An Introductory Guide to Orthopaedic Oncology

What is Orthopaedic (Ortho) Oncology?

Ortho-oncology is a specialised field that concentrates on the diagnosis, treatment, and management of cancers and tumours related to the skeletal system. This multidisciplinary area of medicine integrates expertise from orthopaedics, which focuses on the musculoskeletal system, and oncology, the branch of medicine dedicated to cancer. In ortho-oncology, the overarching objective is to treat the cancer effectively while striving to preserve as much function and quality of life for the patient as possible.

Types of Orthopaedic Cancer

Bone cancer can manifest in any part of the skeletal structure. When abnormal growth occurs, it is termed a tumour, which can either be benign or cancerous. A benign tumour is prone to growth but typically does not metastasize to other body parts. Conversely, malignant or cancerous bone tumours can erode the cortex and extend to other body areas.

Osteosarcoma

Osteosarcoma is the most common type of bone cancer, primarily affecting children and young adults. It usually starts in the long bones of the arms and legs, often around the knee or shoulder. Osteosarcoma can cause pain and swelling in the affected area and may weaken the bones, leading to fractures.

Ewing Sarcoma

Another cancer primarily impacting children and adolescents, Ewing sarcoma can start in the bones or in the soft tissue around the bones. It is most frequently found in the pelvis, femur, humerus, and ribs. Ewing sarcoma can cause pain, swelling, and fever, and may be mistaken for other more common conditions like infections.

Chondrosarcoma 

This cancer originates in the cartilage cells and is more common in adults. It typically affects the pelvis, legs, and arms. Unlike other bone cancers, chondrosarcoma often grows slowly and may not cause early symptoms, making it challenging to diagnose promptly.

Chordoma

This rare type of cancer usually affects the bones of the spine, particularly the lower spine (sacrum) and base of the skull. Chordomas are slow-growing tumours that can cause pain, neurological symptoms, and, depending on their location, issues with bowel or bladder function.

Undifferentiated Pleomorphic Sarcoma (UPS) 

Previously known as malignant fibrous histiocytoma, UPS typically arises in the extremities, particularly around the knees. It is more common in adults and can be aggressive, requiring prompt treatment.

Sarcoma of Paget’s Disease of the Bone

Paget's disease, a condition characterised by abnormal bone growth, can sometimes lead to osteosarcoma. This transformation, though rare, is more likely in older adults and can cause bone pain, deformities, and fractures.

Conditions Treated by Orthopaedic Oncologists

Orthopaedic oncologists are specialists in the comprehensive treatment of both cancerous and noncancerous tumours affecting bones and soft tissues. This encompasses a variety of tumour types, including:

• Benign soft tissue tumours: Noncancerous growths in soft tissues like muscles, fat, blood vessels, tendons, and nerves. Examples include ganglion cysts, giant cell tumours of soft tissue, glomus tumours, lipomas, neurofibromas, schwannomas, and tenosynovial giant cell tumours.
• Malignant soft tissue tumours: These include osteosarcomas, chondrosarcoma, multiple myeloma, ewing's sarcoma, radiation sarcomas, and undifferentiated pleomorphic sarcomas.

Diagnosis of Orthopaedic Cancer

An orthopaedic oncologist will conduct a physical examination of the affected area and subsequently employ various diagnostic tests, including:

Blood Tests 

Some patients may exhibit elevated levels of specific tumour markers or biomarkers indicative of tumours. For instance, increased alkaline phosphatase and lactate dehydrogenase levels are observed in patients with osteosarcoma or Ewing sarcoma. However, solely relying on blood tests for bone cancer diagnosis is not advisable, as elevated levels may result from other factors such as healing fractures or normal growth in children.

X-rays 

The examination of bony structures is commonly done through X-rays.

Bone Scans 

This procedure involves injecting a radioactive tracer into the bloodstream, detected through a scan, which reveals areas with increased tracer accumulation.

CT Scan 

Computed tomography scans utilise X-rays and, at times, a dye injected into the patient to generate two-dimensional images of body tissues, highlighting any tumours or abnormalities. Although there is minimal radiation exposure, in cases where radiation is discouraged, an MRI scan might be preferred.

MRI 

Magnetic resonance imaging captures images of body tissues using magnetic fields, suitable for studying tumours, measuring their size, and examining soft tissues. Contrast dye may be used for clearer images. MRI is unsuitable for patients with implanted devices due to strong magnetic fields.

PET-CT Scan 

Combining Positron Emission Tomography with a CT scan yields highly detailed internal body images.

Biopsy 

While imaging techniques detect tumours and abnormalities, a cancer diagnosis is confirmed only through the study of tissue samples. Biopsy procedures, involving needle or surgical extraction, are conducted to obtain tissue samples. In some cases, making a small hole in the bone is necessary for sampling. However, depending on the tumour's location, biopsy may not be feasible in certain instances.

Treatments Offered by Orthopaedic Oncologists

Orthopaedic oncologists possess expertise in various advanced techniques and procedures, encompassing:

Limb Salvage and Reconstruction 

These procedures are designed to completely remove tumours without the necessity of amputating an entire limb. The surgeon may extract the bone surrounding the tumour and substitute it with an implant to preserve the limb's functionality.

Expandable Bone Implants 

These implants can be enlarged as a child grows, eliminating the need for subsequent operations. A specialised device, utilising a magnet, extends the implant, allowing patients to return home on the same day as the treatment.

Mass Excision 

These surgical interventions eliminate soft tissue tumours, often involving the removal of a small portion of surrounding tissue. The excised mass undergoes laboratory testing to gather insights into the tumour type and function.

Curettage

In curettage, a surgeon employs a curette instrument to scrape away benign bone tumours. Depending on the case, the bone may regenerate to fill the void, or the surgeon may combine curettage with a bone graft or implant for cavity restoration

Amputation

While limb-sparing surgery is preferred whenever possible, amputation, either partial or complete, may be deemed the most effective option for curing bone or soft tissue cancer in certain cases.

Targeted Muscle Reinnervation 

This procedure involves the reassignment of nerves controlling muscle movements, enabling patients to control prosthetic limbs through thought. It proves effective in alleviating phantom limb pain in individuals who have undergone amputations.

Metastatic Disease Treatment

In instances where cancer has metastasized, patients may undergo various treatments, including chemotherapy, radiation therapy, targeted therapy, or immunotherapy, as part of a comprehensive care plan.

Conclusion

If you or someone you know is dealing with symptoms related to orthopaedic oncology, it's crucial to seek expert medical advice promptly. The specialists at Max Hospitals are well-prepared to provide personalised care and guidance, ensuring an accurate diagnosis and tailored treatment options for orthopaedic oncological conditions. Don't let uncertainty or hesitation prevent you from seeking help. Reach out to the dedicated professionals at Max Hospitals to receive the support and specialised care needed to address orthopaedic oncology effectively, restoring comfort and overall well-being.