Author: Raffi S. Avedian, MD
Description
Receiving a diagnosis of a bone sarcoma is scary and often overwhelming. A team of doctors who have expertise and experience in taking care of people with bone sarcomas can help patients get through this oftentimes difficult time. The journey forward for a patient with a bone sarcoma can be thought of in stages as follows 1) initial diagnosis and evaluation, 2) treatment, and 3) life after completion of treatments.
Initial Diagnosis and Evaluation
The first step in evaluating a bone sarcoma is to assess its size and how it is affecting the surrounding normal body tissues such as muscles, arteries, and nerves. This is typically done with X-rays and MRI. The next step is to see if the tumor has spread to any other part of the body such as the lungs or another bone which is done with lung cat scan and either bone scan or PET scan. For people who will receive chemotherapy, such as in cases of osteosarcoma or Ewing’s sarcoma, additional preparation such as heart exams, port placement, and reproductive health planning may be performed under the guidance of a medical oncologist.
Treatment
The treatment for bone sarcomas involves surgery to completely remove the tumor. In cases of Ewing’s sarcoma radiation therapy may be substituted for surgery in select cases. The details of the surgery depend on the location and size of the tumor. Patients should talk with their orthopedic oncologist to review options that are specific to their case. Most bone sarcomas occur in the arms or legs in which case the surgery may involve what is called a limb salvage procedure where the tumor and involved portion of the bone are removed and a reconstruction of the missing bone is performed. The reconstruction of the person’s missing bone may involve using metal replacement, an artificial joint, such as hip or knee replacement, cadaver bone graft called allograft, using patient’s own bone called autograft or combination of these. Regardless of the technique used all of these options may at times require additional surgeries or need for revision surgeries in the future. In some cases, patients may choose to undergo amputation, which for some patients may afford a better chance of being cured and overall better quality of life than limb salvage surgery. In terms of timing of surgery, for people who receive chemotherapy the surgery usually takes place after 2 or 3 cycles of treatment (approximately 3 months). Chemotherapy resumes 2-3 weeks after surgery and lasts an additional 6 to 9 months approximately. Surgical complications such as delayed wound healing may alter this schedule. The details of surgery can significantly vary from one patient to another; however, most people should plan for many months if not over a year of gradual recovery that includes physical therapy.
Life after Completion of Treatment
After completion of treatment people go on a schedule to undergo several imaging scans per year to check if the tumor is coming back. This is called “surveillance” and lasts approximately 5 years. With respect to physical function after surgery people can expect a good quality of life, however virtually all patients do experience some degree of limitation. This does significantly vary from person to person based on the details of their tumor and surgery, thus, it is important for patients to discuss the details of their specific case with their orthopedic oncologist.
More Information:
AAOS orthoinfo: https://orthoinfo.aaos.org/en/diseases--conditions/bone-tumor/
Sarcoma Alliance: https://sarcomaalliance.org/
Cancer Research UK: https://www.cancerresearchuk.org/about-cancer/bone-cancer/living-with/life-after-bone-surgery
This is not intended as a substitute for professional medical advice and does not provide advice on treatments or conditions for individual patients. All health and treatment decisions must be made in consultation with your physician(s), utilizing your specific medical information. Inclusion in this is not a recommendation of any product, treatment, physician or hospital.