in soft tissue sarcomas.

Postoperative Care and Rehabilitation
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Physical Therapy: Rehabilitation is crucial for regaining strength and function after surgery. This may include mobility training, strengthening exercises, and functional training.
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Pain Management: Multimodal approaches may be employed to manage postoperative pain effectively.
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Follow-Up Care: Regular follow-up with imaging and clinical evaluation is essential to monitor for recurrence, manage complications, and assess functional outcomes.

Complications and Risks
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Infection
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Blood loss
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Nerve or vascular injury
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Wound healing complications
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Recurrence of the tumor
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Amputation-related complications (if applicable)