There are two types of bone tumors: benign (non-cancerous bone tumor that does not spread) and malignant (cancerous).
When you come see us, our first step is to determine which type of tumor it is. We also need to determine if the tumor has spread to the bone from some other part of the body (metastatic disease to bone).
Certain types of bone cancer are more common in specific bones. Among young patients, osteosarcoma and Ewing's sarcoma are most common. In adults, chondrosarcoma is the most common bone cancer.
Osteosarcoma is most commonly found in the bones around the knee, while Ewing's sarcoma is more common in the upper leg, pelvis, and other bones of the trunk. Both osteosarcoma and Ewing sarcoma usually begin during the young teenage years.
Chondrosarcoma is commonly found in the bones around the knee, the shoulder, and the pelvis. It occurs most commonly in patients between the ages of 40-60 years old.
Metastatic disease to bone occurs when a cancer from another part of the body spreads to the bone. This occurs most commonly in breast, lung, thyroid, kidney, and prostate cancer. The bones most commonly affected by metastatic disease are the spine, pelvis, ribs, upper leg, and upper arm. Our multidisciplinary team includes medical oncology, radiation oncology, and Radiology; all participate in treatment planning to provide the most comprehensive care.
We treat many kinds of soft tissue sarcomas as well, which are malignant tumors that originate from soft tissue. That tissue can be bone (osteosarcoma and chondrosarcoma for example, as outlined above), but can also come from nerves, tendons, fat, blood vessels, lymphatics, and tissues around joints. They can be found anywhere in the body, including the extremities.
The more common soft tissues sarcomas we see are liposarcoma, leiomyosarcoma, and fibrosarcoma, just to name a few. However, we have experience treating all types of soft tissue sarcomas. We work in conjunction with both medical oncology and radiation oncology to make sure there is comprehensive and collaborative patient care.
Symptoms can vary widely between patients and types of cancer. The most common symptoms of bone sarcomas include:
When you first meet with us, we'll discuss your medical history in detail and do a physical examination, along with imaging and/or blood tests.
If a biopsy is needed to determine the type of the tumor, it will be performed by our orthopedic oncologist (a doctor who specializes in bone tumors). A biopsy is a small surgery during which a sample of tissue or bone is taken. For children and for many adults, this is done under general anesthesia in the operating room.
If a biopsy was already performed before coming to our system, another may or may not be necessary.
In addition to determining whether the tumor is benign or malignant, the musculoskeletal tumor team may perform other tests to further classify the tumor. This series of tests is known as staging. The tests will determine the extent of the tumor, if it is continuing to grow, or if it has spread to other areas of the body.
Some of these tests will be performed before the biopsy. The results will help give your team the information they need to provide the most effective treatment.
Bone scan: A bone scan is an imaging study done to detect bone tumors and determine other abnormalities. Sometimes the doctor will order a bone scan with "contrast," a dye injected into a vein two hours before the scan is done.
It is important that you be well hydrated for this study. Your doctor will give you detailed instructions on how to prepare and when to arrive at the radiology department.
PET scan: A PET (positron emission tomography) scan is an imaging study that also detects tumors in the bone and surrounding soft tissues. This is a very sensitive test that will pick up any abnormalities. To ensure accurate results, there are specific preparations for the scan, which your doctor or nurse will share with you.
CT Scan: A CT (computed tomography) scan is an imaging study that uses a combination of x-ray and computer technology to produce cross-sectional images of the body, including bones, muscles, fat, and organs. CT scans are primarily used to check for a tumor in the bone as well as tumor in the chest and lungs.
MRI Scan: An MRI (magnetic resonance imaging) scan is a study that uses a combination of large magnets, radiofrequency, and a computer to produce detailed images of structures in the body. It is used to determine the extent of the tumor within the bone and soft tissues. Your health care team will provide specific instructions about eating and drinking before the MRI.
Treatment is based on the extent and location of the disease. Treatment recommendations may include a combination of the following:
Chemotherapy refers to a type of medicine that acts to help shrink the size of the tumor and kill cancer cells. It is administered through a special type of IV known as a port, which goes into a large vein in the upper chest. The port is placed surgically in the operating room.
Chemotherapy drugs can also be given to treat the tumor and other potential cancer cells throughout the body.
The tumor will typically be removed by surgery. The kind of surgery depends on the size of the tumor, where the tumor is located, and if the cancer cells have spread.
Surgical options may include limb-sparing surgery, which removes the tumor and the tissues surrounding it that contain cancer cells while leaving the surrounding muscles, nerves, and blood vessels. A bone graft or metal implant will replace the bone and soft tissues that have been removed, thereby preserving the patient's extremities.
Sometimes the tumor has to be taken out with the removal of the affected extremity, and amputation is necessary. This may be done because the tumor is too large to treat with limb-sparing surgery or has a high risk of recurring.