Patient Resources

Osteosarcomas (Bone Tumors)

 

 

OVERVIEW

Osteosarcomas are the most common type of cancer that develops in bone. Eighty percent of all osteosarcomas develop in the bones around the knee. Osteosarcomas can spread into nearby tissues and to distant organs (the lungs and other internal organs). In 2007, the American Cancer Society estimates that 900 new cases of osteosarcoma will be diagnosed in the United States - 500 in adults and 400 in children, adolescents, and adults younger than 20.

Because osteosarcomas are rare, it is crucial for patients to be treated by a board-certified orthopedic oncologist with special training to be certain the surgeon treats these tumors regularly and has expertise in their removal and ongoing management of the cancer. Research studies over the past few years in various areas of surgery prove that an experienced surgeon who performs a procedure often is the best choice for a positive surgical result. Not all orthopedic tumors are malignant. But even benign orthopedic tumors need to be treated carefully by an orthopedic oncologist because although these tumors will not metastasize, they can grow aggressively and destroy bones.

At The Cancer Center, the orthopedic oncology team of the Division of Sarcoma and Skin Cancer is pioneering innovative techniques in sophisticated limb-sparing surgery and the use of heat energy in radiofrequency ablation and extreme cold in cryosurgery to provide patients with the most advanced orthopedic cancer care in North Jersey. Advancements in surgical techniques, new modalities, technology, orthopedic materials, chemotherapy, radiation, and imaging studies at The Cancer Center mean that 95 percent of patients with an orthopedic malignancy such as an osteosarcoma do not need to lose a leg or arm to cancer.

Our chief of the Division of Sarcoma and Skin Cancer , James C. Wittig, M.D., is one of only a handful of orthopedic oncologists in the metropolitan New York-New Jersey area who is experienced in performing complicated limb-sparing surgeries and other orthopedic cancer techniques. During a two-year fellowship in orthopedic oncology at the Washington Cancer Institute in Washington, D.C., he trained in vascular surgery and plastic surgery as well as his specialty. He offers patients these additional skills and can perform an entire limb-sparing surgery himself.

If you are diagnosed with osteosarcoma, it is important to be treated in a major academic and research center such as Hackensack University Medical Center because there are specialists here that you will not find in community hospitals. These include not only Dr. Wittig, but also musculoskeletal radiologists, who make diagnoses and monitor treatment, and interventional radiologists, who perform minimally invasive percutaneous biopsies, which can be complex with osteosarcomas.

Dr. Wittig and the orthopedic oncology team at The Cancer Center offer their patients the following advanced diagnostic and treatment methods:

  • limb-sparing surgery, during which Dr. Wittig removes the bone or portion of the bone containing the tumor and replaces it with a metal prosthesis;
  • radiofrequency ablation, during which Dr. Wittig places a probe into the tumor and destroys it with heat energy;
  • cryosurgery, during which Dr. Wittig pours liquid nitrogen into the surgical site to kill any remaining tumor cells;
  • pre-operative chemotherapy to kill osteosarcomas prior to surgical removal, making the surgery less extensive and reducing the chance of recurrence;
  • external beam radiation therapy following surgery in some cases;
  • minimally invasive percutaneous biopsies performed by interventional radiologists, who extract the tissue needed for a diagnosis without cutting; and
  • epineural analgesia to provide post-operative pain relief directly to the surgical site.

 

 

DIAGNOSTIC SERVICES

To diagnose osteosarcoma, your physician may use one or more approaches:

  • bone X-rays
  • CT scan
  • MRI
  • chest X-rays
  • radionuclide bone scan
  • PET scan
  • blood tests
  • biopsy (needle or open needle)

 

 

RISK FACTORS

Osteosarcomas are 50 percent more common in males. Most develop between the ages of 10 and 30, with the highest incidences occurring during teenage "growth spurts." Only 10 percent of all osteosarcomas occur over age 60. Those at risk for developing osteosarcomas also include people who were treated for another cancer with radiation therapy and those with a history of Paget's disease of bone and multiple hereditary osteochondromas.

 

SYMPTOMS

Symptoms of osteosarcoma include pain in the bone and swelling at the pain site. It may be possible to feel a lump or mass.

 

TREATMENT SERVICES

Surgery is the most common treatment for osteosarcomas. Surgery may be combined with chemotherapy, cryosurgery, or radiofrequency ablation for optimal treatment.

Surgery

In the past, amputation of a leg because of osteosarcoma was common. Today, at The Cancer Center, 95 percent of our patients with an orthopedic malignancy can be treated without losing a limb. However, in about 5 percent of cases, amputation of the limb is necessary if the tumor extends into tendons, nerves, and blood vessels.

A biopsy and limb-sparing surgery should be planned together and undertaken by an orthopedic oncologist who is highly experienced in this procedure because it is a very complex and intricate operation. The challenge of surgery is to remove the tumor while preserving tendons, nerves, and blood vessels. Our chief of the Division of Sarcoma and Skin Cancer , James C. Wittig, M.D., is one of only a handful of orthopedic oncologists in the metropolitan New York-New Jersey area who is experienced in performing complicated limb-sparing surgeries and other orthopedic cancer techniques. During a two-year fellowship in orthopedic oncology at the Washington Cancer Institute in Washington, D.C., he trained in vascular surgery and plastic surgery as well as his specialty. He offers patients these additional skills and can perform an entire limb-sparing surgery himself. Dr. Wittig is also skilled in delivering epineural analgesia directly to the surgical site to provide post-operative pain relief.

Radiofrequency Ablation

Radiofrequency ablation is a minimally invasive procedure that involves placing a probe into a tumor and destroying it with heat energy.

Cryosurgery

Cryosurgery may be used in combination with surgery to kill any remaining tumor cells with extremely cold temperatures. Cryosurgery involves pouring liquid nitrogen into the surgical site.

Chemotherapy

Our chief of the Division of Sarcoma and Skin Cancer , James C. Wittig, M.D., is investigating the use of pre-operative chemotherapy to kill orthopedic malignancies, including osteosarcomas, prior to surgical removal. This makes the surgery less extensive and reduces the chance of recurrence of the cancer. In most cases, chemotherapy is also administered after the surgery. Chemotherapy for osteosarcoma usually involves a combination of drugs.

Radiation Therapy

Osteosarcoma is not easily destroyed by radiation so radiation therapy does not play a major role in the treatment of the cancer. However, it may be recommended to control pain and swelling if the cancer comes back after surgery or if surgery is not possible.