What is Orthopedic Oncology?
Orthopedic Oncology is a surgical specialty that offers exceptional care to individuals diagnosed with tumors and tumor-like medical conditions of the bone and soft tissue, including bone metastases, sarcomas, benign and cancerous tumors of the bone or soft tissue, and pathologic fractures.
An orthopedic oncologist is a highly-trained doctor who specializes in the diagnoses and treatment of primary, benign, and malignant tumors of the bones.
Orthopedic Oncology involves working closely with general surgical oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, and plastic surgeons to deliver a coordinated and multidisciplinary approach to care for each individual.
Some of the procedures that require Orthopedic Oncologist perform include:
Open and closed biopsies are mainly performed to determine if a tumor is malignant (cancerous) or benign (non-cancerous). The biopsies can also identify the presence of infection in the sample.
Preparation for Open and Closed Biopsies
You may be required to stop eating 8-12 hours prior to the surgery, avoid smoking as it can slow down the healing process, and inform your surgeon about any health conditions, allergies, and regular medications.
Open and Closed Biopsy Procedure
- Regional or general anesthesia and IV sedation may be used for the biopsy.
- For an open biopsy, an incision is made on the skin to access the tumor and a tissue sample is obtained under direct visualization.
- For a closed biopsy, a long, hollow needle is inserted through the skin to penetrate the tumor under CT or fluoroscopic guidance. Cancer cells are aspirated through the needle.
- A bandage may be applied to the site of the biopsy.
- The biopsy is then sent to the laboratory for analysis.
Recovery after Open and Closed Biopsy
Following the procedure, you may be observed for a short time to ensure there are no complications from the procedure. Protect the site of the biopsy by wearing the bandage as instructed. There may be a slight discomfort that should resolve in a day or two.
Prophylactic Intramedullary nailing
Malignant tumors can develop in or spread to the humeral (arm) or femoral bone (thigh bone) causing progressive bone tissue destruction that can lead to a fracture. Prophylactic femoral nailing is a procedure to stabilize the bone that has become weak due to the presence of a tumor. The procedure involves passing a nail or rod through the intramedullary canal or central canal of the bone to reinforce the bone along its entire length. Prophylactic femoral nailing can help treat pain and prevent loss of function.
Indications for Prophylactic Nailing
Your doctor will recommend prophylactic nailing after considering a number of factors including the size and type of the tumor, its location, its radiographic features, the underlying diagnosis, your level of pain, and expected survival.
To diagnose your condition, your symptoms and medical history are reviewed and a history and physical examination is performed. Diagnostic tests that may be ordered include X-rays, a bone scan, MRI, or CT scan. In certain cases, a biopsy of the lesion may be needed to make a clear diagnosis. If the tumor is a metastatic lesion, tests are performed to identify the primary site of the tumor.
Recovery after the Procedure
Prophylactic nailing fortifies the weakened bone with impending fracture. Patients will be able to sue the limb the day of surgery. Stabilizing the bone in this manner also provides pain relief and is thus a palliative measure to improve quality of life.
Removal of a soft tissue or bone tumor
A sarcoma is a rare type of malignant tumor originating from the connective tissue in the body. It can develop in both the hard bones and soft tissues. Soft tissue sarcomas may develop in the muscles, fat, nerves, blood vessels, tendons, and other tissues around the joints and the deep tissues of the skin. Soft tissue sarcoma resection is a procedure to surgically remove the soft tissues affected by the sarcoma. Sarcomas mostly develop in the arms and legs but can affect any part of the body. The goal of resection surgery is to completely remove the tumor at the site and ensure that no cancer cells are left behind.
Indications for Soft Tissue Sarcoma Resection
Your doctor will recommend this procedure after considering a number of factors including the size and extent of the tumor, its location, involvement of neurovascular structures, whether it has spread, and your expected survival.
When a sarcoma is confined to one region of the body, surgery is the best chance for cure. For small, low-grade(slowly growing and spreading) tumors, surgery alone may be adequate. Larger tumors or high-grade tumors, may require a combination of surgery, radiation, and chemotherapy.
Preparation for Soft Tissue Sarcoma Resection
Diagnostic studies help determine the extent of the soft tissue involvement and the proximity of the tumor to important nerves and vessels. Prior to surgery your doctor may recommend a biopsy.
How is Soft Tissue Sarcoma Resection Performed?
Surgery is performed under general anesthesia. One or more incisions are made based on the location of the tumor.
Wide local excision: Most soft tissue sarcomas are treated by wide local excision where the entire tumor is removed with a healthy tissue margin of 1-2 inches. The soft tissues are then rearranged to close the defect or a tissue graft from your own body may be used to replace lost tissue.
The margins of the removed specimen are examined microscopically in the laboratory to ensure that no cancer cells are seen (negative margins). The presence of cancer cells in the margin (positive margins) indicates that cancerous tissue is still present in the region and your doctor may suggest further surgery, chemotherapy, or radiation. Often radiation and chemotherapy is performed prior to surgical resection to help shrink the tumor and control its spread. These treatments may also be administered following surgery to kill cancer cells that may return after surgery.
For tumors in the limb, a limb salvage procedure is performed whenever possible. If the tumor is extensive and involves major blood vessels or nerves, your doctor may recommend amputation of the limb, though this is rare.
If the tumor has spread to the surrounding lymph nodes, surgery may be performed to remove the involved lymph nodes as well.