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>> Bone sarcomas are a rare collection of cancerous tumors
that affect the bones predominately
and they originate in the bones.
The most common types are osteosarcoma,
Ewing's sarcoma, and chondrosarcoma,
but there are multiple other subtypes as well.
Each of them are rare.
There's about 1200 in the country every year,
but at Johns Hopkins Hospital we see
a disproportionate number of those
and we have a very experienced team at managing them.
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Oftentimes we can tell based off of imaging
that there's an abnormality there that's
highly concerning, but ultimately, we need a biopsy
where a pathologist looks at a small piece
of the tumor under a microscope to confirm
that it really is bone sarcoma.
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So, it depends on the type of bone sarcoma.
The most common being osteosarcoma
or Ewing's sarcoma are typically treated
with a very coordinated course of chemotherapy
and surgery.
The surgery is a detailed surgery where we excise
the entire tumor, that we specialize in limb salvage
where we can save and reconstruct the limb
and put them back together.
We work closely with our colleagues
from medical oncology or pediatric hematology
and oncology to coordinate the timing of the chemotherapy
versus the surgery to ensure optimal outcomes.
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So, primary bone sarcomas can be found in any
part of the body.
The most common is in the femur.
So, osteosarcomas in particular tend to be around the knee,
either in the lower part of the femur bone
or the upper part of the tibia bone,
though frankly they can occur in any part of the body
and we have a treatment option for each
and every one of those spots.
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Typically bone sarcomas present initially with pain,
particularly pain that's at night,
though they don't have to be painful all the time
and the mass.
So oftentimes, we note them because you have some discomfort
in and around, say, the knee.
On radiographs we can start seeing that there's
an enlarging or a swelling of the bone at that area
that can be highly concerning for a sarcoma
in many instances, though others can be quite subtle
and it takes a good clinical acumen
to be able to identify them.
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There are.
Most bone sarcomas are sporadic, meaning that we don't
know why they occurred.
It just happened, though there are some rare conditions,
either patients that have had radiation for other causes,
radiation is known to predispose to sarcomas,
or there are some rare genetic conditions
that can predispose to all sorts of cancers
including primary bone sarcomas.
Though, most of the time we don't quite know the reason.
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So, bone sarcomas can reoccur.
They occur either locally in the area where it
was initially taken out
or it can recurr systemically,
meaning somewhere else in the body.
We do very close surveillance
and obviously we take great care in our surgeries
to ensure that we can minimize the risk
of any local recurrence.
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Well, we're constantly exploring new ways
to go and augment and improve the outcomes
for our patients.
That's both on the surgery side
as well as the radiation and chemotherapy side
of our treatment plans.
We work closely with national and international
cooperative groups as well
in order to go and make sure that we are
at the cutting edge for all of our treatment strategies.
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