Introduction to Orthopaedic Oncology

8/12/2019 Introduction to Orthopaedic Oncology

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TUMOR TULANG DAN SENDI


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INTRODUCTION TO

ORTHOPAEDIC ONCOLOGY

SMF ORTOPEDI DAN TRAUMATOLOGI

RSU SIGLI


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ORTHOPAEDIC ONCOLOGY NEOPLASMS OFLOCOMOTOR SYSTEM


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TUMOR : enlargement of a body part Inflammation swelling

Accumulation of fluid haematoma,effusion, pus collection

Neoplasms

Others


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NEOPLASM: neoplasia of a tissue Abnormal growth

Progressive

Abnormal cells


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ETIOLOGY

Unknown

Suspected to be associated with- Environmental factors trauma

- Occupational chemicals

- Previous radiation exposure

- Chronic lymphedema

- Genetic predisposition- Oncogene activation

- Tumor suppressor genes


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Types of Musculoskeletal Neoplasm

Based on the primary site:

1. Primary neoplasm

2. Secondary neoplasm

Based on malignity:

1. Benign tumor2. Malignant tumor

3. Conditions that mimic neoplasm


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Origin of Primary MusculoskeletalNeoplasm

1. Osteogenic

2. Chondrogenic

3. Fibrogenic

4. Hematopoietic

5. Angiogenic

6. Lipogenic

7. Neurogenic

8. Uncertain origin


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DIAGNOSIS

1. History

2. Clinical presentation

3. Laboratory

4. Radiology

5. Biopsy


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History

Bone tumors Pain- Typically deep seated and dull, may

resemble a toothache

- Initially intermittent, usually progressesin intensity and becomes constant

- Night pain

- May be a long standing mild to moderatepain (low-grade tumors), or a shortercourse (high-grade)

Soft tissue tumors Lump


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Clinical Presentation

1. Basic orthopaedic clinical examination

2. Clinical examination for neoplasm

- Color

- Temperature

- Venous dilatation- Smoothness of the mass smooth/rough

- Overlying skin changes , peau de orange, skin retraction

- Size

- Consistency cysteous, hard, bony-hard, pulsative

- Margins/borders well/ill-defined border

- Mobility of the mass mobile/fixed to surrounding tissue

- Tenderness

- Auscultation bruit

- Adenopathy


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Laboratory Studies

Nonspecific

Phosphatase alkali

Serum globulin-albumin ratio Bence-Jones protein


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Radiography

Plain film orthogonal view

Bone scan Technetium bone scan

CT-scan MRI

Others angiography, etc


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Pay attention to:

1. Race predilection

2. Age predilection

3. Sex predilection

4. Location of the masswithin the bone

AID IN

DIAGNOSIS


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Biopsy

Role of biopsy in orthopaedicneoplasm:

- Confirm diagnosis- Decision-making in treatment

- Prognosis

BIOPSY MAY BE THE MOST IMPORTANT

DIAGNOSTIC TOOL FOR ORTHOPAEDIC

NEOPLASM


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Biopsy

Method:

1. Needle biopsy

a. Fine needle aspirationb. Core biopsy

2. Open biopsy

a. Incisional biopsy take tissue sample at

least 1 cm3b. Excisional biopsy


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STAGING FOR ORTHOPAEDICNEOPLASIA

1. Musculoskeletal Tumor Society /Enneking system most

popular,easy and useful2. AJCCs TNM system not widely

accepted in Orthopaedy


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Enneking System

Based on:1. Mass site/spread (T)

- T1: Intracompartmental

- T2: Extracompartmental

2. Histologic grading (G)- G0: Benign lesion

- G1: Low-grade malignancy

- G2: High-grade

3. Distant metastasis (M)- M0: No metastasis

- M1: Metastasis present


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TREATMENT

Based on staging

Method:

1. Radiotherapy alone, or in combinationwith chemotherapy and surgery

2. Chemotherapy multi-agents, adjuvant,neo-adjuvant

3. Operative


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Operative Treatment

Based on staging stage

determines the resection margin

Method:1. Limb-salvage complex operation

2. Amputation


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REHABILITATION INCLUDES INTREATMENT

- Rehabilitation of function reconstructive surgery may be needed

- Rehabilitation of psychological state

- Rehabilitation of social factors


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THANK YOU

ERRY YUNUS AUGUST, 2006

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Introduction to Orthopaedic Oncology