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Orthopedic Oncology at Memorial Hermann

Orthopedic oncology is a specialty related to cancers found inside your bones or connective tissues. Orthopedic malignant tumors, typically called sarcomas, differ from other more common forms of cancer, such as lung, breast or colorectal cancers, in that they occur in musculoskeletal tissues, at any age and in any anatomic location. They are frequently presented as a painless mass that is often overlooked for long periods of time. Orthopedic oncology is primarily focused on two types of tumors: bone and soft tissue cancers.

The Orthopedic Oncology Division at Memorial Hermann is committed to providing compassionate, comprehensive cancer care for you or your loved ones. We strive to deliver experienced, personalized care through a multidisciplinary approach.

Types of Bone and Soft Tissue Tumors

At Memorial Hermann, we diagnose and treat major types of musculoskeletal tumors.

  • Adult or pediatric soft tissue sarcomas in any location, including all sarcoma subtypes such as:
    • Ewing sarcoma, which occurs in children and young adults and can form in the legs, pelvis and arms.
    • Osteosarcoma, the most common bone malignancy which occurs primarily in children and young adults (generally between 12- 18 years of age). Osteosarcomas are most commonly located in the knee and shoulder.
    • Liposarcoma, which is one of the most common adult soft tissue sarcomas that occur frequently with benign or low grade tumors (also known as lipomas or atypical lipomas) or as a high-grade malignancy. Liposarcomas occur frequently in the extremities, pelvis and abdomen.
    • Leiomyosarcoma, which is a soft tissue cancer that can develop in muscle, fat or blood vessels.
    • Myxofibrosarcoma, which typically forms in groups of soft tissue tumors in extremities.
    • Peripheral Nerve Sheath
    • Fibrosarcoma, which is a rare bone tumor that begins in fibrous bone tissue and spreads to lung and/or flat bones such as the femur, tibia and jaw.
  • Chordoma and Chondrosarcoma, which is a rare cancerous tumors that can grow anywhere along the spine, sacrum or extremities. These types of tumors are very difficult to diagnose in a timely fashion because of subtle clinical symptoms and initial X-Rays.
  • Skeletal Dysplasias, such as:
    • Fibrous Dysplasia, which is a rare bone disorder in which scar-like tissue develops in a normal bone.
    • Hereditary Multiple Exostoses, which is a development of multiple benign bone tumors along the upper and lower limbs.
    • Padget’s Disease, which is a bone disorder that most commonly occurs in the levis, skill, spine and legs and interferes with your body’s ability to replace old bone tissue with new.
  • Benign bone and soft tissue tumors, such as:
    • Osteochondroma, which can be found at the ends of bones near growth plates. It is an overgrowth of cartilage and bone. They are typically benign and do not present a risk for cancer, just discomfort.
    • Osteoma, which is a benign tumor that typically grows on the skull.
    • Non-ossifying Fibroma
    • Bone cysts
    • Exostoses
    • Lipomas
    • Fibromas
    • Vascular hemaniomas

In many cases, orthopedic tumors are low-grade and can be treated easily once they are caught. Children, for example, have a large incidence of benign tumors and skeletal dysplasias. Adult malignancies typically involve soft tissues such as muscle or fat. Generally speaking, the incidence of soft tissue cancers (10,000 to 15,000 cases) falls below that of pancreatic cancers (20,000 to 30,000 cases) per year. Pediatric malignancies represent a small percentage (10 to 20 percent) of all malignancies in the United States, often with a higher incidence in older teenagers and young adults, aged 18-30 years old. The incidence of pediatric osteosarcoma and Ewing’s sarcoma is approximately 2,000-3,000 patients per year in the United States while the incidence of benign pediatric and adult bone and soft tissue tumors tend to be much more common.

Survival rates for sarcoma patients who achieve adequate care can be as high as 60 percent (depending on the tumor grade, size response to treatment and presenting stage at diagnosis), but it requires diagnosing malignant tumors earlier, within the first three to four months.

Diagnosing Orthopedic Cancer

Diagnosing bone and soft tissue cancers can be challenging because there is not a regular screening process for these cancers as part of your normal health routine. However, there are some key signs you can watch for. Bone cancer can usually present as a break in the bone or as acute pain, while soft tissue cancers often present as soft, painless masses in a muscle, on the skin or near a joint.

A large part of successfully diagnosing and treating orthopedic cancer is catching it early, which will depend greatly on your own awareness of your body, as well as your primary care provider knowing what to look for when performing a regular examination. Any area of concern should be imaged with an MRI and biopsied by a surgical oncologist.

Who is at Risk for Orthopedic Cancer?

Bone and soft tissue cancers can impact patients of any age, from infancy to the elderly. You may be at greater risk for bone and soft tissue cancers if you are older than 40 years of age because there is often a greater risk of cancer in older age groups. In some cases, it presents as an abnormal growth in the bone of your hip joint or pelvis. You could also be at increased risk of a sarcoma if you have a family history of multiple cancers or have had prior treatment for other sarcomas or malignancies.

Orthopedic Cancer Treatment

Effective treatment depends entirely on the initial stage, grade and size of the tumor. Bone and soft tissue cancers are typically treated with an aggressive combination of chemotherapy, surgery and radiation therapy.

Chemotherapy

Chemotherapy is typically used in the treatment of aggressive, high-grade sarcomas. Adults and pediatric patients requiring chemotherapy should be followed carefully for tumor response to chemotherapy with several PET scans or MRI imaging.

Chemotherapy can be an effective treatment for soft tissue cancers in both children and adults. These therapies are typically ones that kill rapidly growing cells, which can also include hair, lining of the gut, bone marrow and red and white blood cells.  Your doctor may prescribe additional drugs to minimize the chemotherapy’s toxicity.

Recovery and side effects from chemotherapy are fairly standard but may vary from patient to patient. You run the risk of infection if your white blood cell count is low. In addition, chemotherapy may cause liver toxicity. Permanent alopecia (hair loss) is a rare side effect. Talk to your doctor about how chemotherapy may affect your body.

Radiation Therapy

Radiation therapy for soft tissue cancers is also standard, although radiation standards for metastatic tumors change frequently. Radiation for soft tissue cancers usually involves a 6-week course of radiation therapy and is primarily used as a supplement to surgical treatment. Side effects with radiation treatment are fairly minimal—the equivalent of a sunburn and some fatigue in the middle of the treatment.

Surgery for Bone and Soft Tissue Cancers

Successful surgical treatment for soft tissue cancers and osseous sarcomas is highly dependent upon surgical expertise, tumor degree of aggressiveness, prior treatment, tumor size and tumor location. Nearly 80 percent to 90 percent of patients who undergo surgery for bone and soft tissue cancers are able to avoid an amputation with their surgical treatments. If the patient is under the age of 10, surgical resection can be more difficult due to increased growth, especially if the tumor is near a growth plate.

Following the biopsy, diagnosis is obtained and you will have surgery to remove as much of the tumor as possible while also attempting to preserve healthy tissue (called margins). Recovery after surgery may take as long as 6 to 12 weeks. After surgery, you will likely undergo chemotherapy and/or radiation.

Your whole treatment plan, depending on the complexity of the surgery and cancer, can take anywhere from 6 to 12 months. You should be observed for 3 to 6 months to ensure the tumor does not recur, for a total of 5 years.

Surgery for bone and soft tissue cancers does carry a long list of possible side effects and recovery complications that your physician should be able to help you understand. Aggressive or large tumors are much more difficult to treat surgically and occur more commonly in the pelvis, abdomen or spine. Soft tissue tumors are easier to remove than bone tumors unless they involve a major nerve or vessel. In addition, you may have peripheral nerve issues and lose sensation, especially if the tumor is near the sciatic nerve or femoral nerve. In these cases, your ability to walk may be impacted. Post-operative function may be affected by either neurovascular compromise of loss of muscular soft tissue or significant resection of an adjacent joint or skeletal segment,

Other Treatment Concerns

In most cases, the most important part of effective treatment for bone and soft cancer issues is prompt diagnosis. Patients have an initial a 2- to 3-month period where cancer needs to be diagnosed and treatment should begin. Any excessive delay in diagnosis can significantly impact your recovery as bone and soft tissue cancers spread to other areas of the body, usually the lungs. Any persistent pain lasting greater than 6 to 8 weeks or a soft tissue mass larger than 4 to5 centimeters should have an MRI to obtain a reliable preliminary diagnosis and determine the need for a biopsy.

If you are experiencing any ongoing pain around the hip or have noticed soft tissue mass in your legs or arms, contact your physician. If the diagnosis is questionable, get a second opinion. Do not delay, however, because you should begin treatment as soon as possible to minimize the risk—no more than 3 to 4 months. It is important to work with a physician who understands bone and soft tissue cancers and is experienced in performing the surgery because a patient’s initial surgical procedure can frequently affect their final outcome.

Choosing Memorial Hermann for Orthopedic Cancer Treatment

Orthopedic cancer care from Memorial Hermann involves a diverse team of talented medical, radiation and surgical oncologists, dedicated to the purpose of providing effective, compassionate cancer treatment for you or your loved ones. Our affiliated specialists are dedicated to providing you with the information you need to make informed decisions about your cancer care.