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An orthopedic oncologist is a surgeon that specializes in
tumors of bones and muscles.
And they can be benign tumors, or non-cancerous tumors, or
sarcomas, which are a type of cancer.
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So orthopedic cancers include sarcomas of bone, and
those would be things like osteosarcomas, or
Ewing's sarcomas.
They can be cancers out in the muscle, and
those are call soft tissue sarcomas.
Or they can be cancers that spread to bone,
and that's called metastatic carcinoma.
So if a patient has breast cancer, unfortunately sometimes
women with breast cancer get breast cancer that goes to bone.
Or people with lung cancer or
prostate cancer might get metastases that go to bone.
And so orthopedic tumors constitute all of those things.
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A sarcoma is a type of tumor that starts in the bone.
So metastatic carcinoma is a cancer that travels to bone,
like breast cancer or prostate cancer.
A sarcoma is a type of cancer that starts in the bone or
starts in the muscle.
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Sarcomas are actually fairly rare.
There are only about 2,500 bone sarcomas diagnosed annually
in the United States, and maybe another 10-to-12,000
soft tissue sarcomas diagnosed in the United States.
So overall they constitute probably about 1% of all
cancers.
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So the most common primary bone cancer is
something called osteosarcoma.
Osteosarcoma is a cancer that arises in the bone, and
it typically occurs during the peak growing years, so
it tends to happen in teenagers.
Unfortunately, why children develop osteosarcoma is unknown.
So 90% of the cases are gonna arise largely de novo,
meaning there is no reason, we don't know why.
So it can't be prevented because we really don't know why they
occur in the first place.
There are other children that have some underlying conditions,
such as retinoblastoma, for example, that we know
have a high tendency to develop osteosarcoma later in life.
So those types of children typically require close
surveillance, but most oncologists are doing that for
their patients anyway.
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Bone cancers, in general, will usually present with pain.
Bone sarcomas most commonly occur in children, so children
will complain of pain around the knee, or pain in the shoulder
that doesn't go away, pain that wakes them up from sleep.
And when that happens, that probably prompts a referral to
a physician to see why that's going on.
When patients have metastatic carcinoma to bone, that travels
to bone, that is usually painful also, which is how it's found.
Soft tissue tumors tend not to be painful.
So those often can go on for
quite a long time before patients will come in and
have those treated,
because they're really not causing any symptoms.
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They can be detected on physical exam.
Often patients will notice a lump themselves in their arm or
their leg.
Or their physician or their family member might see a lump
on their body, and that’s how they're often detected.
But they usually don’t say that they hurt.
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So anytime a patient is diagnosed with cancer,
they undergo a staging.
And a staging tells the physician and
tells the patient what prognosis is and, essentially,
how to direct treatment.
And grade refers to how aggressive a cancer appears
under the microscope.
So cells that are dividing very rapidly have a higher grade, and
cells that are dividing very slowly have a lower grade.
And a pathologist puts together a constellation of things that
they see under the microscope to make that determination.
Higher grade cancers have a higher tendency to spread to
another part of your body,
whereas lower grade cancers tend to stay put where they are.
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Sarcomas in general are treated with either surgery,
chemotherapy, radiation, or a combination of two or
three of those things.
Some tumors require one of those treatments.
Other tumors require all three of those treatments.
Metastatic carcinoma to bone is often treated with radiation
first, if we don't think that someone is at risk of breaking.
But if we think that someone is going to break their arm or
their leg, then surgery is pretty quickly
incorporated into that.
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So here at Hopkins we're very team oriented.
We've initiated something called
the Sarcoma Multidisciplinary Clinic,
where patients can see all the specialists in a single visit.
So in the clinic you can see your orthopedic oncologist,
your general surgeon, your radiation oncologist,
your chemotherapist, other sub-specialties if
they are needed, such as plastic surgery or urology.
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So patients that evaluated in the orthopedic oncology clinics
see both the surgeon or nurses, nurse practitioners,
physician assistants.
And we very much take a team approach to managing our
patients.
We take care of all patients with any type of bone or
soft tissue tumor, whether it's benign or malignant, and
adjust the plan accordingly.
Not every patient needs surgery.
Some patients just need guidance on how to manage
end of life affairs.
Some patients just need help when trying to navigate what's
a very complex system when taking care of their cancer.
And then, lastly, some patients need surgery and
that's what we will focus on.
But we're really there to take care of the whole patient,
regardless of how big or small the problem is.
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