Musculoskeletal Oncology Service The Musculoskeletal Oncology Service specializes in the diagnosis and treatment of musculoskeletal tumors in children and adults. We manage benign and malignant bone and soft-tissue tumors of the extremities, including the shoulder girdle and pelvis. The Musculoskeletal Oncology Service works closely with medical oncologists, radiation oncologists, other surgical specialists, pathologists and radiologist to diagnose and treat your musculoskeletal tumor. Mission Health Musculoskeletal Oncology 21 Hospital Drive Asheville, NC 28801 828-213-1994 Primary bone tumors Benign bone tumors Most bone tumors are benign and are not life-threatening. There are many kinds of benign bone tumors as well as metabolic diseases and conditions that mimic bone tumors. Treatment for each tumor may be different, ranging from observation to surgery. Most of these tumors are asymptomatic, meaning they do not cause any pain or functional problems for patients. Some benign bone tumors can, however, destroy normal bone and weaken it, making the bone susceptible to fracture. There are even some benign bone tumors that can (rarely) transform into a malignant bone cancer. Some common benign bone tumors include: Aneurysmal bone cyst Chondroblastoma Enchondroma Fibrous dysplasia Fibroxanthoma (non-ossifying fibroma) Giant cell tumor Osteochondroma Osteoid osteoma Unicameral (simple) bone cyst Malignant bone tumors (bone sarcoma) Some bone tumors are cancerous, with the ability to destroy bone and spread to other organs in the body (metastasize). These malignant bone tumors frequently present with pain. This pain is usually described as an ache and commonly will worsen at rest or at night. The pain can also worsen with activity. Some patients will not have pain but notice a mass instead. In almost all cases, malignant bone tumors will be treated with a combination of chemotherapy, radiation, and surgery. A multi-disciplinary team, comprised at its core of a musculoskeletal oncologist, bone pathologist, medical/pediatric oncologist, radiation oncologist, and musculoskeletal radiologist are necessary to treat malignant bone tumors. Some common malignant bone tumors include: Multiple myeloma Osteosarcoma Ewing’s sarcoma Chondrosarcoma Surgery for malignant bone tumors usually comprises of limb salvage surgery where the tumor is removed with some normal tissue around it, preserving the extremity. In rare circumstances, amputation may be necessary to remove the entire tumor. Soft-tissue tumors Benign soft-tissue tumors Soft-tissue tumors of the extremities arise from a variety of tissues such as skeletal muscle, fat, tendon, fibrous tissue, nerve and blood vessels. These tumors have a very small or no chance to metastasize (spread to another location in the body). It is common for advanced imaging (MRI or CT scan) to be used to help diagnose these tumors and to help recommend if any treatment needs to be considered. Most tumors can be treated with observation where some will need to be surgically removed. Some common benign soft-tissue tumors include: Lipoma Hemangioma Fibroma Neurofibroma Pigmented villonodular synovitis (PVNS) Ganglion cyst Malignant soft-tissue tumors (sarcoma) Malignant soft-tissue tumors are also known as soft-tissue sarcomas (STS). These malignancies are more common than bone sarcomas and usually occur in adults. These tumors are often painless and commonly confused with the more common benign soft-tissue tumors. Because of this, it is common that the diagnosis of soft-tissue cancer is made after a presumed benign mass is removed. Soft-tissue sarcomas are categorized by tissue type and are similar to their benign counterparts in that they may arise from skeletal muscle, fat, tendon, fibrous tissue, nerve and blood vessels. When a STS is diagnosed, it is additionally classified by grade. The grade of a malignancy determines the aggressiveness of the lesion and its likelihood to spread to other locations. STS most commonly spread to the lungs, although there are some that may also spread to lymph nodes (synovial sarcoma and epithelioid sarcoma). Some common malignant soft-tissue tumors (sarcomas) include: Liposarcoma Myxofibrosarcoma Synovial sarcoma Malignant fibrous histiocytoma (MFH) Fibrosarcoma Leiomyosarcoma Angiosarcoma Neurofibrosarcoma Metastatic Bone Disease Metastatic Bone Disease (MBD) is the most common malignancy of bone. MBD occurs when a cancer spreads from its original location to the skeleton. The skeleton is the third most common site for metastasis with the lung and liver being more common. Any cancer can spread to bone, but the most common are thyroid, breast, lung, renal and prostate cancers. Only 20 percent of patients with MBD will have symptoms; therefore, physicians need to routinely examine cancer patients for evidence of MBD. A patient’s quality of life can be greatly affected if a metastatic lesion becomes large enough to cause a fracture. A musculoskeletal oncologist can help maintain a patient’s quality of life by stabilizing a bone before it fractures. He or she will work alongside a patient’s medical and radiation oncologist to prevent complications from MBD. It is crucial that any patient with a history of cancer, no matter how remote, be evaluated by a musculoskeletal oncologist if he or she is experiencing any unusual or new bone pain.