Orthopaedic Oncology

What is Orthopedic Oncology 

Orthopedic oncology is a specific branch of medicine that concentrates on diagnosing and treating tumors and cancers of the bones, cartilage, fibrous tissues, muscles, nervous tissues, soft tissues, and vessels. Despite their rarity, accounting for only 0.5% of global cancer cases, these conditions pose significant challenges to orthopedic surgeons. However, recent research indicates an increasing incidence of bone cancer, which can be treated with advanced diagnostic methods, innovative treatments, and comprehensive management approaches, thereby addressing the complexities of musculoskeletal oncology. Let’s understand some of the conditions that fall under orthopedic oncology.

Common Conditions/Diseases

Orthopedic cancers primarily affect bones and soft tissue. Typically, these cancers are metastatic; that is, they spread from another area of the body. Some of these cancers are described below.

• Soft Tissue Sarcoma: These cancers develop in the soft tissues of the body, including muscles, fat, blood vessels, nerves, tendons, and ligaments. Examples include liposarcoma, leiomyosarcoma, and synovial sarcoma.
• Bone Sarcoma: Also called bone cancer, it is rare and mainly affects the pelvis or long bones, accounting for <1% of all cancers. Non-cancerous bone tumors are more commonly prevalent. Different types of sarcomas include:
• Osteosarcoma: This type of bone cancer typically affects children and adolescents. It originates from the cells responsible for forming new bone tissue.
• Chondrosarcoma: This type of bone cancer arises from cartilage cells and commonly affects adults. It can occur in the bones or within the soft tissues surrounding joints.
• Ewing’s sarcoma: This type of bone cancer arises in the long bones of the arms and legs or the pelvis. It primarily affects young adults and children.
• Giant Cell Tumor of Bone: While typically benign, giant cell tumors can be locally aggressive and cause bone destruction. They most commonly occur in the long bones of the extremities.
• Metastatic Bone Disease: It refers to the cancer that has spread (metastasized) to the bones from other primary sites, such as breast, lung, prostate, or kidney. It can lead to many complications, such as bone pain, fractures, and spinal cord compression.
• Multiple Myeloma: In multiple myeloma, the plasma cells present in the bone marrow are impacted. This condition can lead to bone pain, fractures, and various skeletal complications because of abnormal cell infiltration into the bones.

Causes 

Studies have shown that many cases of bone cancer are neglected, resulting in delayed presentation, particularly among those of low socioeconomic status, individuals with limited education, and those with poor access to healthcare facilities. Initial visits to traditional bone setters and misdiagnoses also contribute to this issue. Despite negligence, the exact cause of bone cancer remains unclear. However, major risk factors for bone cancers include:

• Previous exposure to radiation therapy
• Genetic predisposition
• Compromised immunity or immune system abnormalities
• Lymphedema
• Exposure to harmful chemicals

Common Symptoms 

When a bone tumor develops, it exerts pressure on the surrounding healthy bone tissue, destroying it. This, in turn, results in the following symptoms:

• Lumps or swollen near the affected area
• Long-lasting pain or tenderness
• Unexplained fracture or fracture following a mild injury or drop

Diagnostics 

Diagnosing bone and soft tissue tumors requires expertise and a multidisciplinary approach to determine the grade or stage of cancer. Advancements in diagnostic techniques and targeted therapies have increased the number of cases treated for bone metastasis, reflecting improved overall survival in bone cancer patients. Some examples of relevant diagnostic procedures include:

• Plain radiograph or chest X-rays
• Bone scan
• Complete blood count
• Magnetic resonance imaging
• Positron emission tomography (PET) scan
• Fine-needle aspiration cytology (FNAC) or biopsy of the lesion (to confirm the histological diagnosis of the tumor)

Treatments 

Research reports that individuals with bone cancer demonstrate improved outcomes when managed at specialized centers that provide advanced treatment options specific to orthopedic oncology. In contrast, a multidisciplinary team of oncologists collaborates to devise comprehensive treatment plans, incorporating various therapeutic approaches to optimize patient care. Some common bone cancer treatments include:

• Chemotherapy: These drugs kill the cancer cells and prevent further tumor growth.
• Surgery: Surgery involves the extraction of the tumor and a portion of the adjacent healthy tissue through a surgical procedure. Doctors known as surgical oncologists and orthopedic oncologists possess expertise in treating bone sarcoma via surgical means.
• Immunotherapy: Immunotherapy employs the innate mechanisms of the body to combat cancer by enhancing the immune system’s efficacy in targeting malignant cells.
• Targeted Therapy: Targeted therapy is a form of treatment that directs its focus towards the specific genes, proteins, or the tissue environment of the cancer that promotes its growth and existence. Such a treatment impedes the proliferation and dissemination of cancerous cells and simultaneously mitigates the harm inflicted upon healthy cells.
• Radiation Therapy: Radiation therapy employs high-energy X-rays or particles to eradicate cancer cells. A radiation oncologist specializes in administering this treatment for cancer.

Orthopedic oncologists collaborate closely with rehabilitation specialists, physical therapists, and oncology nurses to optimize treatment outcomes and improve patient’s quality of life. 

Prevention and Lifestyle Modification 

Unlike some cancers, orthopedic cancers typically stem from other types of cancer, and there is no scientific evidence linking bone fractures to the development of bone cancer. Hence, preventing bone cancer is challenging. However, maintaining a healthy lifestyle and undergoing regular check-ups can help reduce the overall risk of developing any form of cancer. 

Orthopedic oncology is a perfect example of integrating cutting-edge medical expertise and compassionate patient care in the battle against musculoskeletal tumors and cancers. Through early diagnosis, personalized treatment, and comprehensive management strategies, orthopedic oncologists strive to achieve optimal outcomes while upholding the highest standards of patient care.