Orthopaedic oncology is the treatment of cancerous tumors in the bone and soft-tissue that involve the musculoskeletal system, such as Ewing sarcoma and osteosarcoma. Our orthopaedic oncology goal is to optimize resection of musculoskeletal cancers while preserving function and reducing pain.
Bone cancer is a term commonly used when discussing the condition of many patients who have been diagnosed with a malignant tumor. However, the term “bone cancer” can mean many things. There are many types of malignant tumors that can affect bone and the diagnosis and treatment may vary dramatically.
The most common type of malignant tumor affecting the bones is metastatic bone cancer - a tumor that started in another location and spread through the blood system to the bone. The cancers which most commonly spread to bone include lung, kidney, prostate, breast and thyroid cancer. Other cancers, such as colon and uterine, may also spread to the bones, but much less commonly.
When metastatic tumors develop, they often involve the bones of the spine, shoulders, hips or pelvis. This is because of a system of valve-less veins which supply these areas of the body and allow cells to move relatively freely. It is very rare to see metastatic disease develop distal to the elbows and the knees.
When a tumor begins in a bone, it is called a primary bone tumor. Multiple myeloma is the most common primary malignant bone tumor and arises in the bone marrow. Sarcomas are malignant tumors arising from bone, cartilage, muscles or other connective tissues. Bone sarcomas such as osteogenic sarcoma or Ewing’s sarcoma occur most commonly in teenagers.
At UPMC, treatment for metastatic bone disease is focused on preventing fractures and may include chemotherapy, radiation and surgery for stabilization. The effectiveness of each of these options differs depending on the specific diagnosis. For instance, metastatic breast cancer responds to radiation treatment much more reliably than metastatic kidney cancer. Bisphosphonate therapy has been proven to decrease the progression of bone loss associated with metastatic bone disease and is considered as a part of the treatment program. Bracing or surgical intervention may become necessary if the structural integrity of a bone is weakened to the point that a fracture is imminent.
Multiple myeloma (bone marrow cancer) is treated similarly to metastatic disease - primarily with chemotherapy but radiation, bracing and surgical intervention may all be required to prevent fractures.
Bone sarcomas are best treated with chemotherapy followed by surgical removal of the tumor and all tissues involved. This gives patients the best chance for long-term survival; in fact, survival rates for patients with one of these tumors have improved greatly from 20% to 67% with appropriate chemotherapy and surgery. Advances in imaging such as MRI and reconstructive techniques have also made it possible to save the extremities of many patients who not so long ago would have required an amputation.
William Parrish, MD, offers comprehensive, multidisciplinary treatment for patients with cancerous and noncancerous musculoskeletal tumors of the bones and soft tissues.
Benign tumors often require observation or limited treatment. When a malignant tumor requires complex treatment, MSK tumor service provides leading-edge treatment including major reconstruction. Surgical procedures are performed at UPMC Lititz and UPMC Community Osteopathic.
For more information or to schedule an appointment, please call 717-735-1972
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