MUSCULOSKELETAL TUMOURS

The Joint Space provides expert surgical care to adolescents and adults diagnosed with
both benign and malignant musculoskeletal tumours and tumour-related conditions.  
These can include soft tissue sarcomas, primary & metastatic bone tumours and pathological fractures (fractures caused by the presence of tumour).  

 

Both A/Prof Sommerville and Dr Rowell are members of the Wesley Sarcoma MDT (Multi-Disciplinary Team). The Wesley Sarcoma MDT is the first private sarcoma treatment centre in Queensland. The MDT combines the expert knowledge of surgical oncologists, radiation oncologists, medical oncologists, radiologists and pathologists who work together as a team to provide a multidisciplinary, coordinated and customized treatment plan.   
 

The term 'musculoskeletal tumours' broadly refers to tumours that grow in the bone, and tumours that grow in the soft/connective  tissues i.e. fat, skin, nerves, muscle, cartilage etc. 

 

Having any form of tumour or abnormality can be very distressing but it is important to remember that not all soft tissue and bone tumours are malignant (cancerous).  Some may be benign (usually non-life threatening), but can still be very aggressive, and others may be malignant (life-threatening), but can be very indolent and slow growing.  Malignant tumour cells can occasionally 
spread cancer cells to other parts of the body, and this process is known as metastasizing, or metastasis/metastatic cancer. 

Common benign soft tissue and bone tumours include:

schwannoma, lipoma, enchondroma, pvns (pigmented villonodular synovitis), giant cell tumour, osteochondroma, osteoid osteoma, osteochondroma, aneurysmal bone cyst, chondroblastoma, chondromyxoid fibroma.

The most common primary malignant soft tissue and bone tumours are called sarcomas.  The term 'sarcoma' describes over 70 types of cancer.  Sarcomas are classified according to the type of tissue/cell that they grow from and include both bone and soft tissue. 

 

Common sarcomas include:

osteosarcoma, ewing's sarcoma, chondrosarcoma, synovial sarcoma, liposarcoma, leiomyosarcoma, fibrosarcoma, angiosarcoma.

Another common malignant bone tumour is sacral chordoma.

Diagnosis

Making a diagnosis usually entails a combination of the following -

* Blood tests to look for any signs of inflammation or infection

* Imaging modalities (x-ray, CT, MRI etc.)

* Biopsy (a sample of the tumour tissue). There are two basic biopsy methods used to obtain a tissue sample - a core-needle biopsy,  and an open biopsy. Core-needle biopsies are usually performed under imaging guidance i.e. ultrasound or CT scan.  It involves inserting a needle into the tumour to collect a sample which is then sent for histological analysis.  These biopsies are often performed by a radiologist.  An open biopsy is a surgical procedure performed by the surgeon to surgically excise a tissue sample. 

Once a diagnosis has been made, and the specific type of tumour is known, a treatment plan can then be formulated. 

Treatment

Treatment for musculoskeletal tumours depends on a number of factors, such as what type of tumour it is (benign or malignant), which part of the body it affects, the presence and severity of symptoms (pain etc.) and, if malignant, whether it has spread (metastasized) to other parts of the body. 

Treatment  may include any, all, or a combination of the following -  

* Observation only and regular surveillance with clinical reviews and imaging (MRI etc.)

* Non-surgical treatment using techniques such as radiofrequency ablation 

* Surgery to excise the tumour.  Sometimes, depending on the tumour's location, reconstructive surgery using a tumour endoprosthesis or plastic surgical techniques may be necessary to restore and maintain limb function.  

* Chemotherapy

* Radiotherapy / radiation

Resources

A cancer diagnosis can be overwhelming and it is important to get information from the right sources. The following organisations and contacts can provide further tumour-specific information and support. 

Wesley Hospital Cancer Care Co-ordinators - M: 0418 903 042 (Mon - Fri, 0700 - 1530)

ANZSA (Australia & New Zealand Sarcoma Association)

Cancer Council Australia - Soft Tissue Sarcoma

Cancer Council Australia - Bone Cancer

Cancer Council Australia - Secondary Bone Cancer

Cancer Australia

Chordoma Foundation

Treatment Pathways

cancerpathways.org.au/optimal-care-pathways/sarcoma