Orthopaedic Oncology

Orthopedic oncology is a subspecialty of medicine that focuses on treating tumors and cancers that affect the bones, cartilage, fibrous tissues, muscles, nerve tissues, soft tissues, and arteries. Orthopedic oncologists are orthopedic surgeons with additional education and training in the management of cancers and tumors of the bone, joint, and muscle.

Orthopedic oncologists commonly receive training on fellowships to further their specialist expertise in this field. They treat all orthopedic tumors and cancers which includes sarcomas, osteosarcomas, chondrosarcomas, metastatic cancer of the bones, malignant bone tumors, multiple myelomas, benign bone tumors and all types of soft tissue tumors.

Generally malignant tumors spread to other areas of the body and develop faster. Although benign tumors must be periodically checked for growth because of their much slower rate of growth, they may not need to be surgically removed right away. Some cancers can be treated non-surgically using techniques like chemotherapy and radiation. While some simply need surgical intervention for effective removal, others may need both of these methods.  (1)

Definition and Overview

Orthopedic oncology doctors work collaboratively with their colleagues in medical oncology and radiation therapy to provide treatment options for patients.

Orthopedic oncologists deal with any part of the body except the neck and skull, and the inside of the chest and abdomen. Interested in limb preservation techniques and reconstruction, orthopedic oncologists can treat a range of malignant and benign tumors of bone and soft tissue, not only in pediatrics but also in adults.

Their goal is to shrink tumors as much as possible before surgery to minimize damage to surrounding bone or tissue. In orthopedic oncology, radiology, pathology, and laboratory services are also used during the treatment.

The orthopedic oncology team and other healthcare providers regularly communicate with each other and their patients to ensure the best available treatment is provided. (2)

Procedures

Depending on the patient's cancer's type, size, location, and stage, several treatment options are considered. The patient's age and overall health are also taken into consideration at the same time. Treatment options for bone cancer are as follows.

• Surgery

Surgery is the main option for the treatment of bone cancer. The surgery completely removes the tumor with no residual tissue. To reduce the quantity of healthy tissue removed alongside the tumor during surgery, distinctive surgical procedures may also be used.

Most patients with bone cancer in an arm or leg are now able to avoid invasive surgical treatments thanks to significant advancements in surgical methods and preoperative tumor treatment. However to regain limb function, the majority of patients who have limb-sparing surgery require reconstructive surgery.

• Chemotherapy

In order to treat bone cancer, a patient must take a variety of medications, which are typically administered through a drip into a vein or line implanted into a bigger blood vessel. The normal method of treatment is in cycles. A cycle is taking the chemotherapy medication for a few days, followed by a break to let the body recuperate from the effects of the treatment for a few weeks. The type and severity of the bone cancer will determine how many rounds the patient requires. Chemotherapy is the process of killing cancer cells with anti-cancer medications. It is uncommon to use chemotherapy to treat chordoma or chondrosarcoma.

• Radiotherapy

Similar to chemotherapy, radiotherapy is a treatment option for bone cancer that can be used both before and after surgery. When a cure is not achievable, radiotherapy can also be used to manage symptoms and delay the progression of the disease. 

Radiotherapy for bone cancer involves beams of radiation directed at the cancerous part of the bone by an external machine. This is normally given in daily sessions, 5 days a week, with each session lasting a few minutes. The entire treatment process usually takes a few weeks. High-energy X-rays are used in radiation therapy, often known as radiotherapy, to kill cancer cells. It is possible to combine this therapy with surgery. 

• Targeted therapy

Utilizing a medicine created to interact with a particular molecule involved in the growth and spread of cancer cells is known as targeted therapy. An effective targeted therapy for treating giant cell bone tumors that cannot be surgically removed in adults and skeletally matured adolescents is the monoclonal antibody denosumab. It prevents bone destruction triggered by a type of bone cell called osteoclast. (3,4)

Candidates

People experiencing the following symptoms of bone disease may need orthopedic oncology treatments.

• persistent bone pain that worsens over time and continues throughout the night,
• having swelling and redness (inflammation) over a bone that can make it difficult to move if the affected bone is close to a joint,
• the appearance of a visible lump on a bone,
• a weak bone that breaks (fractures) more easily than normal,
• having problems with movement, such as walking with a limp. (5)

Risks and Side Effects

People who have been treated for bone cancer are more likely to develop risks and side effects of treatments. These include:

• feeling sick and being sick
• diarrhea
• mouth ulcers
• tiredness
• increased risk of getting infections
• temporary hair loss
• infertility
• skin redness and irritation (this can feel like a sunburn)
• joint pain in the treated part of the body
• hair loss on the treated body part (6)

Post-Procedure and Follow-up

For various bone cancer types and stages, follow-up varies. In general, doctors check on patients frequently, and X-rays and blood tests are performed routinely. The discussion of changes in health and prompt treatment of problems is ensured through routine follow-up care.

Recovery

If amputation or limb-sparing surgery is employed, after the procedure, the patient will require assistance to lead a regular life again. This is referred to as rehabilitation. Physiotherapy sessions, where the patient performs exercises to help regain proper function in the treated body part, and occupational therapy, where the patient teaches skills to help the patient deal with daily activities, are typically included in rehabilitation. The patient may be directed to a nearby limb center after amputation for guidance, support, and care. (7)

Results

Some people might recover reasonably quickly, while others might need more time for rehabilitation and getting used to any physical changes brought on by surgery. To achieve good results and regain health, it is essential to maintain open lines of communication with the medical staff and heed their advice. (8)