Benign and Malignant Tumors
Malignant bone tumors can be classified into two groups: primary cancer (meaning that the tumor originated directly in the bone) and secondary cancer (meaning that the tumor spread to the bone from another part of the body). The two most common forms of bone cancer in pediatric patients are osteosarcoma and Ewing's sarcoma. Other forms of cancer affecting children's musculoskeletal system include rhabdosarcoma, lymphoma and leukemia.
Benign (non-cancerous) bone tumors are generally less harmful than malignant ones. However, it is important to monitor any changes in a benign tumor and plan for treatment accordingly. Benign bone tumors occasionally turn malignant, and those that do not may nonetheless compromise the bone and make it more vulnerable to fracture.
Surgical Treatment of Bone Tumors
Treatment for a malignant tumor usually begins with radiation and/or chemotherapy to shrink the tumor and stop it from spreading. If surgery becomes necessary, the patient's physician calls upon a pediatric orthopaedic surgeon to develop a strategy for removing the tumor while preserving the patient's musculoskeletal function as much as possible. If the cancer is in a limb, this leads to the question of whether the limb should be salvaged or amputated.
Limb Salvage vs. Amputation
In a limb-salvage operation, the tumor is removed from the bone along with a small amount of surrounding tissue. Then an artificial prosthesis or a donated bone graft is implanted as a replacement for the excised bone. The surgeon may also perform microvascular surgery on the local blood vessels to keep the limb sufficiently perfused with blood as it heals. After surgery, the patient undergoes a rehabilitation period ranging from a few months to a year. Additional operations may be needed to control the cancer, adjust the prosthesis, and cosmetically enhance the limb's appearance.
In recent years, surgical innovations have made limb salvage safer and more successful than ever before, making it the preferred choice for many situations, with the exception of tumors whose size and location indicate that amputation would be the wiser choice. However, limb amputation is not without its advantages. Patients who opt for limb amputation out of medical necessity or personal preference usually recover from surgery more quickly and with a reduced likelihood of complications that could lead to additional surgery in the future. In addition, the ability of an amputee to function using an artificial limb often equals or surpasses the ability of limb-salvage patients to function using their natural limbs. Patients should consult with their surgeon and a prosthetist in order to make an informed decision about their surgery and rehabilitation options.
To learn more about pediatric orthopaedic conditions, please refer to the following organizations: