Defining Orthopedic Oncology
Orthopedic oncology is a specialized field combining orthopedics and oncology. Orthopedics focuses on the musculoskeletal system (bones, joints, muscles, tendons, ligaments), while oncology studies and treats cancer. This subspecialty addresses tumors originating in or affecting these body components.
An orthopedic oncologist is a surgeon extensively trained in orthopedic surgery and musculoskeletal tumors. This specialized training allows them to expertly handle both benign (non-cancerous) and malignant (cancerous) growths. Their expertise is crucial for bone and soft tissue tumors, which present unique challenges due to their location and impact on movement and function. The field focuses on preserving limb function and overall quality of life while effectively treating the disease.
Conditions Addressed
Orthopedic oncology manages primary bone tumors, soft tissue sarcomas, and metastatic bone disease. While benign tumors are addressed, the primary focus is on malignant conditions due to their aggressive nature. Tumors can arise throughout the musculoskeletal system, including extremities, pelvis, abdominal wall, chest wall, back, spine, and sacrum.
Primary bone tumors originate directly in the bone tissue and include several distinct types. Osteosarcoma, a common primary bone cancer, frequently affects children and young adults, often developing around the knee. Chondrosarcoma arises from cartilage cells and is more prevalent in adults aged 30 to 60, commonly found in long bones or flat bones like the pelvis. Ewing sarcoma primarily impacts children and adolescents and can begin in bones or the surrounding soft tissues, often in the legs, pelvis, or ribs.
Primary soft tissue sarcomas develop in soft tissues like fat, muscle, nerves, tendons, and blood vessels. Examples include liposarcoma, which originates in fatty tissue, and rhabdomyosarcoma, a cancer of muscle tissue often seen in children. Other types include leiomyosarcoma, affecting smooth muscle cells, and undifferentiated pleomorphic sarcoma, commonly found in the limbs. These sarcomas are rare, representing about 1% of adult cancers.
Metastatic bone disease occurs when cancer cells from a primary tumor spread to the bones. This is more common than primary bone cancer, especially in adults. Cancers most likely to spread to bone include those from the breast, lung, prostate, kidney, and thyroid. These metastatic lesions can cause pain, weaken bones leading to fractures, and elevate blood calcium levels.
Diagnostic Methods
Diagnosis of musculoskeletal tumors relies on advanced imaging and tissue analysis. Imaging provides detailed views of tumor location, size, and relationship to surrounding structures. Plain radiographs (X-rays) are often the initial step to detect bone lesions and assess their basic characteristics.
Further imaging includes Magnetic Resonance Imaging (MRI), effective for visualizing soft tissue tumors and assessing bone marrow involvement. Computed Tomography (CT) scans offer high-resolution images, valuable for evaluating bone destruction and identifying calcifications within tumors. Positron Emission Tomography (PET) scans assess tumor metabolic activity, helping detect malignant growths and monitor treatment response.
Beyond imaging, a biopsy is crucial for definitive diagnosis. This procedure involves taking a tissue sample from the tumor for microscopic examination by a pathologist. The biopsy determines if the tumor is benign or malignant, its specific type, and its grade (aggressiveness), guiding treatment decisions.
Treatment Approaches
Treatment for musculoskeletal tumors involves therapies tailored to tumor type, stage, and patient factors. Surgical intervention is a primary approach, aiming to remove the tumor while preserving function. Limb-sparing surgery is a common technique where the tumor is removed with a margin of healthy tissue, retaining the affected limb.
Following tumor removal, reconstruction techniques restore limb function and appearance. This can involve metal prostheses (megaprostheses) to replace resected bone, bone grafts, or soft tissue transfers. These advanced surgical methods prioritize mobility and stability.
Non-surgical treatments are used with surgery to improve outcomes. Chemotherapy uses drugs to destroy cancer cells, often administered before or after surgery to shrink tumors or eliminate remaining cancer cells. Radiation therapy uses high-energy rays to target and kill cancer cells; it may shrink tumors before surgery, destroy residual cancer cells, or manage pain. These combined treatments are individualized to achieve the best possible outcome for each patient.
The Specialized Care Team
Orthopedic oncology care is multidisciplinary, involving a collaborative effort among various medical specialists. The orthopedic oncologist plays a central role, performing surgical removal and reconstruction of bone and soft tissue tumors. This surgeon works closely with a team of experts to ensure comprehensive patient care.
Medical oncologists manage systemic treatments like chemotherapy, while radiation oncologists oversee radiation therapy. Pathologists analyze tissue samples from biopsies and surgical resections to provide precise diagnosis and characterize the tumor. Radiologists interpret imaging studies, guiding diagnosis and surgical planning.
Rehabilitation therapists (physical and occupational) are integral to the team, helping patients regain strength, mobility, and function after treatment. This collaborative approach, often coordinated through multidisciplinary tumor board meetings, allows for shared knowledge and coordinated treatment plans, essential for managing complex musculoskeletal tumors.