Orthopaedic Oncosurgery/ Musculoskeletal Oncology
This is one of the sub-specialities of Oncology dealing with patients suffering from cancers and tumours arising from the Bones and Soft tissues of the human body. Soft tissues can be fat, muscles, fascia, tendons, ligaments, joint linings/synovium, vessels or nerves of the body. These cancers also known as Sarcomas, are a rarity compared to other forms of cancers like Breast, Prostate or Lung cancer.
Bone cancers or Bone sarcomas can be broadly classified into Primary and Secondary Bone Cancers. Primary bone cancers are those arising from the Bone primarily. Osteosarcoma, Ewing’s Sarcoma and Chondrosarcoma are few of the common types of primary bone cancers encountered. Primary bone cancers like Osteosarcoma and Ewing’s Sarcoma are encountered mainly in the young age group. The age group mainly affected is between 10-20yrs, while Ewing’s Sarcoma may be encountered in children younger than 10years too. Chondrosarcomas are seen mainly after the age of 30-40yrs. The common sites or bones in which these bone cancers are encountered are thigh bone/femur, leg bone/tibia, arm bone/humerus, hip bone/pelvis and shoulder blade/scapula. The symptoms which patients usually complain of are spontaneous onset bony pain or pain around the joints, limp/difficulty in walking, lump/palpable swelling and occasionally may complain of high-grade fever, decreased appetite and weight loss as in Ewing’s Sarcoma. Radiological investigations like X-rays are ordered by the treating clinician/Orthopaedic Oncosurgeon after a clinical examination and if anything, suspicious is noticed on these, further advanced imaging like a contrast-enhanced MRI will also be got done.
Nowadays, Limb salvage surgeries/Limb preservation surgeries can be offered to almost 90% of the patients suffering from bone or soft tissue cancers, provided they present to us at an early stage and undertake proper treatment as advised. With the availability of modern modular endoprostheses/tumour prostheses, patients suffering from bone cancers can only get their limb preserved but also get a good function and lead a normal life. In the right indications and with the advanced surgical techniques available to us like intra-op imaging and navigation, patients can also undergo limb salvage surgeries using recycled autografts. In this technique, the patient’s own tumour bearing bone is resected out safely with wide margins and recycled with techniques such as ECRT (Extra-corporeal Radiotherapy) in which the tumour bearing bone is sterilized with radiation and re-implanted back into the patient. Also use of cryotherapy techniques such as Liquid Nitrogen, involving the use of Liquid Nitrogen at -196degrees Celsius can be employed for sterilizing the bone before re-implanting the bone back into the patient. Both techniques have given excellent oncological and functional results.
Patients suffering from soft tissue tumours cancers undergo surgery involving removal of the soft tissue masses with a wide margin (meaning a cuff of normal tissue around the tumour). To further, prevent the chances of local recurrence, patients undergo post or pre-surgery radiotherapy on a day-care basis and may also undergo chemotherapy in high-grade cancers.
Bone tumours can also be debilitating for patients due to the presence of excruciating bony pains and swelling, which is not relieved even after taking analgesic medications. In advanced cases of bone tumours, their sizes may increase and even cause pathological fractures of the bone in which they are present. Initial diagnosis and treatment of bone tumours can be very beneficial for patients with rewarding outcomes. Techniques such as CT-Guided micro-drilling and Radiofrequency ablation for bone lesions such as osteoid osteomas, osteoblastoma and chondroblastoma, is the standard of care these days. Techniques such as some image-guided percutaneous injections like curopsy, sclerotherapy, intralesional steroids can be very useful for lesions like an aneurysmal bone cyst, unicameral bone cyst or simple bone cyst. Use of techniques such as a high-speed burr curettage and reconstruction with various modalities is very useful for lesions such as Giant-cell tumours of bone, provided done at the right centre by an expert Ortho-Oncosurgeon.
Treatment of Secondary bone cancer/bone metastases in a palliative setting is very important nowadays, due to increased survival of even advanced cancer patients with effective chemotherapy, immunotherapy and targeted therapies. Use of bone-strengthening injections, splints and braces and palliative radiotherapy form a major part of the rehabilitation of such patients. Surgeries such as decompressive laminectomy may be required in patients developing neural/cord compression following spine metastases. Techniques such as Kyphoplasty, Vertebroplasty and Acetabuloplasty may be required in patients with vertebral compression and acetabular defects. Prophylactic fixation surgeries may be required in patients with impending fractures.
An Orthopaedic-Oncosurgeon plays a pivotal role in the management of patients suffering from bone and soft tissue cancers and obtaining an expert specialist advice is paramount for successful the outcome for such patients.