Orthopaedic Oncology

Malignant fibrous histiocytoma is the most common malignant soft tissue tumor in late adulthood. The most common location is in the lower limbs, particularly the thigh region, where it can appear as a painless mass. Less frequently, it can grow in the abdomen and be undetected until the patient starts to develop symptoms related to an increase in abdominal pressure, such as bloating, frequent urination or constipation. There have been some reports of malignant fibrous histiocytoma developing in patients who received high-doses of radiation for many years in the past, and other reports suggest a viral or a chemical cause. In most cases, the origin is not known.

Cancer that begins in an organ, such as the lungs, breast, or prostate, and then spreads to bone is called metastatic bone disease (MBD). MBD causes pain in the area of spread, damages and weakens bone, and puts the patient at a greater risk for broken bones. It can make it hard to participate in daily activities. The biggest concern for patients with MBD is the general loss in quality of life. Sometimes, the tumor can completely destroy the bone in a particular area. This type of process is termed osteolytic bone destruction. This type of damage is most common in cancers that have spread to bone from the lung, thyroid, kidney, and colon.

Myeloma is the most common primary bone cancer. It is a cancer that begins in bone (primary bone cancer) which is different from cancer that begins somewhere else in the body and spreads to bone (secondary bone cancer). It is a malignant tumor of bone marrow. Multiple myeloma affects approximately five to seven people per 100,000 each year. According to the Multiple Myeloma Research Foundation, more than 56,000 Americans are living with the disease each year. Most cases are seen in patients between the ages of 50 and 70 years old. Any bone can be involved.

Sarcoma is a broad term that describes cancerous tumors that can develop from bone, tissue around joints, fat, muscle, nerves, fibrous tissues, blood vessels, or deep skin tissues. Sarcomas can develop in any part of the body. Bone and soft tissue sarcomas are rare conditions that affect approximately 13,000 people each year. In the US, 10,000 are diagnosed with soft tissue sarcomas and approximately 3,000 are diagnosed with bone sarcomas, of which 1,000 are osteosarcomas.

The rarity of sarcomas means most doctors seldom see one, which explains why patients are often referred to specialty hospitals where experienced surgeons utilize limb-sparing (no amputation) surgery whenever possible.

Included in the list below are the different types of sarcoma:

Chondrosarcoma is found mainly in adults. Limb sparing surgery (LSS) is a special operative procedure performed by oncology orthopaedic surgeons and has become the accepted standard of care for patients with sarcomas of the extremities. The cancer in the bone or soft tissue is removed surgically and replacement of bones and joints is done with metal prostheses and/or reconstruction of the defect. Even though the salvaged extremity looks and moves in a near-normal manner, function rarely returns to 100% normal. Common causes of prosthesis failure include infection, aseptic loosening, bone resorbtion and fracture.

Ewing's sarcoma is a cancerous tumor that usually begins growing in a bone. It occurs primarily in children and young adults, often appearing during the teen years. Although Ewing's sarcoma can develop in any bone, it usually affects the long bones, such as the thighbone (femur), shinbone (tibia), and upper arm bone (humerus). The bones of the pelvis are also often affected.

Fibrosarcoma of the bone is a cancerous tumor that represents only about 10% of musculoskeletal sarcomas and less than 5% of all primary tumors of bone. These occur slightly more commonly in men than in women. Fibrosarcoma of bone can be diagnosed in patients of any age, but it is diagnosed more commonly in patients in their 40’s. It is usually located in the lower extremities, especially the femur and tibia.

Osteosarcoma is the most common bone cancer. It is a cancer that begins in bone (primary bone cancer) which is different from cancer that begins somewhere else in the body and spreads to bone (secondary bone cancer). More males are affected than females. Osteosarcoma starts in the ends of long bones of the arms or legs where new bone tissue rapidly forms with most tumors occurring around the knee. Other common locations include the hip and shoulder.

Soft tissue sarcomas are cancerous tumors that grow in muscles, fat, joints, nerves or blood vessels. Soft tissue sarcomas make up 1% of all cancer types. Studies have connected soft tissue sarcomas to exposure to certain chemicals, high-dose radiation, certain viral infections, and to specific genetic abnormalities. In most cases, the cause is unknown.