Bone Tumours Limb Salvage Surgery: A Cure and A Hope - Bone tumours need no longer be a source of morbidity, loss of livelihood and social ostracisation.


Bone tumoursBone tumours comprise of benign (non-cancer) and malignant tumours. They afflict people in the prime of their life, and since they usually involve the limbs, they are a source of morbidity, loss of livelihood and social ostracisation.

Great strides have been made in the early diagnosis and management of bone sarcomas especially in the field of limb preservation, so much so, that malignant bone tumours are no longer the dreaded cancers that they once were.

Signs and Symptoms:

 
  • Pain in the bones, Swelling

  • Restriction of joint movement, Erythema (redness and raised temperature over swelling)


Evaluation

Bone tumoursA preliminary work up by way of a clinical examination and X-ray of the local part reveals it to be a bony lesion. Thereafter, taking into consideration the age of the patient and radiological characteristics of the tumour, the lesion can be characterized as benign or malignant with greater than 90 per cent accuracy. Suspected malignant lesions require further evaluation to know the histology and stage of the tumour. Bone biopsy by a bone needle done as a day-care procedure is the preferred method. It produces minimal trauma and soft tissue contamination by tumour as compared to an open biopsy, which should be used only as a last resort.

CT scan and MRI scan identify local spread of the disease and neurovascular (blood vessels and nerves) involvement.


Staging

Bone scan and PET scan identify metastatic disease i.e. spread of disease to other parts.



Management

Benign bone tumours, which are asymptomatic, can be observed whereas the larger lesions and symptomatic (bone pain etc.) require surgery:

 
  • Bone curettage with bone cementing or grafting

  • Wide local excision with bone cementing and bone grafting

Malignant bone tumours

bone tumoursThe principles of treatment are local control of the disease and prevention of metastases. The chemo sensitive bone sarcomas like osteosarcoma and Ewing's tumour undergo two to three cycles of neoadjuvant chemotherapy (i .e. drugs that kill cancer cells given by way of intravenous infusion) to downstage and downsize the tumour. The next stage of the treatment is surgery.



Surgery for Malignant Bone Tumour:

Prior to the 1990s, nearly all extremity sarcomas were treated by amputation of the affected limb which still did not lead to high cure rates. In the last decade, with better understanding of the biology of the disease, and achievement of specialised expertise procedures like limb salvage surgery, today limb conservation is possible in more than 70 per cent of patients. Limb salvage surgery is a complex two stage limb preservation procedure.

 
  • Stage I - Meticulous neurovascular dissection is done to separate nerves and vessels from the tumour bearing bone. The entire liability and functionality of the limb is dependent on this step.

  • Stage 11- Prosthetic (Titanium) implantation in the gap produced by removal of the bone enzymes preserves integrity of the limb. Thus at the end of the procedure the diseased portion of the limb has been removed with preservation of a functional limb.

  • Children and adults no longer have to face ostracisation and pity due to amputation, and with the help of limb salvage surgery can continue to lead productive lives on their own feet. Early detection of bone sarcomas and appropriate treatment leads to high cure rates. Apollo Musculoskeletal Unit (Hyderabad) has performed 72 limb salvage procedures with high cure rates.

 

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