Orthopedic Oncology: Specialists and Information

Orthopedic oncology deals with

• tumors of the musculoskeletal system, known as “primary bone and soft tissue tumors,” as well as
• muscle and bone metastases, known as “musculoskeletal metastases.”

The latter refers to tumor metastases from, for example,

• prostate cancer,
• breast cancer, or
• lung tumors.

The incidence is as follows: Less than four percent of malignant orthopedic tumors are primary bone tumors. The rest are metastases, i.e., secondary tumors originating from other sites.

Tumors of the musculoskeletal system can be divided into bone tumors and soft tissue tumors. These, in turn, are classified as either benign or malignant. The ratio of malignant soft tissue tumors to bone tumors is approximately 10:1.

Malignant bone tumors (bone sarcomas) occur most frequently between the ages of 20 and 40. They primarily affect the arms and legs. They account for only about 0.2 percent of all malignant tumors.

Malignant soft tissue tumors (soft tissue sarcomas), on the other hand, occur primarily after age 50. They most commonly affect the lower extremities. They account for approximately one percent of all sarcomas.

Benign tumors generally spread only slowly and do not metastasize. Sarcomas, on the other hand, often grow rapidly and behave aggressively at the local site. They also have a high tendency to metastasize.

Tumor orthopedics and sarcoma surgery deal largely with tumor diseases in the metastatic stage. These account for about 25 percent of all deaths. Approximately 90 percent of people who die from tumors have bone metastases.

An early and accurate diagnosis is crucial for successful treatment. Unfortunately, many bone or soft-tissue tumors are diagnosed late because their symptoms vary widely. Pain, too, often does not appear until later in the course of the disease.

For this reason, patients should always seek care at a specialized center for orthopedic oncology.

For proper treatment, it is extremely important to classify bone and soft tissue sarcomas as accurately as possible. For example, sarcomas are evaluated based on their degree of differentiation—that is, the extent to which the tumor tissue differs from healthy tissue. In addition, the degree of metastasis—that is, the regional and systemic spread of the tumor—plays a role.

Diagnosis relies on physical examinations and imaging techniques, such as

• X-rays,
• MRI, or
• CT.

If a patient is subsequently suspected of having bone sarcoma, a biopsy is performed to confirm the diagnosis. As a rule, such a diagnosis is also evaluated by an interdisciplinary team of physicians.

If the suspicion of a malignant tumor is confirmed, the medical team develops a personalized treatment plan.

In the case of benign tumors, monitoring the course of the disease may be sufficient in some cases. Malignant tumors, on the other hand, must always be completely removed surgically. After surgery, systematic follow-up care is required in every case and extends over several years.

The prognosis depends on the type and degree of differentiation of the tumor.

If bone metastases are already present, this means that the sarcoma has entered the bloodstream. As a result, it can form secondary tumors independently of the original tumor.

Metastases can, in principle, form in any bone. Various tumors affect certain bone segments more frequently than others; for example,

• lung tumors,
• thyroid tumors, or
• kidney cancer.

For example, breast cancer frequently metastasizes to the bones, whereas soft-tissue muscle tumors rarely do.

Surgical treatment of primary bone and soft-tissue tumors aims to safely remove the tumor.

The goal of surgical treatment for bone and soft tissue metastases is usually not to remove the metastasis. Instead, the focus is on preserving quality of life and mobility as much as possible. Physicians therefore strive to control the tumor locally and avoid functional deficits as well as the need for further surgery.

In the case of bone and soft tissue metastases, surgery generally does not affect the prognosis or chances of cure. Radiation therapy is used for sites that are difficult to access surgically and for local tumor pain.

The appropriate point of contact for patients with bone and soft tissue tumors or metastases are specialized musculoskeletal tumor centers. These centers employ not only specialists in orthopedic oncology but also representatives from other medical disciplines such as

• radiology,
• oncology,
• radiation therapy,
• orthopedics,
•  visceral surgery,
• Thoracic Surgery, and
• spinal surgery.

In Germany, the German Cancer Society certifies tumor centers as

• Centers of Excellence in Oncology (CCC),
• Oncology Centers, or
• Organ Centers.

This certification allows for the comparison of cancer centers. It also ensures that patients with these rare diseases receive optimal care at the certified centers.

Certification takes place through a three-step process.

Specialists also have the option of registering with the Professional Association for Oncology as

• tumor surgeon or
• tumor orthopedist

with the Professional Society for Oncology.

To further improve treatment, scientific research and studies are also conducted at the cancer centers.

The fields of application for orthopedic oncology include the diagnosis and treatment

• benign and malignant bone and soft-tissue tumors, as well as
• bone and soft tissue metastases.

Tumors of the skeletal system are very rare, and their diagnosis and treatment are complex.

While benign tumors are often simply monitored, malignant tumors must always be completely removed during surgery. If the tumor has already metastasized, the goal of surgery is primarily to preserve the patient’s quality of life.

Early and appropriately initiated treatment is crucial for treatment success and survival prospects. Therefore, patients should always seek treatment at specialized cancer centers.