Musculoskeletal Tumor Clinic
Musculoskeletal tumours arise in connective tissues such as bone, cartilage, muscle, fibrous tissue, fat tissue, blood vessels and nerves. There is a wide range of such tumours from common to extremely rare, and they can occur throughout life, although some are particularly more common in young people. There are a number of conditions, such as infections, which can mimick bone and soft tissue tumours. The spectrum of musculoskeletal tumours runs from benign tumours that one never realises are present, to benign tumours that are aggressive at their site of origin but do not spread elsewhere in the body, to malignant tumours that are aggressive and do have the ability to spread elsewhere, or metastasise. These latter types are known as sarcomas.
Management of a suspected bone or soft tissue tumour often involves a stepwise, multidisciplinary series of tests, depending on the initial findings. The aim of these tests is to distinguish a tumour from a tumour-mimicking condition, to determine whether it is benign or malignant and how aggressively it is behaving at its site of origin, to determine the precise anatomical relationship of the tumour to its surroundings, and to establish a precise diagnosis among the many types of tumours that exist. Having said that, because of the invasive nature of some tests, not all available tests are necessary for all tumours in children, particularly if they are obviously benign and not destructive. The range of tests performed includes x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), whole body bone scans, thallium scans, gallium scans, angiography, bone marrow aspiration, and biopsy. A number of these procedures require general anaesthesia or sedation. Once all of the diagnostic information is available, a plan can be made for treatment.
Benign tumours may or may not require treatment. Some tumours can be periodically monitored if they are not causing any trouble. Those tumours that cause destruction of bone often are best treated surgically in order to remove the tumour and restore skeletal integrity and prevent the bone from breaking. Some of these surgical procedures are minor and some are major.
Malignant musculoskeletal tumours, or sarcomas, require a combination of treatments to give one the best chance at eradicating the tumour and restoring function. The multidisciplinary team is most important with this group of tumours. Medicines (chemotherapy) are essential to eradicating sarcomas, and because of them, survival from sarcoma has increased dramatically since the mid-1970s. The treatment is intended to treat the whole body and can take many months. Usually midway through this medical treatment, surgical treatment of the tumour at its site of origin is undertaken. Specialist orthopaedic oncology surgeons perform these procedures, with the goal of removing the tumour with a wide margin of normal tissue around it, all the while preserving as much function as is possible. Most limb sarcomas today can be treated with a limb-preserving operation, by reconstructing the limb from within after removing the tumour. Living bone and tissue, bone grafts, state-of-the-art artificial implants and total joint replacements can be used for these reconstructions.
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