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Musculoskeletal Oncology

Providing comprehensive diagnosis and treatment for benign and malignant tumors of bones and soft tissues.

Musculoskeletal Oncology

Providing comprehensive diagnosis and treatment for benign and malignant tumors of bones and soft tissues.

AOI > Centres of Excellence > Musculoskeletal Oncology > FAQs

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    How is bone cancer caused?

    In most cases, bone cancer occurs when a primary cancer has spread from its region into the bones. Very rarely does bone cancer begin from the cells that make up the bone. Hence it is very important to determine if there is a primary cancer elsewhere in the body which has resulted in the bone cancer.

    Whom does bone cancer affect the most?

    Bone cancer can affect people at any age. Primary bone cancer, except multiple myeloma and chondrosarcoma, is more common in the rest two decades of life whereas secondary bone cancer and multiple myeloma is more common after the age of 45 years. Soft tissue sarcomas can occur at any age.

    What are the possible causes of bone cancer?

    Although primary bone cancer does not have a clearly defined cause, several factors have been identified that could increase the likelihood of developing these tumors.

    They include:

    Previous cancer treatment with radiation, chemotherapy, or stem cell transplantation: People who underwent Osteosarcoma treatment and have had high-dose external radiation therapy (particularly at the location in the body where the radiation was given) or treatment with certain anticancer drugs, particularly alkylating agents; those treated during childhood are at particular risk. In addition, osteosarcoma develops in a small percentage of children undergoing myeloablative hematopoietic stem cell transplantation.

    Certain inherited conditions: A small number of bone cancers are due to hereditary conditions. For example, children who have had hereditary retinoblastoma (an uncommon cancer of the eye) are at a higher risk of developing osteosarcoma. Members of families with Li-Fraumeni syndrome are at increased risk of osteosarcoma and chondrosarcoma as well as other types of cancer. Additionally, people who have hereditary defects of bones have an increased lifetime risk of developing chondrosarcoma.

    Certain benign bone conditions: People over age 40 who have Paget’s disease of bone (a benign condition characterized by abnormal development of new bone cells) are at increased risk of developing osteosarcoma.

    What are the imaging studies helpful in diagnosis of bone cancer?

    X-rays: Are used to identify the type of cancer and to identify if there is any weakening of the bone or fracture in the bone.

    CT scan / Computed Tomography: This is used to give a cross-sectional picture of the bones and get additional information about the tumor in terms of its size and location.

    MRI: Give better information about the soft tissues surrounding the bone like muscles, tendons, ligaments, nerves, blood vessels etc.

    Bone Scan: This is used to identify rapidly growing or remodelling of bone and to see if any other bones in the body are affected.

    Which bones are mostly affected by cancer?

    These tumors can develop in any part of the body that involves a bone including in the hands, arms, elbows, shoulders, scapula, feet, knees, thighs, hips, pelvis, or the sacrum.

    Are there any risk factors of developing musculoskeletal tumors?

    Certain patterns amongst people have been identified by doctors, which increases their risk of developing bone and soft tissue tumors or musculoskeletal tumors. Genetic factors, the most common one followed by other factors such as – predisposition of Paget’s disease and undergoing radiation therapy.

    Do musculoskeletal tumors occur in any specific age-group?

    Most cases, musculoskeletal tumors occur in children in their teenage and women above the age of 30. And everyone above the age of 60 is equally at risk.

    Whom does bone cancer affect the most?

    Bone cancer can affect people at any age. Primary bone cancer, excepting multiple myeloma and chondrosarcoma is more common in the first two decades of life where as secondary bone cancer and multiple myeloma is more common after the age of 45 years. Soft tissue sarcomas can occur at any age.

    What are the common types of musculoskeletal tumors?

    Musculoskeletal tumors are of three main types – Osteosarcoma, Chondrosarcoma and Ewing’s sarcoma. Osteosarcoma is the most common bone cancer in children. Chondrosarcoma is the second most common bone cancer in children, primarily occurring in the pelvis, legs or arms of middle-aged/elderly adults. Finally, Ewing sarcoma is the least common type of bone cancer largely affecting children & young adults.

    What are the screening tools employed to diagnose musculoskeletal tumors?

    There are various advanced screening methods available to accurately diagnose musculoskeletal tumors. Initially, a patient undergoes an X-ray, following which an MRI or a CT scan is done. Mostly, a bone scan and PET are also commonplace whereas some cases, a biopsy might be required for final confirmation of the cancer.

    What are the modalities available for musculoskeletal tumors or bone cancer treatment?

    Treatment for musculoskeletal tumors or bone cancer treatment in children involves a multi-disciplinary approach and can involve any one or multiple combinations of surgery, radiation and chemotherapy. The doctors plan and decide further management and intervention according to the location of the cancer and its severity.

    Can musculoskeletal tumors be treated in a less invasive way?

    Yes, it is possible. Radio-frequency ablation is a minimally invasive procedure being implemented for the treatment of musculoskeletal tumors. It is a form of radiation therapy that is performed via the minimally invasive method.

    What are the goals of Giant cell tumor treatment?

    The goals of Giant cell tumor treatment are:

    • Removal of the tumor
    • Prevention of further damage to the bone
    • Maintain functional architecture of the bone

    What does Giant cell tumor treatment comprise of?

    Giant cell tumor treatment can compose of:

    • Surgical treatment – Curettage and suitable reconstruction of bone
    • Non-surgical treatment modalities – Chemotherapy, radiation therapy or radiotherapy, targeted therapy. Opted in rare cases where surgery is not safely possible.

    The treatment of choice for Giant cell tumor is surgery. However, there can be some cases where surgery is not effective. Such cases require nonsurgical treatment options.

    What does bone cancer treatment include?

    Bone cancer treatment includes a combination of surgery, chemotherapy, and radiation therapy. For some tumors only surgery is the treatment whereas for some cancer types, surgery along with chemotherapy and/or radiation therapy or all three could be the treatment.

    What are the risk factors for bone cancer?

    There are few things that someone should be careful and might be a contributing factor of bone cancer in future. These risk factors could be:

    • Any cancer treatment
    • Paget’s disease
    • Inherited conditions

    What is staging in bone cancer?

    Staging is a set of investigations to determine whether the disease is localized to the site of its origin or whether it has spread to other regions of the body. In bone tumors, there are a few investigations which are specially designed for staging. They are CT scan of the chest, Bone scan and sometimes PET scan. This is because, more than 90 % of metastatic malignant bone tumors spread either to the lungs or to other bones.

    What is the chance of recovery in bone cancer?

    Due to the advancement of modern chemotherapy, the chance of recovery (or prognosis) for orthopedic tumors or bone tumors has improved significantly. It depends on several factors such as the extent of cancer spread, cancer type, tumor size, location and any pre-existing health conditions of the patient.

    How is metastatic bone cancer treated? (or) What is the treatment for secondary bone cancer?

    For metastatic bone cancer, there is no specific treatment. The treatment basically depends on factors like the extent of cancer spread, cancer type, tumor size, location and any pre-existing health conditions of the patient. Your oncologist or cancer specialist will assess and decide the best suited treatment plan for you as per individual needs. In general, the treatment of bone metastases can be palliative (to relieve symptoms) or curative. The basic cancer treatment comprises of chemotherapy, radiotherapy and possibly bone marrow / stem cell transplantation.

    Can bone cancer or orthopedic cancer be detected early?

    There are tests these days available for the early detection of a few types of tumors like breast cancer, cervical cancer, skin cancer, etc. But in case of bone tumors, it is unfortunate to say that no special tests have been developed yet for the early detection. The only and possibly the best way is to be fit and keep going for regular visits to your clinician in case you have any signs and symptoms of this disease.

    How often will I need check-ups after treatment?

    After completion of the treatment, usually check-ups are required every 3–12 months maybe for next several years just to ensure that the cancer does not recur and any side effects of the received treatment are under check. Your oncologist or cancer specialist may call you for follow-ups depending on the type of your bone cancer. If everything is keeping fine, your follow-up visits can be less frequent.

    How do Implants in bone cancer treatment work?

    Implants in bone cancer treatment replace or support damaged parts of the body. The surgeons use pins, screws, plates and metal rods. Usually, implants are made of stainless steel, titanium, or ceramic, usually any inert material. These replace bone and provide support and function to the joint. Now a days, 3D titanium/plastic implant printing machine are also available. These machines can print the same size of the implant like the defect.

    What is the role of stem cell transplants in treatment of Ewing’s sarcoma?

    Stem cell transplants are useful when Ewing sarcomas become non-responsive to chemotherapy. Such cases require radiation therapy and even stem-cell transplants.

    How does stem cell transplants act?

    Stem cells kill bone marrow cells of the tumor affected region, and aids in induction of growth of new cells to replace destroyed cells through a blood transfusion. Gradually, these new cells contribute in producing new healthy bone cells.

    What are the types of stem-cell transplants?

    There are basically two main types of stem cell transplants:

    • Autologous stem-cell transplants – The stem cell is taken from patient’s own body.
      • Uses: treatment of certain leukemia’s, lymphomas, and multiple myeloma.
      • Advantage: very few/no risks of graft-versus-host cancer effect (new cells attacking the body)
    • Allogeneic stem-cell transplants – The transplant is taken from other person and that other person could be either a close family member or a donor from the general public called the MUD or matched unrelated donor.
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