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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.

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Common Conditions in Orthopaedic Oncology

  • Primary Bone Tumors:These are tumors that originate in the bone itself and can be benign (non-cancerous) or malignant (cancerous). Common types include:

  • Osteosarcoma: The most common type of bone cancer, usually affecting the long bones (e.g., femur, tibia).

  • Ewing Sarcoma: A type of cancer that typically occurs in children and adolescents, often in the pelvis or long bones.

  • Chondrosarcoma: A cancer that develops in cartilage cells, often occurring in the pelvis, ribs, or long bones.

  • Giant Cell Tumor of Bone: A usually benign tumor that can be aggressive, often occurring around the knee.

  • Soft Tissue Tumors:These tumors arise in the soft tissues surrounding bones, such as muscles, fat, nerves, and blood vessels. Common types include:

  • Liposarcoma: Cancer that arises in fat cells, often found in the limbs or abdomen.

  • Rhabdomyosarcoma: A malignant tumor of skeletal muscle tissue, often occurring in children.

  • Synovial Sarcoma: A rare tumor that typically occurs near joints, especially in young adults.

  • 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.

  • Surgical Treatment: Involves stabilizing fractures, removing metastatic lesions, or performing joint replacement in cases of significant bone loss.

  • Benign Bone Lesions:Non-cancerous conditions such as:

  • Osteochondroma: A benign bone growth that usually occurs near the growth plates of long bones.

  • Enchondroma: A benign tumor made of cartilage, often found in the small bones of the hands and feet.

  • Aneurysmal Bone Cyst: A blood-filled cyst that can cause swelling and pain, often occurring in children and adolescents.

Diagnosis and Evaluation

  1. Imaging Studies:

    • X-rays: Initial imaging to assess bone structure.

    • MRI: Provides detailed images of bone and soft tissue, helpful in assessing the extent of tumors.

    • CT Scans: Used for evaluating complex cases or assessing metastases.

    • Bone Scintigraphy (Bone Scan): Helps detect areas of increased bone metabolism, indicating possible tumors.

  2. Biopsy:

    • 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.

  3. Blood Tests:

    • 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

  • Tumor Resection:The primary treatment for malignant tumors, where the tumor and a margin of healthy tissue are surgically removed. This can involve:

  • Wide Resection: Removal of the tumor with a surrounding margin of normal tissue to ensure complete removal.

  • 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.

  • 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.

  • 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.

  • 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.

  • Reconstruction:After tumor removal, reconstructive techniques may be needed, including:

  • Endoprosthetic Reconstruction: Involves the use of metal implants to replace the bone that has been removed.

  • Bone Grafting: Using the patient’s own bone (autograft) or donor bone (allograft) to reconstruct the defect left after tumor removal.

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Adjuvant Therapies

  • 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.

  • 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.

  • Targeted Therapy: Involves using medications that specifically target cancer cell pathways. This is more common in soft tissue sarcomas.

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Postoperative Care and Rehabilitation

  • Physical Therapy: Rehabilitation is crucial for regaining strength and function after surgery. This may include mobility training, strengthening exercises, and functional training.

  • Pain Management: Multimodal approaches may be employed to manage postoperative pain effectively.

  • 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

  • Infection

  • Blood loss

  • Nerve or vascular injury

  • Wound healing complications

  • Recurrence of the tumor

  • Amputation-related complications (if applicable)

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