Effective cancer care depends on a complete and accurate diagnosis. Each of our patients receives a thorough evaluation and diagnosis before we create an individualized treatment plan. This allows us to provide the most effective and successful treatment plan possible.
Our physicians at MedStar Health gather information from the most advanced methods to develop the fullest and most accurate diagnosis possible.
- Minimally invasive biopsies help accurately identify the cancer without a complex, open, and painful surgery. During a biopsy, your doctor removes tissues or cells from the area for detailed examination under a microscope. By examining tumor cells, your doctor learns whether the tumor is benign (non-cancerous) or malignant (cancerous), as well as how aggressive it may be and how it may spread. These details help your doctor develop the most effective treatment plan.
- During pathology review, an expert musculoskeletal pathologist examines the tissue sample from your biopsy under a microscope. The goal of the pathology review is to gain important information about the tumor and cancer, including:
- Type of cancer
- Grade of the cancer (a measure of how aggressively it grows)
- Tumor margins, which measures whether the tumor was completely removed on a microscopic level. It also determines whether your doctor needs to surgically remove more tissue around the tumor.
- Advanced imaging pinpoints the tumor and possible growth of the cancer, using the most advanced technology.
- Orthopaedic radiology review by our expert orthopedic surgeons and radiologists, to examine the scans and films, and identify the location and possible growth of the tumor.
By combining these different pieces of information, our physicians can decide on the best course of treatment for each patient. Treatment usually requires our surgical services and, for some patients, our cancer treatment services.
MedStar Health physicians are recognized internationally for their expertise in complex orthopaedic tumor surgery and see patients referred from all over the United States and the world. Our limb-salvage rate is 98 percent, and our patients have a greater return to function because of our advanced techniques.
Surgery to remove tumors from the musculoskeletal system involves three main steps:
- Removing the tumor. Complete removal of the tumor during surgery is critical for patients. It helps minimize the risk of the tumor returning at a later date.
- Fixing the bone. This determines how well the limb works after surgery and returns to full function.
- Repairing the soft tissues—including muscles, tendons, and ligaments—and closing the skin to return function (complete movement of the limb, if possible) and cosmetic appearance
When a surgery is extremely complex—with large tumors or hard to treat areas, such as the pelvis and spine—our orthopaedic surgeons consult with and include other surgical specialists as part of the treatment team. These specialists may be vascular, microvascular, general, spine, plastic, or neurosurgeons who work as a coordinated surgical team to determine the best surgical approach for each patient. Goals include removing as much of the cancer as possible, and maintaining function of the limb.
Cyrosurgery uses extremely cold temperatures to freeze and destroy tumor cells. This procedure begins with the surgical removal of the tumor, where the bone is opened, and the main bulk of the tumor is scraped out with curettes (special surgical scalpels). Following curettage, the surgeon uses liquid nitrogen or specialized gas probes to freeze and kill all remaining tumor cells left along the edges of the tumor cavity.
Cryosurgery is necessary for aggressive lesions or tumors, since simple curettage may leave behind microscopic amounts of tumor cells that could grow back into a new tumor mass. By extending the area around the resection (site of the surgery), cryosurgery can kill remaining cells. This improves the chance that the tumor is completely eliminated.
The technique is often used to treat benign (aneurysmal bone cysts), aggressive (giant cell tumor of bone) and certain low grade malignant tumors (low grade chondrosarcomas).
Endoprosthetic Reconstruction Surgery
Endoprosthetic reconstruction replaces portions of the skeleton with an internal prosthesis, or implant, to provide stability and function after tumor removal. These implants are similar to total joints for the hip and knee—they are completely internal and covered by muscle and skin.
These implants, many of which are modular, are selected and customized for each patient to ensure the best possible fit and function. Pediatric patients who are still growing may require special custom-made implants that can expand. These allow the limbs to be lengthened as needed, while the children continue to grow.
Sarcomas affecting the soft tissues in the abdominal cavity can affect several organs. Surgical procedures to remove these tumors are very complex. Our surgical oncologists perform a large number of them every year.
In the past, most bone and soft tissue sarcomas were treated by amputating the affected limb. Surgical procedures, radiation therapy, and chemotherapy techniques have advanced significantly, however, changing treatment options and minimizing amputations.
In a limb-sparing surgery, the entire tumor is removed, along with a small area of healthy cells around the tumor to ensure complete removal of the cancer. Once the cancer is removed, the damage done by the tumor must be repaired. This may include replacing any missing bone or joints with an internal prosthesis or implant or transferring muscles or tendons to restore the area. The benefits of this surgery include:
- Removal of the entire tumor
- Preservation of function and the ability to use the limb soon after surgery
- Ability to use other treatments, such as radiation and/or chemotherapy as soon as possible after surgery, when needed to treat the cancer
Minimally-Invasive Percutaneous Tumor Ablation
Using minimally invasive techniques, physicians insert a needle-like probe into the tumor, using advanced imaging techniques to ensure proper placement of the probe. The tumor can then be heated (radiofrequency ablation) or frozen (cryosurgery) to destroy the tumor mass.
Neoadjuvant, or, induction, chemotherapy is given prior to surgical removal of a tumor. By killing all or part of the tumor, it permits a smaller operation and makes a limb-sparing surgery safer (prevents tumor recurrence). Chemotherapy is usually continued after surgery. This is essential to kill any remaining tumor cells at the surgical site as well as elsewhere in the body. Most bone sarcomas, such as osteosarcoma and Ewing's sarcomas, are treated with neoadjuvant chemotherapy and limb-sparing resection.
Revision surgery is a procedure to redo or complete a prior operation to correct problems or improve function. Revision surgery aims to treat tumors that were partially removed or have grown back. Many of the revision surgeries we perform are for patients previously treated at an outside institution who have been referred to our skilled team.
Many of the same skills needed for removing a tumor are the same skills used to correct problems arising from prior surgery. Our physicians have a great deal of experience dealing with such cases and can often offer innovative solutions to very challenging problems.
Radiation therapy uses carefully calibrated amounts of high-intensity radiation to kill tumor cells. It is usually used after surgical resection of tumors to kill any remaining cells. It is administered by radiation oncologists and given in brief, daily, outpatient treatments over several weeks.
Shoulder Girdle Surgery
After the limbs, the shoulder girdle, which includes several major bones in the shoulder area, is the most common site for the development of bone sarcomas.
Recent advances in surgical procedures, as well as chemotherapy techniques, have helped doctors treat these sarcomas without amputation. These new procedures help patients maintain useful function of the shoulder, arm, wrist, and hand.
Your surgeon will remove the entire tumor, as well as a small area of healthy cells around the tumor, to make sure the cancer is removed completely. Once the cancer is removed, the surgeon can insert an internal prosthetic to reconstruct the bone and joint.