Treatment

Musculoskeletal Extremity Symptoms, Risk and Diagnosis

Sarcoma makes up only one percent of cancers diagnosed, but many of them come to Siteman because of our dedicated sarcoma team and clinical and research expertise.

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Symptoms of Musculoskeletal (Extremity) Sarcoma:

By far, the greatest numbers of bone tumors are metastatic from another organ like the lung, colon or breast. Of primary bone sarcoma, osteosarcoma is the most common type. The sarcoma team also treats Ewing sarcoma and chondrosarcoma, in addition to osteosarcoma. Sarcomas arise in bone anywhere in the body. Bone sarcomas often appear in the long bones of the body or around the knee, shoulder or pelvis.

It is critical to identify sarcomas as early as possible in the course of the disease. For osteosarcomas, symptoms to bring to your doctor’s attention include:

  • Swelling over a bone or bony part of the body.
  • Pain in a bone or joint.
  • A bone that breaks for no known reason.

Risk Factors for Primary Bone Sarcoma

Risk factors for musculoskeletal sarcoma include:

  • Past treatment with radiation therapy.
  • Having a certain change in the retinoblastoma gene.
  • Having certain conditions, such as the following:
    • Paget disease.
    • Li-Fraumeni syndrome.
    • Rothmund-Thomson syndrome.

Sarcomas vary in size and location, and they require different approaches to biopsy and surgery. Siteman’s experienced, multidisciplinary team meets early to plan an approach to each new case. A very thorough knowledge of anatomy is necessary to determine precisely what kinds of incisions can be made and what type of surgery will yield the best result.

Diagnosing Musculoskeletal Sarcoma

Imaging tests are done before biopsy. These imaging tools help physicians more accurately determine where tumors are and their location in relation to surrounding body structures. With that information, they can measure what tissues and length of bone are involved and decide what they have to remove and what they can spare.

Making a diagnosis of bone sarcoma may involve different approaches. The following tests and procedures may be used:

  • Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities.
  • X-Ray: Doing an X-ray of bones and organs in the region of symptoms can give important information.
  • CT scan (CAT scan): A series of detailed pictures of areas inside the body, taken from different angles may be combined with injection or oral intake of a dye to help the organs or tissues show up more clearly.
  • MRI (magnetic resonance imaging): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
  • Bone scan: In this test to check if there are rapidly dividing cells, such as cancer cells, in the bone, a very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
  • Biopsy: Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. It is important that the biopsy be done by a surgeon who is an expert in treating cancer of the bone. It is best if that surgeon is also the one who removes the tumor. The biopsy and the surgery to remove the tumor are planned together. The way the biopsy is done affects which type of surgery can be done later.
  • Light microscopy: With the tissue that is removed, the pathologist look for certain changes in the cells. With that information, they can measure what tissues and length of bone are involved and decide what they have to remove and what they can spare.

Stages of Primary Musculoskeletal Sarcoma

It is described as either localized (still within the bone where it originated) or metastatic.

Prognosis

The prognosis (chance of recovery) depends on the following:

  • Where the tumor is in the body.
  • The size of the tumor.
  • Whether the cancer has spread to other parts of the body and where it has spread.
  • The type of tumor (based on how the cancer cells look under a microscope).
  • The patient’s age at diagnosis.
  • Whether the tumor has caused a break in the bone.
  • Whether the patient has certain genetic diseases.

Sarcoma is best controlled before it has spread and can be removed by surgery. Clinical trials are a good option for getting the latest treatment. For sarcoma that has metastasized, clinical trials are a good option for treatment, not available elsewhere.