Diagnosis & Treatment for Bone Tumors & Limb Reconstruction

The orthopedic surgeons at Virginia Mason Franciscan Health are part of a highly skilled team of specialists dedicated to limb reconstruction and the diagnosis and treatment of bone tumors. And if you need treatment for bone cancer or soft tissue tumors, our orthopedic surgeons are here for you. We take pride in offering you the latest surgical techniques with surgical outcomes that exceed national averages. Virginia Mason Franciscan Health has achieved a rate of bone cancer recurrence that is two-thirds below the national average of 8 to 10 percent.

Growths or tumors in bones develop for any number of reasons and can be either benign or cancerous. Most bone tumors are painless noncancerous growths that result from an abnormal development of cells. When a bone tumor is cancerous, it’s either a primary cancer (a cancer that originates in bone) or cancer that has spread to the bones from another site in the body. Tumors also can originate in the connective tissue and spread to bones.

Bone tumors are diagnosed during a medical history and physical exam, which may include X-rays, blood and urine tests, and a needle or surgical biopsy of the growth. Depending on the tumor's location, a biopsy of the tumor tissue is performed as an outpatient procedure in your doctor's office or in the operating room. A pathologist (a specialist who looks at cells under a microscope) will determine whether the growth is cancerous.

The following signs and symptoms may indicate cancerous bone tumors:

• Bone pain or painful growth (cancerous tumors also can be painless)
• Tenderness and swelling in joints
• Bone fractures
• Symptoms of cancer such as fatigue, weight loss, fever, and shortness of breath

In most cases, benign bone tumors are watched and not treated unless there is a risk of a bone fracture or if the growth is putting pressure on a nerve or blood vessel. In these instances, the tumor will be surgically removed. Some bone tumors may be treated with medication only. It’s possible that a benign growth or tumor can later become cancerous. It’s also possible that a tumor that has been removed will grow back.

Osteochondroma is the most common form of benign tumor growth in bones. It results from the abnormal growth of bone and cartilage during skeletal development and primarily affects children, adolescents, and young adults. Surgery isn’t usually recommended until skeletal growth is completed to help ensure the growth won’t return.

Our orthopedic surgeons specialize in treating people with primary bone cancer, with outcomes that are better than national rates for length of stay in the hospital, recurrence, and mortality. Virginia Mason Franciscan Health also specializes in limb reconstructive surgery following cancer treatment.

Surgery to remove a cancerous bone tumor is performed under a general anesthetic in an operating room. Your orthopedic surgeon works with a team that includes a vascular surgeon to repair blood vessels and a plastic surgeon who specializes in soft tissue (muscle) transplants. Your surgeon will remove the tumor as well as a margin of normal tissue around it. Depending on the tumor's size, location, and the extent of reconstruction required, the surgery will take two to eight hours. Prior to surgery, your surgeon will discuss limb reconstructive surgery with you. With today's techniques, you have more choices for preserving your limbs with reconstructive surgery, and fewer amputations are necessary.

Cancerous or malignant primary bone tumors include osteosarcomas (the most common), Ewing's sarcoma, chondrosarcoma, and fibrosarcoma.

• Osteosarcoma occurs more often in children, adolescents, and young adults, and arises in developing bone tissue. Osteosarcoma can spread to nearby tissue and throughout the body via the blood stream. 
• Ewing's sarcoma also occurs more often in children, adolescents, and young adults, and develops in the bone marrow. It's a rapidly spreading cancer.
• Chondrosarcoma is the second most common type of bone cancer and is seen primarily in adults over age 50. It develops in cartilage cells in the thighbone, arm, pelvis, knee, and spine.
• Fibrosarcoma arises in a particular type of cell (mesenchymal) in collagen, a connective tissue in the body. Fibrosarcomas can originate in soft tissue or in bone and are seen most often in the long leg bones near the knee, in the arm, and hip. It occurs most often during middle age and is slightly more common in men than women. It's a rare type of bone cancer.

Treatment for primary bone cancer is surgery either before or after chemotherapy (and/or radiation therapy). You may be started on a course of radiation therapy or chemotherapy first to shrink tumors so they’re amenable to surgery.

Virginia Mason Franciscan Health’s orthopedic surgeons also perform surgery in people who have other types of cancer that has spread to the bones. Surgery in these cases depends on the type of cancer, its location, how advanced it is, how aggressive it is, and the age and functional status of the patient. Additional treatment may include radiation and chemotherapy, alone, or in combination.

To schedule a consultation about bone tumors, call 206-341-3000. For patients in King County, call 253-274-7504.

Limb reconstruction is a highly specialized area within orthopedic surgery at Virginia Mason Franciscan Health, offering people a viable option for saving an extremity. Our orthopedic surgeons work with a team of highly trained specialists to perform limb reconstruction, with outcomes that exceed national averages.

Previously, when a bone tumor was large and surgery compromised the limb, or if injury was extensive, amputation was often the only treatment choice. Today, with advances in surgical techniques, implant materials, and tissue harvesting, Virginia Mason Franciscan Health’s orthopedic surgeons can offer more and better options. 

To learn more about limb reconstruction, visit our Resources & FAQs page.