Treatment Information for Orthopedic Oncology

There are several disorders that can occur in the bones. These include

• benign (non-cancerous) disorders
• cancers that originate in bone
• cancers that have spread to the bones

Physicians at the Alvin & Lois Lapidus Cancer Institute are frequently asked to see patients with tumors in the bone. Some tumors may be cancerous while others are benign. The physicians can usually tell whether a bone tumor is benign or malignant based on the clinical history and imaging studies. Sometimes a biopsy will be needed.

In this Section:

Benign Bone Tumors
Malignant Bone Tumors 
Cancer has Spread to Bone (Metastasis)
Benign Soft Tissue Tumors
Malignant Soft Tissue Tumors

 

Benign Bone Tumors

There are several types of benign bone tumors. Benign tumors are not cancerous and generally mild. Some benign bone tumors may go away on their own.
Symptoms may include pain at the adjacent joint, a visible mass, swelling or limited movement in the adjacent joint.
Treatment may include observation (watchful waiting), minimally invasive surgery or surgery.

Benign bone tumors include:

Chondroblastoma
Chondroblastomas are a type of benign bone tumor that starts in the cartilage cells.  Cartilage is a dense connective tissue that's present throughout the body. While it can impact people of all ages, it is most common in children and young adults between the ages of 10 and 20 years. Chondroblastomas, although not cancerous, are locally aggressive.

Enchondroma
Enchondromas are benign bone tumors originating in the cartilage cells. Enchondromas usually begin in the hand, humerus, femur or tibia.

Giant Cell Tumor
A giant cell tumor of bone (GCT) is a non-cancerous (benign) tumor that grows and destroys bones rapidly. A giant cell tumor most commonly occurs near the knee. Since a GCT is locally aggressive, it requires surgical treatment.
It generally occurs in adults between the ages of 20 and 40 years.

 

Malignant Bone Tumors

The most common cancer involving bones is the result of cancer that spreads from another part of the body, such as the breast, thyroid, prostate, kidney or lung. Primary malignant bone tumors are cancers that originate in the bone. Most patients with primary bone cancer can be cured. In greater than 90 percent of cases, patients can be treated with limb-sparing surgery.

Osteosarcoma
Osteosarcomas are malignant bone tumors that often develop during adolescence. An osteosarcoma develops from osteoblasts, which are cells that create bones.

Osteosarcomas are the most common malignant bone tumors, generally impacting children. The average age at diagnosis is 15. Boys and girls have a similar incidence of this tumor until late adolescence, at which time boys are more commonly affected.

Ewing's sarcoma
Ewing's sarcoma is a malignant tumor that usually involves the bones in the pelvis or long bones (arm or thighbone.) It generally impacts children and adolescents between the ages of 10 and 20. Advances in chemotherapy and surgery make this a curable disease, without the need for amputation.

Chondrosarcoma
Chondrosarcoma is a cancer that starts in the bones and produces abnormal malignant cartilage. It often effects the things, arms, or pelvis. While chemotherapy is not proven to be effective for this type of cancer, surgical removal of the tumor offers the potential for a cure.

 

Cancer has Spread to Bone (Metastasis)

Any cancer has the ability to spread to bone. The most common types of cancer to spread to bone are prostate, kidney, breast, lung and thyroid. Bones are one of the most common sites for circulating cancer cells to settle and start growing.

Some people with metastatic cancer do not have symptoms. The type and frequency of the symptoms will depend on the size and location of the metastasis. For example, cancer that spreads to the bones is likely to cause pain and can lead to bone fractures. Almost all of the malignant cancers have the ability to metastasize.

If a bone is weakened by cancer and at risk for a fracture, it can be treated by a variety of options, including medical management (chemotherapy, bisophosphonates, radiation and/or surgery.)

Your physician is the best person to offer a long-term prognosis.

 

Benign Soft Tissue Tumors

Benign tumors of soft tissue involve muscles, ligaments, nerves and blood vessels.
Most benign soft tissue tumors are painless. Some, like angiolipoma, schwannoma, neurofibroma and glomas, may be painful.

Treatment may include observation (watchful waiting), surgery, or the tumor may go away on its own. However, some benign tumors are aggressive and require prompt treatment. Some, such as desmoid tumors, do not metastasize but do invade nearby tumor.

 

Malignant Soft Tissue Tumors

Sarcomas are malignant soft tissue tumors that can appear in the fat, muscles, tendons, nerves, synovial tissue, blood vessels and other fibrous tissue. Since sarcomas are malignant (cancerous), the cancer can spread and become life-threatening. Patients with these tumors often do not have symptoms. In order to diagnose these types of cancer, an orthopedic oncologist will use imaging studies, such as X-ray, CT, MRI, bone scan or a PET scan. At times, a biopsy may be needed.

Surgery remains the primary method of treatment. It often involves removal of the entire tumor and surrounding tissue. In addition to surgery, pre-operative or post-operative radiology is frequently recommended. The role of chemotherapy remains controversial for malignant soft tissue sarcomas. You and your physician will decide together whether chemotherapy for your type of sarcoma is advised.

Fibrosarcoma
Fibrosarcomas develop from fibroblasts, which are cells that produce connective tissue. They are very rare. There are two forms of fibrosarcoma – infantile, or congenital fibrosarcoma, which occurs in children under the age of 10, and adult fibrosarcoma, which is most likely to appear in people between the ages of 35 and 55.

Angiosarcoma
Angiosarcomas are cancerous tumors that arise from blood or lymphatic vessels. They are most common in the arms, legs, neck and head. They are about one percent of all sarcomas.

They are most common in adults over age 20 and are more common in men.

Leiomyosarcoma
Leiomyosarcoma is cancer that develops in the muscle tissue. It can appear anywhere in the body, but is often found in the abdomen, gastrointestinal tract, or uterus.

Rhabdomyosarcoma
Rhabdomyosarcoma is a cancer made up of cells that normally develop into skeletal muscles of the body. It is the most common soft tissue sarcoma in children.

There are two types of rhabdomyosarcoma: embryonal and alvelolar.

• Embryonal
An embryonal rhabdomyosarcoma (ERMS) is the most common type of rhabdomyosarcoma, appearing in the head and neck area, bladder, vagina, or and in or around the prostate and testes. ERMS usually affects infants and young children.

• Alveolar rhabdomyosarcoma
Alveolar rhabdomyosarcoma (ARMS) occurs more often in large muscles of the trunk, arms, and legs and typically affects older children or teenagers.

Synovial sarcoma
Synovial sarcomas are tumors of the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. They occur most often in areas near the joint but almost never within the joint.

About 50 percent of synovial sarcomas develop in the legs, especially the knees, and is a slow growing tumor. Synovial sarcomas occur mostly in people around age 25. Approximately 30 percent of patients with synovial sarcoma are younger than 20.
Other types of sarcomas include neurofibrosarcoma, fibrous histiocytoma and liposarcoma. 

 

Lipoma
Lipomas are common tumors made up of fatty tissue. They are most common in adults between the ages of 40 and 60. Many lipomas can be observed, but some can grow tremendously and require excision.

Since lipomas are common and sarcomas are rare, patients are often told their mass is a lipoma. In many cases, an MRI is needed to confirm that the mass is a lipoma.
 
Angiolipoma
Angiolipomas are rare benign tumors made up of fatty cells and blood vessels. They most often appear in men between the ages of 20 and 30.

Fibroma
Fibromas are benign tumor made up of connective or fibrous tissue, and can appear in any part of the body.
Fibromas are most common in children and adolescents.

Benign Fibrous Histiocytoma
Benign fibrous histiocytomas are tumors made up of fibrous tissue, which forms tendons and ligaments and covers bones as well as other organs in the body.
These tumors appear most often in young or middle-aged adults. They are more likely to appear in men than women.

Neurofibroma
Neurofibromas are a type of nerve sheath tumor. They can splay apart nerve fibers.
They are among the most common benign tumors appearing in the nerves.

Neurofibromas sometimes occur because a patient has a genetic disorder of the nervous system called neurofibromatosis. This disease causes skin changes and deformed bones and usually starts at birth (Type 1) or hearing loss, ringing in the ears and poor balance (Type 2).

Schwannoma
Schwannomas are tumors that come from the cells that form a protective sheath around the body's nerve fibers. They usually appear as a single tumor.

Hemangioma
Hemangiomas are benign growths within the blood vessels. They are frequently treated with observation (watchful waiting) or a minimally invasive technique by an interventional radiologist. Techniques used by interventional radiologists include embolization and/or chemical sclerosis. At times, a surgical excision may be recommended.