TUMOR TULANG DAN SENDI

INTRODUCTION TO
ORTHOPAEDIC ONCOLOGY

DEPARTMENT OF ORTHOPAEDIC AND TRAUMATOLOGY

FACULTY OF MEDICINE HASANUDDIN UNIVERSITY
 NEOPLASMS OF
ORTHOPAEDIC ONCOLOGY
LOCOMOTOR SYSTEM
 TUMOR : enlargement of a body part
• Inflammation  swelling
• Accumulation of fluid  haematoma,
effusion, pus collection
• Neoplasms
• Others
 NEOPLASM: neoplasia of a tissue
• Abnormal growth
• Progressive
• Abnormal cells
ETIOLOGY
 Unknown
 Suspected to be associated with
- Environmental factors  trauma
- Occupational chemicals
- Previous radiation exposure
- Chronic lymphedema
- Genetic predisposition
- Oncogene activation
- Tumor suppressor genes
Types of Musculoskeletal Neoplasm

 Based on the primary site:

1. Primary neoplasm
2. Secondary neoplasm

 Based on malignity:
1. Benign tumor
2. Malignant tumor
3. Conditions that mimic neoplasm
 Origin of Primary Musculoskeletal
Neoplasm

1. Osteogenic
2. Chondrogenic
3. Fibrogenic
4. Hematopoietic
5. Angiogenic
6. Lipogenic
7. Neurogenic
8. Uncertain origin
DIAGNOSIS

1. History
2. Clinical presentation
3. Laboratory
4. Radiology
5. Biopsy
 History
 Bone tumors  Pain
- Typically deep seated and dull, may
resemble a toothache
- Initially intermittent, usually progresses
in intensity and becomes constant
- Night pain
- May be a long standing mild to moderate
pain (low-grade tumors), or a shorter
course (high-grade)
 Soft tissue tumors  Lump
 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
 Laboratory Studies
 Nonspecific
 Phosphatase alkali
 Serum globulin-albumin ratio
 Bence-Jones protein
 Radiography
 Plain film  orthogonal view
 Bone scan  Technetium bone scan
 CT-scan
 MRI
 Others  angiography, etc
 Pay attention to:

1. Race predilection
2. Age predilection
3. Sex predilection AID IN
DIAGNOSIS
4. Location of the mass
within the bone
 Biopsy

 Role of biopsy in orthopaedic

neoplasm:
- Confirm diagnosis
- Decision-making in treatment
- Prognosis

BIOPSY MAY BE THE MOST IMPORTANT

DIAGNOSTIC TOOL FOR ORTHOPAEDIC
NEOPLASM
 Biopsy
 Method:
1. Needle biopsy
a. Fine needle aspiration
b. Core biopsy
2. Open biopsy
a. Incisional biopsy  take tissue sample at
least 1 cm3
b. Excisional biopsy
 STAGING FOR ORTHOPAEDIC
NEOPLASIA

1. Musculoskeletal Tumor Society /

Enneking system  most
popular,easy and useful
2. AJCC’s TNM system  not widely
accepted in Orthopaedy
 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
TREATMENT
 Based on staging
 Method:
1. Radiotherapy  alone, or in combination
with chemotherapy and surgery
2. Chemotherapy  multi-agents, adjuvant,
neo-adjuvant
3. Operative
 Operative Treatment

 Based on staging  stage

determines the resection margin
 Method:
1. Limb-salvage  complex operation
2. Amputation
 REHABILITATION INCLUDES IN
TREATMENT
- Rehabilitation of function 
reconstructive surgery may be needed
- Rehabilitation of psychological state
- Rehabilitation of social factors
THANK YOU

ERRY YUNUS AUGUST, 2006