Musculoskeletal Oncology disorders consist of the following:
- • Benign Bone and Soft Tissue Tumors
- • Malignant Bone and Soft Tissue Cancers (Sarcoma)
- • Metastases Bone Disease
The management of musculoskeletal tumors has made vast strides in the last few decades. We have traversed from an era where amputation was the only option to the present day management which involves function preserving resections and complex limb reconstructions.
About Musculoskeletal Oncology Disorders:
These are a group of heterogeneous tumors which arise from tissues like muscles, bone, blood vessels, nerves, tendons, skin etc. These tumors in bone or soft tissues can either be Benign (Not life threatening) or Malignant (Sarcoma-Life threatening).
Sarcomas account for over 20% of all pediatric solid malignant cancers and less than 1% of all adult solid malignant cancers.
With the increase in Cancer incidence and treatment, there is also an increase in spread of such cancers to bone-termed as Metastatic bone disease.
- What are the sites in body these tumors can occur?
Limbs are most common site followed by spine, pelvis and other flat bones.
- What is the cause?
The cause of these tumors is not well understood. Several factors like socio-economic environment, poor dietary habits, genetic factors, exposure to radiation etc have been proposed. People of all ages are susceptible for these tumors. Certain bone tumors like Osteosarcoma, and Ewing’s sarcoma are more common in children and adolescent compared to Chondrosarcoma which is common in adults and elderly. Similarly, rhabdomyosarcoma is common in children compared to liposarcoma in adults to name a few.
- What are the types?
Musculoskeletal tumors are broadly classified as Benign (Non-Cancerous) and Malignant (Cancer/Sarcoma). They are further divided or identified based on certain specific genetic or immune-histochemistry markers.
Benign tumors cause local damage to the bone and soft tissue but are not life threatening. It is very rare for these tumors to spread to other organs systems. It is also very rare for benign tumors to convert to malignant variety.
Malignant tumors commonly called as Cancer/Sarcoma not only cause damage to the bone and surrounding soft tissue but also endanger life due to propensity of spreading to other organ systems in the body. These malignant tumors may be Primary or Secondary Bone Cancers. Primary bone cancers arise from the bone and may spread to other parts of the body. Secondary bone cancers may arise from any part of the body and spread to the bone and cause damage. Secondary soft tissue cancer/sarcoma can occur due to environment, exposure to chemicals and radiation.
- What are the symptoms?
- Swelling (Growing more than size of 5 cm /Lemon)
- Fracture due to trivial injury
- Weakness or paralysis of limbs
- Weight loss, fatigue, loss of appetite in advanced cases
- How to diagnose Musculoskeletal Tumor?
- Physical examination
- Blood tests
- X-ray of the part may be followed by Ultrasound, MRI or CT scan
- A working clinical diagnosis made which is confirmed by a properly planned Biopsy by the Treating surgeon
- If a diagnosis of a Bone Cancer/Sarcoma is made, investigations should be performed to look for Metastasis (Other organ system spread) by a Bone scan or PET CT Scan.
- What is the treatment for Musculoskeletal Tumors:
- Treated with inputs from Multi-Disciplinary team to achieve best results
- This team includes Musculoskeletal Oncosurgeon, Pathologist, Radiologist, Medical Oncologist, Radiation Oncologist, Rehabilitation Specialist, Pain Specialist, Counselor and Social worker.
- Benign bone tumors may require surgery alone. Bone cancer/Sarcoma may require a single modality of treatment or combination of Surgery, Chemotherapy and Radiation.
- Individuals with bone and soft tissue tumors have several treatment choices depending on the type of cancer/sarcoma and extent of the disease. These include individual or combination of chemotherapy, radiation and surgery.
- The goal of any surgery is to completely remove the tumor while preserving and maximizing extremity mobility and function. In more than 90 percent of cases, we are able to avoid amputation because of our extensive experience in innovative limb salvage techniques.
- How is life after treatment?
- Rehabilitation starts soon after treatment, once a patient is surgically and medically stable. Inpatient rehabilitation focuses on teaching patients how to move and function safely with reconstructed limbs which continue on an outpatient basis.
- Musculoskeletal tumors are prone to recur either locally or in other parts of the body which may endanger both limb and life. It is also important to identify metastases during follow-up. Presence of recurrence or metastases changes the outlook of treatment and may need further aggressive intervention in form of surgery, chemotherapy or radiotherapy.