Bone and soft tissue tumors- What makes them different?
Bone and soft tissue tumors are essentially of two kinds- Benign and malignant. Malignant bone and soft tissue tumors are also called sarcomas. Sarcomas are rare, and form <2 % of all cancers. The rarity of these cancers means: 1) They are frequently misdiagnosed as other musculoskeletal conditions such as injury, infection, hematoma etc. 2) The teams or centres equipped to deal with them are also very few. It has been proven time and again that the outcome of bone and soft tissue sarcomas is optimal only if they are managed right from the beginning by expert sarcoma management teams. In fact, a wrongly done surgery or even a wrongly done biopsy can be detrimental, and may lead to amputation of a limb. Recent decades have seen vast strides in the management of these cancers. More than 90 percent of these patients are now offered limb saving options. This has been made possible by refinements and advancements in imaging, prosthetic engineering, surgical techniques and pathology. Not only that, the survival of these patients has also improved over the last few decades, thanks to developments in diagnostics, chemotherapy and radiation therapy.
Benign bone tumors too, even if they are not life threatening, can cause significant bone destruction leading to pain and disability. A lot has changed in the past decade or so in the understanding of these tumors. There is more emphasis on non-operative / minimally invasive treatment of these tumors, such as radiofrequency ablation, sclerotherapy, angioembolisation and intralesional injections. Expert multidisciplinary inputs are required to differentiate these tumors from malignant ones, decide which tumors need no treatment at all, and which is the most optimal (preserving function while ensuring long term disease control) surgical option for any given patient, should surgery be needed.
With bone sarcomas, pain and swelling in the affected limb are usually the presenting complaints. In some cases, the bone may fracture due to trivial injury – pathological fracture. Physical exam findings may reveal a palpable mass, restricted joint motion, pain with weight-bearing or localized warmth/redness. The so-called general signs of cancer—weight loss, malaise and fever—are usually only present in advanced disease. With soft tissue tumors, a painless swelling is often the presenting complaint. Any patient with the above symptoms needs to seek immediate consultation of a musculoskeletal or orthopedic oncologist, the orthopedic surgeons who specialise in managing bone and muscle tumors and cancers; an early diagnosis and prompt management will save not just limbs but also lives of patients.